BACKGROUND: With the revision of the National Essential Medicines List in South Africa, quetiapine is only available at the discretion of individual institutions in the public health sector. However, quetiapine is effective in managing all aspects of bipolar disorder, including preventative treatment of depressive episodes, and may be a cost-effective option in severe illness. AIM: To present the first retrospective review of quetiapine use in a peri-urban health district of South Africa, describing the patient profile, clinical response and prescribing patterns. METHODS: The clinical files of all patients in Sedibeng District who received quetiapine over a defined 3-year period (2011-2013) were reviewed. A positive clinical response was defined as both symptomatic and functional improvement. Demographic and clinical characteristics of responders were compared with that of non-responders. Pre- and post-quetiapine scripts of the responders were audited and costed. RESULTS: Patients who received quetiapine (n = 40) had chronic disabling illness, often with multiple medication trials and hospitalisations prior to quetiapine use. Bipolar II disorder (followed by bipolar I disorder) was the most common primary psychiatric diagnosis documented. Other than improvement in functioning (p < 0.0001), responders differed significantly from non-responders in terms of a higher level of polypharmacy and a significant reduction in median number of medications from pre- to post-quetiapine (p = 0.0057). CONCLUSION: Quetiapine use was associated with a highly significant improvement in functioning; however, it came at a 52% increase in medicine cost. Pre-quetiapine treatments, though, did not achieve an optimal level of functioning, and overall costs may be reduced by more rational prescribing habits.

Background The impact that communication has on adherence, considering outcomes such as patient satisfaction and recall of the content of encounters with health care providers, has been extensively reported on in the literature. The South African Depression and Anxiety Group (SADAG) developed a specific communication intervention program, which was implemented in a local public sector setting. Objective To investigate the attendance and medication adherence of patients at the specialist psychiatric outpatient clinic of the Helen Joseph Hospital in Johannesburg, before and after the pilot implementation of this program. Methods Included quantitative and qualitative methodologies. The retrospective component included a review of participants’ demographic and clinical profile and medication adherence. The prospective, qualitative component included structured pre- and post-questionnaires. Results The typical participant was female (76%), older than 40 years (58.2%) and unemployed (74.2%). Comparing the study and control groups, the communication program resulted in a higher post-intervention booking ratio for the Study group, while the diagnostic category of participants were associated with their understanding of their medication. Discussion Being mindful of the noted limitations of this pilot project, the SADAG program or similar communication intervention strategy, should be a standard operational procedure in local South African state sector clinics.