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.
Subject(s)
Antipsychotic Agents/administration & dosage , Bipolar Disorder/drug therapy , Cooperative Behavior , Interdisciplinary Communication , Medication Adherence/psychology , Patient Care Team , Pharmacists , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Schizophrenic Psychology , Veterans/psychology , Adult , Antipsychotic Agents/adverse effects , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Chronic Disease , Drug Packaging , Female , Humans , Long-Term Care , Male , Middle Aged , Patient Satisfaction , Psychiatric Status Rating Scales , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Quality of Life/psychology , Schizophrenia/diagnosisABSTRACT
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.
