Association Between Therapeutic Alliance, Care Satisfaction, and Pharmacological Adherence in Bipolar Disorder
Sylvia LG, Hay A, Ostacher MJ, et al
J Clin Psychopharmacol. 2013;33:343-350
Sylvia and colleagues aimed to determine whether patients' positive perceptions of their relationships with their psychiatrists and the quality of their psychopharmacologic care were associated with better medication adherence. A total of 3037 persons with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were assessed using the Helping Alliance Questionnaire and Care Satisfaction Questionnaire. Patients' perceptions of collaboration, empathy, and accessibility were significantly associated with adherence to treatment in individuals with bipolar disorder completing at least 1 assessment. Patients' perceptions of their psychiatrists' experience, as well as of their degree of discussing medication risks and benefits, were not associated with medication adherence.
Others have already found that the quality of the patient-provider relationship, or therapeutic alliance, improves treatment retention, adherence, and subsequent outcomes for a wide range of psychiatric illness including substance abuse, unipolar depression, schizophrenia, and bipolar disorder. Providers who acknowledge individual feelings of patients and support self-management of a chronic illness can expect higher rates of medication adherence.
In this study, if patients felt helped and respected by their psychiatrists, they were more likely to be adherent, regardless of factors associated with poor adherence (such as rapid cycling, suicide attempts, earlier onset of illness, current anxiety, or alcohol use disorder) and current mood. Of interest is the degree to which patients felt that their psychiatrists discussed medication risks and benefits was not significantly associated with medication adherence. This finding contradicts other studies that have found that medication adherence in individuals with bipolar disorder is enhanced by psychoeducation, or knowledge about medication risks and benefits. However, this apparent contradiction may not be a complete surprise -- expert technical skills in medication selection and the rote recitation of risks and benefits are not substitutes for a collaborative therapeutic clinician-patient relationship that takes into account the individual patient's values and preferences.