Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1005 — The Impact of a Pharmacy-Based Intervention on Antipsychotic Adherence Among Patients with Serious Mental Illness

Valenstein M (Ann Arbor COE/SMITREC) , Kavanagh J (Ann Arbor COE/SMITREC), Lee T (Hines COE), Smelson D (East Orange VA), Grabowski J (Detroit VA), Dalack GW (Ann Arbor VA/University of Michigan), Woltmann E (Dartmouth University), Reilly P (Detroit VA), Ganoczy D (Ann Arbor COE/SMITREC), Blow FC (Ann Arbor COE/SMITREC)

Objectives:
Antipsychotic medications are an essential component of the treatment of patients with schizophrenia, reducing rates of relapse and rehospitalization. Many patients with bipolar disorder also require long-term antipsychotic maintenance to maintain stability. However, poor adherence with antipsychotic medications is common. We conducted a randomized controlled trial of a practical, pharmacy-based intervention designed to improve antipsychotic adherence among patients with serious mental illness.

Methods:
Using pharmacy data, we identified patients with schizophrenia or bipolar disorder who received antipsychotic medication and completed at least two outpatient mental health visits at one of four VA facilities. We calculated antipsychotic medication possession ratios (MPRs) and confirmed patients' diagnoses and clinician intention to use long term antipsychotics for those with MPRs <0.8. We randomized 150 patients to either: 1) usual care or 2) the Pharmacy Based Adherence Facilitation (PBAF) intervention. The PBAF intervention consisted of usual care plus a) aligning the "refill dates" of patients' medications, b) using "unit-of-use” adherence packaging that included all medications, c) an education session, d) refill reminders, and e) clinician notification of missed fills. We reassessed patients' antipsychotic MPRs at 12 months post-enrollment.

Results:
At baseline, the mean MPR of patients in the intervention and control groups was 0.61 and 0.63, respectively. At 12 months follow-up, the mean MPR for the intervention and control groups was 0.85 and 0.69, respectively; 66% of patients in the intervention group and 37% of patients in the control group had MPRs >0.8. In linear regression analyses that adjusted for baseline MPR, race, age, and concurrent substance use, enrollment in the intervention group was significantly associated with improved adherence (higher MPRs) at follow-up (p<.0001). In logistic regression analyses, patients enrolled in the intervention group had an OR of 4.5 for meeting criteria for "good adherence" (MPRs >0.8) compared to patients in the control group.

Implications:
This practical, low-complexity intervention appears to be effective in increasing antipsychotic adherence among patients with serious mental illness.

Impacts:
VA patients with serious mental illness who are poorly adherent with their antipsychotic medications suffer considerable morbidity. By improving adherence, this pharmacy-based intervention may improve the outcomes of these patients.