Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness.
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.
Valenstein
Marcia
M
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
Kavanagh
Janet
J
Lee
Todd
T
Reilly
Peter
P
Dalack
Gregory W
GW
Grabowski
John
J
Smelson
David
D
Ronis
David L
DL
Ganoczy
Dara
D
Woltmann
Emily
E
Metreger
Tabitha
T
Wolschon
Patricia
P
Jensen
Agnes
A
Poddig
Barbara
B
Blow
Frederic C
FC
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*
D014150:Antipsychotic Agents