Therapieadhärenz bei Multipler Sklerose und Schizophrenie

Zusammenfassung

Der Grad, zu dem ein Patient die gemeinsam mit seinem Behandler definierte Therapie umsetzt, wird als „Adhärenz” oder „Therapietreue” bezeichnet. Obwohl das Konzept der Adhärenz im Rahmen einer wachsenden Zahl von klinischen Studien evaluiert wird, sind relevante Faktoren für Adhärenz bei neurologischen und psychiatrischen Erkrankungen kaum systematisch aufgeklärt. Neben unterschiedlichsten Definitionen der Adhärenz erschwert z. B. die Heterogenität der untersuchten Medikationszeiträume eine generelle Aussage zur Adhärenzrate bei bestimmten Therapien oder Erkrankungen. Patienten mit Schizophrenie können in etwa 50 % als „therapietreu” bezeichnet werden, was in ähnlicher Form für etwa 50 – 60 % der Multiple-Sklerose-Patienten (MS-Patienten) gilt. Verbesserungsansätze umfassen in der Schizophrenietherapie unter anderem psychoedukative Programme und antipsychotische Depotformulierungen. In der MS-Therapie der Multiplen Sklerose sind unter anderem spezielle MS-Schwesterndienste etabliert worden, die durch Information und praktische Hilfestellungen die Therapietreue verbessern sollen. Für die Wirksamkeit der Verbesserungsansätze im psychiatrischen Umfeld liegt ein gewisser Evidenzgrad vor; allerdings werden diese Maßnahmen nicht allen Patienten angeboten. Der Nutzen von MS-Schwesterndiensten für das Coping bei MS-Patienten ist anzuerkennen, allerdings wären weitere Studien zur Therapieadhärenz bei MS-Patienten wünschenswert, um adhärenzfördernde Maßnahmen in diesem klinischen Bereich weiter zu verbessern. Zusammenfassend ist festzustellen, dass die Therapieadhärenz bei beiden Krankheiten vergleichsweise niedrig ist und ein großer Bedarf für die Implementierung und wissenschaftliche Bewertung von Maßnahmen zur Verbesserung der Adhärenz bei der MS und Schizophrenie besteht.

Abstract

The extent, to which a patients behavior corresponds with agreed recommendations from a health care provider is described as ”adherence”. Although the concept of adherence is more and more addressed in the context of clinical studies, yet the relevant factors for adherence are hardly systematically examined in neurological and psychiatric diseases. In addition to various different published definitions of adherence, the sample periods constantly differ between publications, thus contributing to inconsistent data on adherence rates, e. g. in specific diseases. Taking the wide range of published data into account, it seems reasonable to assume an averaged adherence rate of 50 percent for patients suffering from schizophrenia and roughly 50 – 60 percent for multiple sclerosis (MS) patients. Approaches for improvements comprise psychoeducational programs and antipsychotic depot formulations in the therapy of schizophrenia. In the therapy of MS, MS nurse services have been established. In the therapy of schizophrenia, there exists limited positive evidence for the effectiveness of psychoeducational measures and depot formulations on adherence, but approaches for improving medication adherence are accessible only to a part of schizophrenic patients. The usefulness of MS nurse services and other measures for coping mechanisms in MS patients is acknowledged, but further research is preferable in order to optimize adherence supporting activities in this clinical field. In summary, adherence rates in both diseases are comparably low emphasizing a further need for the establishment and scientific evaluation of measures to improve adherence in MS and schizophrenia.

Schlüsselwörter

Adhärenz - Compliance - Schizophrenie - Multiple Sklerose

Keywords

adherence - compliance - schizophrenia - multiple sclerosis

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