Adherence with Outpatient Appointments and Medication: A Two-Year Prospective Study of Patients with Schizophrenia

Objective: Especially for patients with chronic diseases, adherence is an important factor that interferes with the success of treatment. There are few reports examining adherence to appointments and medication in diagnostically specific groups such as individuals with schizophrenia. This study aimed to examine the correlates of missed appointments and medication adherence in a sample of persons attending an outpatient schizophrenia follow-up program after hospital discharge. Methods: The study included 132 patients with schizophrenia. Outpatient appointments were planned to occur in the range of every 1 to 8 weeks by taking into consideration the patient's clinical status. Patients were followed up for a period of two years to assess appointment-keeping behavior and medication adherence. Within this period, patients who did not attend more than 20% of their appointments were evaluated as the "non-attender group." Results: The rate of patients, who have missed a scheduled appointment, was 44.7% during the chosen period. Non-attendance was related to low educational level and living alone. Before discharge of the patient, the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Positive Symptoms (SAPS) total scores were higher in the non-attender group compared to attender patients. Non-attender patients also had higher numbers of psychiatric hospitalizations and involuntary psychiatric hospitalizations and greater medication non-adherence rates. Conclusion: Sociodemographic factors and clinical features affect patient participation in the appointments. In addition, non-attendance at appointments in particular is closely linked with medication non-adherence.