title: Integrated Pharmacies at Community Mental Health Centers: Medication Adherence and Outcomes.
abstract: BACKGROUND
  Patients receiving psychiatric services at community mental health centers (CMHCs) are often prescribed medication that is critical to the treatment of behavioral health conditions, including schizophrenia, bipolar disorder, anxiety, and depression. Previous studies have shown correlation between rates of medication adherence and risk of hospitalization, but potential differences in medication adherence and other outcomes for patients of CMHCs by pharmacy type have not been widely studied.
  
  
  OBJECTIVE
  To determine potential benefits of placing a pharmacy within a mental health service delivery setting on both adherence to medication and health outcomes.
  
  
  METHODS
  A retrospective cohort analysis of medication adherence rates, hospital and emergency department (ED) use, and related costs between patients of CMHCs was conducted using integrated pharmacies versus community pharmacies. Data were from Medicaid claims paid by Southwest Michigan Behavioral Health for all (behavioral and nonbehavioral) inpatient and outpatient services as well as pharmacy prescriptions filled from April 1, 2014, through April 30, 2015. The primary study analysis was composed of an adult dataset representing persons served from 1 of the 2 CMHCs who had filled at least 2 prescriptions for a specific medication from 1 of 2 Genoa pharmacies located in a CMHC during the study period. Each unique patient dataset in the treatment group was matched to a corresponding control patient dataset prescribed the same medication using a modified version of the Gale-Shapley algorithm. The primary analysis compared medication possession ratio, which is a measure of adherence that indicates gaps or oversupply in a patient's medication use history. Statistical tests were performed using the R statistical programming language and Microsoft Excel.
  
  
  RESULTS
  Patients using pharmacies integrated within the CMHCs had higher medication adherence rates, lower rates of hospitalization, and lower ED use than those filling their prescriptions at community pharmacies. These results were associated with a cost savings of $58 per member per month (approximately $700,000 per 1,000 patients annually).
  
  
  CONCLUSIONS
  Pharmacies integrated within CMHCs not only can improve medication adherence but also can reduce the need for other expensive health care services.
  
  
  BACKGROUND
  Southwest Michigan Behavioral Health sponsored this study, which was funded by Genoa, a QoL Healthcare Company. SWMBH is a client of Care Management Technologies and permitted the use of its data for this analysis. Wright and Clayton are employed by Care Management Technologies, which was contracted by Genoa to conduct this analysis. Gorman owns Franklin Behavioral Health Consultants and reports consulting fees from Care Management Technologies; Gorman also reports stock ownership in various pharmaceutical companies. Odorzynski and Peterson are employed by Genoa. Study concept and design were contributed by Clayton, Odorzynski, Peterson, and Gorman, with assistance from Wright. Wright took the lead in data collection, with assistance from Clayton and Odorzynski, and data interpretation was performed by Wright and Gorman, with assistance from Odorzynski, Clayton, and Peterson. The manuscript was written by Gorman, Wright, and Odorzynski, assisted by Clayton and Peterson, and revised by Clayton, Gorman, Odorzynski, and Peterson.
authors: 1 Care Management Technologies, Morrisville, North Carolina.
authors: W Abel
authors: WA
authors: Wright
authors: 1 Care Management Technologies, Morrisville, North Carolina.
authors: Jack M
authors: JM
authors: Gorman
authors: 2 Genoa, a QoL Healthcare Company, Eagan, Minnesota.
authors: Melissa
authors: M
authors: Odorzynski
authors: 2 Genoa, a QoL Healthcare Company, Eagan, Minnesota.
authors: Mark J
authors: MJ
authors: Peterson
authors: 1 Care Management Technologies, Morrisville, North Carolina.
authors: Carol
authors: C
authors: Clayton
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003155:Community Mental Health Centers / Q000639:trends*; D003157:Community Pharmacy Services / Q000639:trends*; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome