Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness

Marcia Valenstein, Janet Kavanagh, Todd Lee, Peter Reilly, Gregory W. Dalack, John Grabowski, David Smelson, David L. Ronis, Dara Ganoczy, Emily Woltmann, Tabitha Metreger, Patricia Wolschon, Agnes Jensen, Barbara Poddig, Frederic C. Blow

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)727-736
Number of pages10
JournalSchizophrenia bulletin
Volume37
Issue number4
DOIs
StatePublished - Jul 1 2011

Keywords

  • adherence
  • antipsychotic medications
  • health services

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