Background: Schizophrenia and bipolar disorders are severe major psychiatric disorders. They are often complicated by recurring relapses. Non-adherence, substance abuse and stressful life events are risk factors for this relapse, in which non-adherence is the most common cause. Patients interrupting or discontinuing their medication are five times more likely to relapse.
Objectives: The aim of the study was to explore perspectives of hospitalised patients with schizophrenia or a bipolar disorder and their healthcare providers on medication self-management.
Methods: In a qualitative descriptive design, semi-structured interviews were used. 49 interviews were completed (nurses n=18; psychiatrists n=3; hospital pharmacists n=2 and patients n=26). Data-analysis was continuously iterative using an inductive and thematic approach.
Results: From the thematic analysis of the interviews, three main themes emerged: monitoring and shared decision- making, relationship based on trust, and patient satisfaction and rehabilitation; as well as three sub- themes: available tools, patient readiness, and safety. Regular monitoring and follow-ups were considered conditions for medication self-management. All stakeholders considered that the patient, the nursing staff, and the psychiatrist should all be involved in the process of medication self-management. All healthcare providers emphasized the importance of regular re-evaluations of the patient and were worried about medication errors and misuse. Most patients considered medication self-management during hospitalisation to increase their confidence, self-reliance, and satisfaction. Many participants thought it would make a positive contribution to the recovery process.
Conclusions: All stakeholders were positive towards medication self-management under specific conditions. According to the participants, medication self-management offered many benefits, including the implementation of more structure for the patient, an ameliorated preparatory phase towards discharge, and an actual improvement of future adherence. All participants considered medication self-management to contribute to more profound medication knowledge and an overall improvement of their health literacy. Implications and future perspectives: These findings will be used to develop a medication self-management tool in hospitalised patients with schizophrenia or bipolar disorders.
