Adherence to Antipsychotics Among Latinos and Asians With Schizophrenia and Limited English Proficiency

Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0622, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 03/2009; 60(2):175-82. DOI: 10.1176/
Source: PubMed


The authors examined data for 7,784 Latino, Asian, and non-Latino white Medi-Cal beneficiaries with schizophrenia to determine the relationship between patients' preferred language for mental health services--English, Spanish, or an Asian language--and their adherence to treatment with antipsychotic medications.
Data reflected 31,560 person-years from 1999 to 2004. Pharmacy records were analyzed to assess medication adherence by use of the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<.5), partially adherent (MPR=.5-<.8), or adherent (MPR=.8-1.1) or as an excess filler of prescriptions (MPR<1.1). Regression models were used to examine adherence, hospitalization, and costs by race-ethnicity and language status.
Latinos with limited English proficiency were more likely than English-proficient Latinos to be medication adherent (41% versus 36%; p<.001) and less likely to be excess fillers (15% versus 20%; p<.001). Asians with limited English proficiency were less likely than English-proficient Asians to be adherent (40% versus 45%; p=.034), more likely to be nonadherent (29% versus 22%; p<.001), and less likely to be excess fillers (13% versus 17%; p=.004). When analyses controlled for adherence and comorbidities, clients with limited English proficiency had lower rates of hospitalization and lower health care costs than English-proficient and white clients.
Adherence to antipsychotic medications varied by English proficiency among and within ethnic groups. Policies supporting the training of bilingual and multicultural providers from ethnic minority groups and interventions that capitalize on patients' existing social support networks may improve adherence to treatment in linguistically diverse populations.

Download full-text


Available from: Concepción Barrio, Feb 12, 2014
  • Source
    • "Studies have indicated a number of factors that affect medication adherence, at both the patient and the provider level (Gilmer et al., 2009), including forgetfulness (Hong, Oddone, Dudley, &amp; Bosworth, 2006), emotional considerations such as depression (Wang, Liu, Bryson, Sharp, &amp; Maciejewski, 2011), adverse effects of medication (Bloom, 2001), complicated dose schedule, multiple doses (Bloom, 2001), and cultural beliefs and preferences (Lowry, Dudley, Oddone, &amp; Bosworth, 2005). Further, patients' negative attitude toward medication and shorter duration of illness also contributed to their poor adherence (Lacro, Dunn, Dolder, Leckband, &amp; Jeste, 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article examines the meanings, practices, and cultural beliefs underlying medication adherence in people of Chinese descent living in the United States. The narratives were analyzed using interpretive phenomenology, resulting in the following themes that influenced the communication and behaviors around medication adherence of the participants: (a) cultural concepts of yin yang balance and "qi," (b) understandings of Western and Chinese medicine's efficacy profiles, (c) importance of family and social support, and (d) level of acculturation. This article discusses the influence of these themes on medication adherence and proposes that health communication campaigns, interventions, and doctor-patient communication about increasing medication adherence with people of Chinese descent should engage these understandings.
    Full-text · Article · Sep 2015 · Health Communication
  • Source
    • "Some Asian American families may lack the English proficiency required for a thorough assessment of the child and identification of important contributors to the process of care, diagnosis, and treatment (Sentell et al., 2007). In addition , limited English proficiency is associated with lower adherence to treatment among Asian Americans with schizophrenia (Gilmer et al., 2009). Fifth, according to the Institute of Medicine (2004), health literacy levels are lower among racial and ethnic minorities and individuals with limited education and English skills. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The idea of a clinical high risk (CHR) for psychosis has focused attention on early intervention to prevent or attenuate psychosis. However, many clinicians may still not be very familiar with the concept of CHR. Current studies have not allowed for an in-depth examination of the challenges and the strategies of working with youth from the range of racial/ethnic minority families, Asian American families in particular. The purpose of this article was three-fold. First, we critically review Asian cultural values and beliefs about mental illness, psychosis in particular, while highlighting specific challenges that Asian American families encounter. Second, we provide a clinical case to illustrate these challenges and inform clinical practice when working with Asian youth at risk for psychosis and their families. Third, practical and easy-to-follow clinical strategies are provided. Implications for clinical practice and directions for future research are presented.
    Full-text · Article · May 2013 · The Journal of nervous and mental disease
  • Source
    • "The third pathway to mental health care takes place within the mental health facility itself, from intake to treatment to discharge. There are many aspects of mental health services that can reflect disparities, including diagnosis (Gara et al., 2012), filling of prescriptions (Gilmer et al., 2009), and quality of care (Young, Klap, Sherbourne, & Wells, 2001). In this section of the article, we focus on research that seeks to improve the quality of treatment of schizophrenia for Spanish-speaking Latinos. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Since publication of the U.S. Surgeon General's report Mental Health: Culture, Race and Ethnicity-A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001), several federal initiatives signal a sustained focus on addressing African American-White American disparities in mental health treatment access and quality and open the way to unprecedented disparity reduction. These initiatives include institutional commitments to (a) research by the National Center for Minority Health and Health Disparities; (b) disparities monitoring by the Agency for Healthcare Research and Quality; (c) new epidemiologic and service delivery information on African American populations from the National Survey of American Life sponsored by the National Institute of Mental Health; as well as (d) opportunities inherent in the World Health Organization's interest in disease burden for making it possible to view African Americans' likely greater disease burden from mental illness as a legitimate source of concern. The Patient Protection and Affordable Care Act affords unprecedented opportunities for increasing African Americans' treatment access and quality of care nationwide. By familiarizing themselves with these initiatives, and taking advantage of possibilities they offer, those committed to reducing African American-White American disparities in mental illness, and treatment access and quality, can make inroads toward improving African Americans' mental health and facilitating their successful functioning in all spheres of community living. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Preview · Article · Oct 2012 · American Psychologist
Show more