Primary Factors That Contribute to Both Non-Adherences and Adherence in Schizophrenia as Well as Their Consequence

Published: 2021-07-12
1747 words
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Boston College
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In this research, the review question was clearly and explicitly stated. It has been illustrated as an objective of the study, which is to investigate the primary factors that contribute to both non-adherences and adherence in schizophrenia as well as their consequences. In this case, the consequences are to the patient, the healthcare system as well as the society at large. Moreover, in the research, the question has sufficiently defined the scope of the review, and it is capable of developing an effective search strategy for locating relevant evidence. Additionally, the question employed for the research has been developed based on superlatively formulated PICO elements. The PICO illustrate the elements of population, comparator as well as the outcome of the research.

Question 2: Inclusion Criteria

The inclusion criteria employed in identifying the research was appropriate for the review question. This is because key elements of the PICO employed were well portrayed in the publications included. The population focused during the research is that affected by Schizophrenia, particularly those who had received treatment for the condition in a healthcare institution. This population is both for persons who have adhered to medication since treatment as well as those who portrayed non-adherence to medication. However, since the research is a systematic review, there is no intervention element in the PICO employed. An intervention would be featured if the research was a quantitative research involving a defined number of the sample population.

However, a comparator element is evident in the systematic review through the publications used. In this case, the number of schizophrenia patients who adhered to treatment is compared to those that portrayed non-adherence to treatment. In addition, the publications that were included were those that illustrated the consequence of patients non-adherence which was 14 (n=14). Also, 15 publications that portrayed the factors that influenced adherence rates to schizophrenia treatment were also included in the research (n=15). Moreover, 12 reviewed publications that illustrated the aspect of non-adherence to treatment, as well as the hospitalization rates of people that were suffering from Schizophrenia, were also included (n=12).

Question 3: Search Strategy

The search strategy employed in the systematic review was appropriate for the research. This is because a qualitative systematic literature review method was employed as an effective methodology of conducting a broad search on the review topics. The method used the terms adherence as well as a disease to find out the publications that were appropriate for the research. Additionally, the number of articles that were used during the review were those that employed large population samples in their studies. They were also those studies that had been published after 2001. The emphasis of this date during the systematic review was to reduce a large number of publications attained after the search. After the evaluation, 37 papers were considered appropriate for the study. These included 15 publications on drivers, 22 on the consequences as well as 12 publications that assessed the link between non-adherence to schizophrenia medications and the hospitalization of schizophrenia medications.

Question 4: Sources and Resources Used for the Study

The resources, as well as sources used during the systematic review, were sufficient for the study. This is because multiple electronic databases were employed for the research. Such databases included the MEDLINE, Cochrane Library, EMBASE as well as MEDLINE In-Process. English-Language manuscripts that had been published from 2000 in the OVID database were also included. Other free texts, as well as publications of the medical subject headings (MeSH), were also used for the study. Nevertheless, to promote the validity of the findings, Conference abstracts from medical seminars were not included in the systematic review. As such, it is arguable that the publications considered for the systematic review were sufficient and appropriate for the study.

Question 5: Criteria for Appraising the Studies

The criteria that were used for appraising the studies used for the systematic review was not appropriate. This is because there are no records of any instruments that were used to check the validity or reliability of the studies selected for the review. Nevertheless, the publications were all attained from recognized scientific research databases. As such, it is plausible to state that since the publications employed during the review had been published on scientifically recognized databases, they must have been validated. However, such an assumption is not sufficient for this systematic review. Instead, a section portraying how the findings of the articles used had been assessed should have been included.

Question 6: Critical Appraisal

Additionally, the number of persons who were reviewing the publications employed for the systematic review is not discussed. Also, it is not stated whether the people who reviewed the publications used in the systematic review performed this function independently. As such, it is plausible to state that the quality of this systematic review is poor since it is not clear whether there were two or more reviewers that took part in reviewing the publication. In addition, the systematic review was authored by six authors. However, it is not mentioned whether the authors were part of the Mapi Consultancy firm who were the reviewers of the publication. As such, an additional discussion on the persons who were involved in appraising the articles used for this systematic review is essential.

Question 7: Minimizing Errors in Data Extraction

The systematic review also lacked to portray the methods that were employed in the minimization of errors during data extraction. Additionally, it is not stated in the systematic review whether the extraction of data was in duplicate and executed independently. Moreover, there were no specific tools that were mentioned as having been used in guiding the reviewers in the data extraction process. This is despite the review having instances of biases such as the large volume of heterogeneity in the definition as well as methods employed in the assessment of medication adherence. This is in reference to the publications employed for the research.

Question 8: Methods Employed to Combine the Studies

Combining the publications that were used for the systematic review was appropriate. This is because they provided substantial information to answer the research question used to develop the review. Nevertheless, the reviewers did not access the heterogeneity of the studies used for the review statistically. Moreover, no information was provided to explain the reason for the heterogeneity of the studies employed. For instance, no method was used in explaining the reason why there is a large amount of heterogeneity manifested in the definitions of the methods employed in the assessment of medication adherence. Nevertheless, there was adequate descriptive as well as explanatory information that was employed to support the final findings of the systematic review executed.

Question 9: Likelihood of Assessing the Publication Bias

In this systematic review, the likelihood of the publication bias was not assessed. This is because no statistical test such as the funnel plot or Eggers test among others were used to discuss the impact of the results biases to the final results of the systematic review. However, the assessment of bias likely to occur while executing the research was not essential since it was largely a systematic review of qualitative evidence.

Question 10: Recommendations for Policy and Support for the Reported Data

The recommendation for policy and practice featured in the study was supported by the reported data after the systematic review was completed. In this systematic review, such recommendations were made in each finding attained from the review. Additionally, the information secured from the findings of the impacts of adherence and non-adherence to the Schizophrenia patients, society and healthcare systems also provided sufficient data for the recommendations for policy and support.

Question 11: Specific Directives for the New Research

The specific directives for the new systematic reviews employed for the research were appropriate. This is because the recommendations illustrated the gaps in the systematic review that could be addressed by executing future reviews on the same research question. For instance, one recommendation stated that there was a great need for future research on the research question employed to use consistent definitions as well as a measure of adherence in patients who have schizophrenia. This is for enabling the attainment of an unbiased as well as a meaningful comparison of results. Also, the review recommended that additional comprehensive prospective adherence studies on the research questions would permit researchers to assess the causes of patients non-adherence to treatment with greater accuracy. Such recommendations were supported by the yielded data in the form of the findings that were attained from the review.

Overall Appraisal

The focus of this systematic review was to investigate the primary factors that contribute to both non-adherences and adherence in schizophrenia treatment as well as their associated consequences. Such consequences were to the Schizophrenia patients, the healthcare system and the society at large. The research question was well articulated and accurate. This is because a good research question must define the scope of a review and also help in the development of the research strategy (Pautasso, 2013; Bryman, 2015). Moreover, the research question was formulated around its PICO elements. This was essential because the PICO elements aid a researcher in executing a research or study review and the readers in ascertaining whether a study or review has accomplished its objectives (Booth, Papaioannou, & Sutton, 2012; Wessex Healthcare Librarians, 2017).

Moreover, the inclusion and exclusion criteria used for the study were appropriate. This is because they PICO elements for the research questions were clearly as well as explicitly featured. Additionally, the types of publications included in the review were eligible for the study, and they were also matched against the defined inclusion criteria that was employed in the review. Also, the publications included in the study were those whose findings illustrated various factors that influence adherence rates and those that portrayed the consequence of non-adherence to Schizophrenia medications. Additionally, the publications that portrayed the rate of non-adherence, as well as hospitalization rates of Schizophrenia patients were also included.

Moreover, some studies were excluded because they were out of scope regarding their study design, interventions, patient population, comparison, outcomes and repeat abstract. Additionally, publications that had been authored in other languages apart from English were also excluded. Also, the search strategy employed in the project was appropriate. This is because it employed the keywords that were relevant for finding appropriate information pertaining the research question. Also, only publications that had not been published past 2001 were considered for the study. The use of a specified time frame in defining the publications to be used in a research is important as it aids in attaining more recent findings that are essential for the quality of a review.

In addition, the emphasis of this date during the systematic r...

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