Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness
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...
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| Veröffentlicht in: | Schizophrenia bulletin 2011-07, Vol.37 (4), p.727-736 |
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| creator | Valenstein, Marcia Kavanagh, Janet Lee, Todd Reilly, Peter Dalack, Gregory W. Grabowski, John Smelson, David Ronis, David L. Ganoczy, Dara Woltmann, Emily Metreger, Tabitha Wolschon, Patricia Jensen, Agnes Poddig, Barbara Blow, Frederic C. |
| description | 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) |
| doi_str_mv | 10.1093/schbul/sbp121 |
| format | Article |
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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.</description><identifier>ISSN: 0586-7614</identifier><identifier>EISSN: 1745-1701</identifier><identifier>DOI: 10.1093/schbul/sbp121</identifier><identifier>PMID: 19933540</identifier><identifier>CODEN: SCZBB3</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Adult and adolescent clinical studies ; Antipsychotic Agents - administration & dosage ; Antipsychotic Agents - adverse effects ; Biological and medical sciences ; Bipolar Disorder - diagnosis ; Bipolar Disorder - drug therapy ; Bipolar Disorder - psychology ; Chronic Disease ; Cooperative Behavior ; Drug Packaging ; Female ; Humans ; Interdisciplinary Communication ; Long-Term Care ; Male ; Medical sciences ; Medication Adherence - psychology ; Middle Aged ; Neuropharmacology ; Patient Care Team ; Patient Satisfaction ; Pharmacists ; Pharmacology. Drug treatments ; Psychiatric Status Rating Scales ; Psycholeptics: tranquillizer, neuroleptic ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychopharmacology ; Psychoses ; Psychotic Disorders - diagnosis ; Psychotic Disorders - drug therapy ; Psychotic Disorders - psychology ; Quality of Life - psychology ; Regular ; Schizophrenia ; Schizophrenia - diagnosis ; Schizophrenia - drug therapy ; Schizophrenic Psychology ; Veterans - psychology</subject><ispartof>Schizophrenia bulletin, 2011-07, Vol.37 (4), p.727-736</ispartof><rights>The Authors 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-2e806fb20811f6a15702ef71267a61936160e4e4f14db102018e5c9ea57c77c43</citedby><cites>FETCH-LOGICAL-c482t-2e806fb20811f6a15702ef71267a61936160e4e4f14db102018e5c9ea57c77c43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122282/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122282/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,883,1581,27907,27908,53774,53776</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24310794$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19933540$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Valenstein, Marcia</creatorcontrib><creatorcontrib>Kavanagh, Janet</creatorcontrib><creatorcontrib>Lee, Todd</creatorcontrib><creatorcontrib>Reilly, Peter</creatorcontrib><creatorcontrib>Dalack, Gregory W.</creatorcontrib><creatorcontrib>Grabowski, John</creatorcontrib><creatorcontrib>Smelson, David</creatorcontrib><creatorcontrib>Ronis, David L.</creatorcontrib><creatorcontrib>Ganoczy, Dara</creatorcontrib><creatorcontrib>Woltmann, Emily</creatorcontrib><creatorcontrib>Metreger, Tabitha</creatorcontrib><creatorcontrib>Wolschon, Patricia</creatorcontrib><creatorcontrib>Jensen, Agnes</creatorcontrib><creatorcontrib>Poddig, Barbara</creatorcontrib><creatorcontrib>Blow, Frederic C.</creatorcontrib><title>Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness</title><title>Schizophrenia bulletin</title><addtitle>Schizophr Bull</addtitle><description>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.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Antipsychotic Agents - administration & dosage</subject><subject>Antipsychotic Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Bipolar Disorder - diagnosis</subject><subject>Bipolar Disorder - drug therapy</subject><subject>Bipolar Disorder - psychology</subject><subject>Chronic Disease</subject><subject>Cooperative Behavior</subject><subject>Drug Packaging</subject><subject>Female</subject><subject>Humans</subject><subject>Interdisciplinary Communication</subject><subject>Long-Term Care</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medication Adherence - psychology</subject><subject>Middle Aged</subject><subject>Neuropharmacology</subject><subject>Patient Care Team</subject><subject>Patient Satisfaction</subject><subject>Pharmacists</subject><subject>Pharmacology. Drug treatments</subject><subject>Psychiatric Status Rating Scales</subject><subject>Psycholeptics: tranquillizer, neuroleptic</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychopharmacology</subject><subject>Psychoses</subject><subject>Psychotic Disorders - diagnosis</subject><subject>Psychotic Disorders - drug therapy</subject><subject>Psychotic Disorders - psychology</subject><subject>Quality of Life - psychology</subject><subject>Regular</subject><subject>Schizophrenia</subject><subject>Schizophrenia - diagnosis</subject><subject>Schizophrenia - drug therapy</subject><subject>Schizophrenic Psychology</subject><subject>Veterans - psychology</subject><issn>0586-7614</issn><issn>1745-1701</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1r3DAQxUVpabZpj70WXQq9uNHIsmRfCtvQj4WEBJrQo5C141jFlhzJXtj_viq7JM0pp4E3P7154hHyHthnYE15lmzfLsNZaifg8IKsQImqAMXgJVmxqpaFkiBOyJuU_jAGopH8NTmBpinLSrAVub9Nzt_RNb3uTRyN3RdfTcIt3fgZ4w797IKnN4FuximGHdJ1Vqa0t32YnaXrbY8Rvc36GLLNtZldfpPobzf39BdGF5ZEL7NkBroZBo8pvSWvOjMkfHecp-T2-7eb85_FxdWPzfn6orCi5nPBsWayazmrATppoFKMY6eAS2UkNKUEyVCg6EBsW2CcQY2VbdBUyiplRXlKvhx8p6UdcWtziGgGPUU3mrjXwTj9dONdr-_CTpfAOa95Nvh0NIjhfsE069Eli8NgPOZvaRA5RlWrss5ocUBtDClF7B7OANP_atKHmvShpsx_-D_bI33sJQMfj4BJ1gxdNN669MBxUQJTjXjMGJbpmZt_AV80rEg</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>Valenstein, Marcia</creator><creator>Kavanagh, Janet</creator><creator>Lee, Todd</creator><creator>Reilly, Peter</creator><creator>Dalack, Gregory W.</creator><creator>Grabowski, John</creator><creator>Smelson, David</creator><creator>Ronis, David L.</creator><creator>Ganoczy, Dara</creator><creator>Woltmann, Emily</creator><creator>Metreger, Tabitha</creator><creator>Wolschon, Patricia</creator><creator>Jensen, Agnes</creator><creator>Poddig, Barbara</creator><creator>Blow, Frederic C.</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>5PM</scope></search><sort><creationdate>20110701</creationdate><title>Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness</title><author>Valenstein, Marcia ; Kavanagh, Janet ; Lee, Todd ; Reilly, Peter ; Dalack, Gregory W. ; Grabowski, John ; Smelson, David ; Ronis, David L. ; Ganoczy, Dara ; Woltmann, Emily ; Metreger, Tabitha ; Wolschon, Patricia ; Jensen, Agnes ; Poddig, Barbara ; Blow, Frederic C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-2e806fb20811f6a15702ef71267a61936160e4e4f14db102018e5c9ea57c77c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Antipsychotic Agents - administration & dosage</topic><topic>Antipsychotic Agents - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Bipolar Disorder - diagnosis</topic><topic>Bipolar Disorder - drug therapy</topic><topic>Bipolar Disorder - psychology</topic><topic>Chronic Disease</topic><topic>Cooperative Behavior</topic><topic>Drug Packaging</topic><topic>Female</topic><topic>Humans</topic><topic>Interdisciplinary Communication</topic><topic>Long-Term Care</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medication Adherence - psychology</topic><topic>Middle Aged</topic><topic>Neuropharmacology</topic><topic>Patient Care Team</topic><topic>Patient Satisfaction</topic><topic>Pharmacists</topic><topic>Pharmacology. Drug treatments</topic><topic>Psychiatric Status Rating Scales</topic><topic>Psycholeptics: tranquillizer, neuroleptic</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychopharmacology</topic><topic>Psychoses</topic><topic>Psychotic Disorders - diagnosis</topic><topic>Psychotic Disorders - drug therapy</topic><topic>Psychotic Disorders - psychology</topic><topic>Quality of Life - psychology</topic><topic>Regular</topic><topic>Schizophrenia</topic><topic>Schizophrenia - diagnosis</topic><topic>Schizophrenia - drug therapy</topic><topic>Schizophrenic Psychology</topic><topic>Veterans - psychology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Valenstein, Marcia</creatorcontrib><creatorcontrib>Kavanagh, Janet</creatorcontrib><creatorcontrib>Lee, Todd</creatorcontrib><creatorcontrib>Reilly, Peter</creatorcontrib><creatorcontrib>Dalack, Gregory W.</creatorcontrib><creatorcontrib>Grabowski, John</creatorcontrib><creatorcontrib>Smelson, David</creatorcontrib><creatorcontrib>Ronis, David L.</creatorcontrib><creatorcontrib>Ganoczy, Dara</creatorcontrib><creatorcontrib>Woltmann, Emily</creatorcontrib><creatorcontrib>Metreger, Tabitha</creatorcontrib><creatorcontrib>Wolschon, Patricia</creatorcontrib><creatorcontrib>Jensen, Agnes</creatorcontrib><creatorcontrib>Poddig, Barbara</creatorcontrib><creatorcontrib>Blow, Frederic C.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Schizophrenia bulletin</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Valenstein, Marcia</au><au>Kavanagh, Janet</au><au>Lee, Todd</au><au>Reilly, Peter</au><au>Dalack, Gregory W.</au><au>Grabowski, John</au><au>Smelson, David</au><au>Ronis, David L.</au><au>Ganoczy, Dara</au><au>Woltmann, Emily</au><au>Metreger, Tabitha</au><au>Wolschon, Patricia</au><au>Jensen, Agnes</au><au>Poddig, Barbara</au><au>Blow, Frederic C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness</atitle><jtitle>Schizophrenia bulletin</jtitle><addtitle>Schizophr Bull</addtitle><date>2011-07-01</date><risdate>2011</risdate><volume>37</volume><issue>4</issue><spage>727</spage><epage>736</epage><pages>727-736</pages><issn>0586-7614</issn><eissn>1745-1701</eissn><coden>SCZBB3</coden><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.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>19933540</pmid><doi>10.1093/schbul/sbp121</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Adult and adolescent clinical studies Antipsychotic Agents - administration & dosage Antipsychotic Agents - adverse effects Biological and medical sciences Bipolar Disorder - diagnosis Bipolar Disorder - drug therapy Bipolar Disorder - psychology Chronic Disease Cooperative Behavior Drug Packaging Female Humans Interdisciplinary Communication Long-Term Care Male Medical sciences Medication Adherence - psychology Middle Aged Neuropharmacology Patient Care Team Patient Satisfaction Pharmacists Pharmacology. Drug treatments Psychiatric Status Rating Scales Psycholeptics: tranquillizer, neuroleptic Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychopharmacology Psychoses Psychotic Disorders - diagnosis Psychotic Disorders - drug therapy Psychotic Disorders - psychology Quality of Life - psychology Regular Schizophrenia Schizophrenia - diagnosis Schizophrenia - drug therapy Schizophrenic Psychology Veterans - psychology |
| title | Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness |
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