title: Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness.
abstract: BACKGROUND
  Similar to patients with other chronic disorders, patients with serious mental illness (SMI) are often poorly adherent with prescribed medications.
  
  
  OBJECTIVE
  We conducted a randomized controlled trial examining the effectiveness of a pharmacy-based intervention (Meds-Help) in increasing antipsychotic medication adherence among Department of Veterans Affairs (VA) patients with SMI. We also examined the impact of Meds-Help on psychiatric symptoms, quality of life, and satisfaction with care.
  
  
  METHODS
  We enrolled 118 patients from 4 VA facilities with schizophrenia, schizoaffective, or bipolar disorder who were on long-term antipsychotics but had antipsychotic medication possession ratios (MPRs) <0.8 in the prior year. Patients were randomized to usual care (UC; n = 60) or the pharmacy-based intervention (Meds-Help; n = 58). We reassessed adherence at 6 and 12 months, at which time patients completed Positive and Negative Symptom Scales (PANSS), Quality of Well-being Scales (QWB), and Client Satisfaction Questionnaires (CSQ-8).
  
  
  RESULTS
  Prior to enrollment, Meds-Help and UC patients had mean antipsychotic MPRs of 0.54 and 0.55, respectively. At 6 months, mean MPRs were 0.91 for Meds-Help and 0.64 for UC patients; at 12 months, they were 0.86 for Meds-Help and 0.62 for UC patients. In multivariate analyses adjusting for patient factors, Meds-Help patients had significantly higher MPRs at 6 and 12 months (P < .0001). There were no significant differences between groups in PANSS, QWB, or CSQ-8 scores, but power to detect small effects was limited.
  
  
  CONCLUSIONS
  Congruent with prior studies of patients with other disorders, a practical pharmacy-based intervention increased antipsychotic adherence among patients with SMI. However, SMI patients may require additional care management components to improve outcomes.
authors.affiliation: Department of Veterans Affairs Serious Mental Illness Treatment, Research, and Evaluation Center, Health Services Research and Development, Ann Arbor, MI 48104, USA. marciav@umich.edu
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Janet
authors.initials: J
authors.lastname: Kavanagh
authors.forename: Todd
authors.initials: T
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Reilly
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Dalack
authors.forename: John
authors.initials: J
authors.lastname: Grabowski
authors.forename: David
authors.initials: D
authors.lastname: Smelson
authors.forename: David L
authors.initials: DL
authors.lastname: Ronis
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.forename: Emily
authors.initials: E
authors.lastname: Woltmann
authors.forename: Tabitha
authors.initials: T
authors.lastname: Metreger
authors.forename: Patricia
authors.initials: P
authors.lastname: Wolschon
authors.forename: Agnes
authors.initials: A
authors.lastname: Jensen
authors.forename: Barbara
authors.initials: B
authors.lastname: Poddig
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002908:Chronic Disease; D003299:Cooperative Behavior; D004349:Drug Packaging; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008134:Long-Term Care; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D010595:Pharmacists; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D014728:Veterans / Q000523:psychology*
chemical_list: D014150:Antipsychotic Agents