Academic journal article British Journal of Occupational Therapy

The Large Allen Cognitive Level Screen as an Indicator for Medication Adherence among Adults Accessing Community Mental Health Services

Academic journal article British Journal of Occupational Therapy

The Large Allen Cognitive Level Screen as an Indicator for Medication Adherence among Adults Accessing Community Mental Health Services

Article excerpt


Occupational therapists working in mental health contexts are concerned with how they can support service users to develop and maintain the skills and supports needed for an independent and productive life (American Occupational Therapy Association 2000). This support includes assisting learning or relearning life skills, with the focus often on those skills that are needed to promote mental health and wellness (Roberts 2008). Medication management is a vital skill for those with mental illness and has been identified as a recurrent theme in treatment practices across mental health settings (Townsend 2009).

Medication non-adherence is a phenomenon that occurs across all areas of primary health care (Dunbar-Jacob and Mortimer-Stephens 2001, Lecomte et al 2008, Gray et al 2010, Crowe et al 2011). Prior reports of medication adherence rates for individuals with a mental illness have ranged from 8% to 85%, with the majority of adherence rates assessed between 40% and 70% (Lingam and Scott 2002, Clatworthy et al 2007, Gray et al 2010). Poor adherence to prescribed treatment regimens undermines treatment benefits and reduces the predictability of medication action, increasing the likelihood of symptoms relapse (Gray et al 2010, Crowe et al 2011), longer recovery times, frequency of hospitalisation and sustained functional impairment (Cramer and Rosenheck 1998). The negative sequelae of medication non-adherence is likely to result in reduced quality of life for individuals, their families and carers, and increased economic and social burden on society (Jeste et al 2003, Ascher-Svanum et al 2006, Gray et al 2010).

There have been numerous studies exploring individual factors that influence medication adherence in people diagnosed with mental illnesses. Factors under investigation have included finances, type and acuity of illness, quality of communication with professionals and presence of illicit drugs and alcohol (Fenton et al 1997, Corriss et al 1999, Lee et al 2010, Zeber et al 2011). However, one of the strongest patient-related predictors of medication non-adherence is cognitive ability, particularly in the domain of memory and conceptualisation (Jeste et al 2003). Neurocognitive deficits in mental illness have been the subject of numerous investigations (Green et al 2000, Aubin 2009). Prior research has indicated that between 20% and 60% of the variance in functional outcome can be explained by the presence of neurocognitive deficits (Green et al 2000). Successful independent medication management relies on executive functioning for success (Williams and Thayer 2009). Impaired cognitive functioning may lead to an inability to manage medication changes competently in response to daily routine or medication regimen alterations (Jeste et al 2003, Sajatovic et al 2009).

There is evidence to suggest that cognitive impairment may not be identified by either patients or their treating health professionals in mental health settings (Moritz et al 2004). Moritz et al (2004) found that doctors incorrectly reported patients' memories to be cognitively intact in approximately 20-40% of cases tested, despite significant impairment evident during neurocognitive tests. Understanding a patient's cognitive capacity is essential for occupational therapists working in mental health settings whose role is to translate cognitive abilities into occupational performance (Duncan 2008), which often includes the management of complex medication regimens. In mental health services, many occupational therapists work in community-based multidisciplinary teams. In this role they provide consultation to other professionals about possible reasons for relapse or medication non-adherence.

A time-efficient screening tool to identify patients with cognitive deficits that may impact on their capacity to manage the medication adherence would be useful in community mental health settings. Despite the importance of this issue, there is a scarcity of research investigating screening cognitive capacity for medication adherence amongst users of mental health services. …

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