Using pharmacy data on partial adherence to inform clinical care of patients with serious mental illness.
OBJECTIVE
Low adherence to antipsychotic medications is a risk factor for poor outcomes for people with serious mental illness. Pharmacy data might be used by health systems to identify partially adherent patients for interventions. This study assessed whether using pharmacy data is an accurate screening method for identifying at-risk patients.


METHODS
Administrative data were used to identify 1,712 veterans as having schizophrenia or a schizoaffective or bipolar disorder and who had 12-month antipsychotic medication possession ratios (MPRs) of less than .80. Patients' charts were reviewed for alternative explanations for low rates of filling prescriptions for antipsychotic medication.


RESULTS
Of 1,712 patients whose pharmacy data indicated partial adherence (MPRs less than .80), 17% (N=297) may have been adherent. Patients with bipolar disorder had higher odds of receiving a false-positive designation (adjusted odds ratio of 1.8, 95% confidence interval of 1.31-2.39).


CONCLUSIONS
MPRs constructed from pharmacy data can be a useful first screen for identifying patients who need assistance with medication adherence.
Woltmann
Emily M
EM
Dartmouth Psychiatric Research Center, NH, USA. emily.woltmann@dartmouth.edu
Valenstein
Marcia
M
Welsh
Deborah E
DE
Lee
Todd A
TA
Wolschon
Patricia A
PA
Grabowski
John
J
Reilly
Peter A
PA
D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015982:Bias; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003625:Data Collection / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D016017:Odds Ratio; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014481:United States; D014728:Veterans / Q000523:psychology*
D018692:Antimanic Agents; D014150:Antipsychotic Agents