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Schizophrenia Bulletin Advance Access published online on November 21, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp121
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© The Authors 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

Marcia Valenstein13, Janet Kavanagh3, Todd Lee4,5, Peter Reilly6, Gregory W. Dalack3, John Grabowski6, David Smelson7,8, David L. Ronis2,9, Dara Ganoczy3, Emily Woltmann2,3, Tabitha Metreger3, Patricia Wolschon6, Agnes Jensen2, Barbara Poddig4 and Frederic C. Blow2,3
2 Department of Veterans Affairs Serious Mental Illness Treatment, Research, and Evaluation Center, Health Services Research and Development, Ann Arbor, MI 48104
3 Department of Psychiatry, University of Michigan, Ann Arbor, MI
4 Center for the Management of Complex Chronic Care, Hines Veterans Affairs Hospital, Hines, IL
5 Institute for Healthcare Studies and Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
6 John D. Dingell Medical Center, Department of Veterans Affairs, Detroit, MI
7 Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
8 Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
9 University of Michigan School of Nursing

1 To whom correspondence should be addressed; tel: 734-845-3649, fax: 734-845-3249, e-mail: marciav{at}umich.edu.

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.

Keywords: adherence / antipsychotic medications / health services


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