Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness

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.

Development and Feasibility Testing of a Smartphone Intervention to Improve Adherence to Antipsychotic Medications

“…This is not necessarily surprising as we did not enroll individuals based upon their medication adherence status and subjective assessments of non-adherence are known to be unreliable (40–41). Future studies evaluating the effectiveness of MedActive and similar adherence-enhancing interventions should enroll individuals with known adherence difficulties (4) and should employ more objective measures of medication adherence (e.g., unannounced pill counts (15–16), pharmacy refill records (13, 15), electronic pill caps (16, 40)) along with self-reports (41). …”

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature*

“…blister packaging) and yet they are part of other multifaceted outpatient programs such as MedsHelp in the United States (US) (Valenstein et al, 2011) and dose administration aids programs in Australia (Pharmacy Guild of Australia, 2013).…”

Development of a Medication Monitoring System for an Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) Team

“…While pharmacy-based interventions in medication adherence 14 and clinical pharmacist interventions with a PACT team 15 have been previously reported, programs with regular pharmacist involvement in longitudinal antipsychotic monitoring were not found. The goals of the monitoring program were to help ensure members receive the most effective care, to minimize potential medication-related adverse effects and to improve coordination of care between medical and psychiatric providers.…”