Blister Packaging Medication Increases Treatment Adherence in Psychiatric Patients

Gutierrez, Peter M.; Wortzel, Hal S.; Forster, Jeri E.; Leitner, Rebecca; Hostetter, Trisha A.; Brenner, Lisa A.

doi:10.1097/pra.0000000000000252

Cited by 18 publications

(19 citation statements)

References 9 publications

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“…We conducted a cost – utility analysis of a pragmatic randomized controlled trial in which 303 veterans with schizophrenia, bipolar disorder, major affective disorder and post‐traumatic stress disorder were randomized to all prescriptions in blister packaging or in bulk vials (dispensing as usual (DAU)). The trial was designed for these participants because veterans and patients with these disorders are at elevated risk for both poor adherence and suicide . The trial and clinical outcomes have been previously described in detail .…”

Section: Methodsmentioning

confidence: 99%

“…The trial was designed for these participants because veterans and patients with these disorders are at elevated risk for both poor adherence and suicide . The trial and clinical outcomes have been previously described in detail . Briefly, participants were 303 veterans aged 18 or older discharged from a psychiatric inpatient unit or receiving services in the outpatient mental health, substance abuse or post‐traumatic stress syndrome (PTSD) clinics of a large, urban VA medical centre in the Western United States between September 2011 and January 2014.…”

Section: Methodsmentioning

confidence: 99%

“…Blister packaging all medications is associated with improved adherence to pharmacotherapy and reductions in suicide, yet the additional cost and lack of evidence of cost‐effectiveness have impeded its use . In the United Kingdom, a regulatory change requiring a switch from bulk packaging of paracetamol (acetaminophen (Tylenol)) to blister packaging has been associated with reductions in suicide .…”

Section: Background and Objectivesmentioning

confidence: 99%

“…and eliminates the need for patients to split tablets for half‐dose prescriptions, a known barrier to adherence . Most recently, Gutierrez and colleagues conducted a randomized controlled trial in the US Department of Veterans Health Affairs and found that among veterans with post‐traumatic stress disorder, bipolar disorder, schizophrenia, substance use disorder or major affective disorder, adherence improved significantly for those with the worst baseline adherence randomized to blister packaging versus dispensing as usual in bulk vials . Yet, studies of the cost – utility of blister packaging are lacking and the use of monitored dosage systems (including blister packaging) is controversial due to the marginal cost associated with repackaging and lack of data about cost‐savings from avoided hospitalizations and overall cost‐effectiveness .…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Yet, studies of the cost – utility of blister packaging are lacking and the use of monitored dosage systems (including blister packaging) is controversial due to the marginal cost associated with repackaging and lack of data about cost‐savings from avoided hospitalizations and overall cost‐effectiveness . The purpose of this study was to perform a cost – utility analysis of blister packaging versus dispensing as usual (DAU) (bulk dispensing in vials) using data from the clinical trial among veterans with serious mental illnesses conducted by Gutierrez and colleagues …”

Section: Background and Objectivesmentioning

confidence: 99%

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Cost–utility analysis of blister packaging all outpatient medications for veterans with bipolar disorder, major affective disorder, post‐traumatic stress disorder or schizophrenia

Lavigne

Falbo

Gutierrez

2019

J Pharm Health Serv Res

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Background Veterans with serious mental illnesses face increased risk of both poor medication adherence and death by overdose or suicide. Blister packaging of medications has been associated with population reductions in suicide in the United Kingdom and may improve adherence. Yet, the lack of studies of cost and outcomes has led to controversy about its use. Objective To conduct a cost-utility analysis of blister packaging versus bulk dispensing using in a randomized controlled trial among Veterans with serious mental illnesses or substance abuse. Methods We conducted a cost-utility analysis of a pragmatic randomized controlled trial of 303 Veterans (243 of whom completed the 12-month trial) with post-traumatic stress disorder, schizophrenia, bipolar disorder or major affective disorder in a large VA academic medical center in the West from the perspective of the VA. Quality adjusted life years (QALYs) were estimated from a monthly SF-36. Total healthcare utilization and costs were derived from the VHA Corporate Data Warehouse. Incremental cost-utility ratio and probabilistic sensitivity analysis were estimated. Costs were modeled with regression. Results Mean total VA healthcare costs (including inpatient, outpatient and pharmacy costs) for intervention and control groups were not statistically different at $28 591 and $30 732, respectively. All subjects survived the 12-month trial period, with similar mean QALYs (0.59 and 0.58). Conclusions In this group of veterans with serious mental illnesses, our results suggest that blister packaging all outpatient prescription medications was budget-neutral. Blister packaging may be a cost-effective barrier to intentional overdose with prescribed medications.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

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