Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

IIR 01-074 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

IIR 01-074
Improving Antipsychotic Adherence Among Patients with Schizophrenia
Marcia T. Valenstein MD AB
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: July 2002 - June 2006

BACKGROUND/RATIONALE:
Long-term anti-psychotic medications reduce rates of relapse and rehospitalization among patients with schizophrenia. Many patients with bipolar disorder also benefit from long-term anti-psychotic use. However, poor medication adherence is common.

OBJECTIVE(S):
We examined whether a pharmacy-based intervention would increase antipsychotic adherence among patients with serious mental illness. We also examined whether the intervention would improve patient psychiatric symptoms, quality of life, and satisfaction with services.

METHODS:
Using VA administrative data, we identified patients with schizophrenia, schizoaffective or bipolar disorder with antipsychotic medication possession ratios (MPRs) <0.8, and no explanation for low refill rates other than poor adherence. 118 patients meeting these criteria were randomized to either: 1) usual care (n=6) or 2) the Pharmacy Based Adherence Facilitation (PBAF) intervention (n=58). We reassessed patients' antipsychotic MPRs at 6 and 12 months post-enrollment. We also determined adherence at 6 and 12 months with a composite measure that included data from pharmacy fills, antipsychotic blood levels, and patient report. Patients also completed a standardized symptom assessment (PANSS), satisfaction questionnaire (CSQ-8), and quality of life measure (QWB) at baseline, 6, and 12 months.

FINDINGS/RESULTS:
At baseline, the mean antipsychotic MPRs were 0.54 and 0.55 for intervention and UC patients, respectively. The mean -MPRs at 6 months were 0.91 and 0.69 and the mean MPRs at 12 months were 0.88 and 0.69 for intervention and UC patients., respectively. 73% of intervention and 44% of UC patients had MPRs 0.8 at 6 months, and 70% of intervention and 40% of UC patients had MPRs 0.8 at 12 months post-enrollment. 50% of intervention patients and 17% of UC patients and 33% of intervention and 18% of UC patients met the composite criteria for adherence at 6 months and 12 months, respectively. In multivariate analysis, the intervention group was significantly associated with improved adherence (higher MPRs) at 6 month and 12 month follow-up (p=<0.001, p=0.0003, respectively). In logistic regression analysis, patients in the intervention group had an ORs of 7.4 and 5.1 for meeting the composite adherence criteria at 6 months and 12 months compared to UC patients.

In multivariate analysis, there were no significant differences between intervention and UC patients in PANSS, QWB, or CSQ-8 scores at 6 or 12 months.

IMPACT:
This practical, low-complexity intervention was effective in increasing antipsychotic adherence among patients with serious mental illness. However, in this relatively stable patient sample, the intervention was not associated with improvements in psychiatric symptoms, quality of life, or patient satisfaction.

PUBLICATIONS:

Journal Articles

  1. Valenstein M, Kavanagh J, Lee T, Reilly P, Dalack GW, Grabowski J, Smelson D, Ronis DL, Ganoczy D, Woltmann E, Metreger T, Wolschon P, Jensen A, Poddig B, Blow FC. Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness. Schizophrenia Bulletin. 2011 Jul 1; 37(4):727-36.
  2. Pfeiffer PN, Szymanski B, Dhawan N, Difranco D, Valenstein M, Zivin K. Is there an "unhealthy volunteer effect" in mental health outpatient research? Psychiatry Research. 2010 Apr 30; 176(2-3):224-8.
  3. Sajatovic M, Blow FC, Kales HC, Valenstein M, Ganoczy D, Ignacio RV. Age comparison of treatment adherence with antipsychotic medications among individuals with bipolar disorder. International journal of geriatric psychiatry. 2007 Oct 1; 22(10):992-8.
  4. Sajatovic M, Valenstein M, Blow F, Ganoczy D, Ignacio R. Treatment adherence with lithium and anticonvulsant medications among patients with bipolar disorder. Psychiatric services (Washington, D.C.). 2007 Jun 1; 58(6):855-63.
  5. Kreyenbuhl JA, Valenstein M, McCarthy JF, Ganoczy D, Blow FC. Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns. Psychiatric services (Washington, D.C.). 2007 Apr 1; 58(4):489-95.
  6. Valenstein M, Ganoczy D, McCarthy JF, Myra Kim H, Lee TA, Blow FC. Antipsychotic adherence over time among patients receiving treatment for schizophrenia: a retrospective review. The Journal of clinical psychiatry. 2006 Oct 1; 67(10):1542-50.
  7. Sajatovic M, Valenstein M, Blow FC, Ganoczy D, Ignacio RV. Treatment adherence with antipsychotic medications in bipolar disorder. Bipolar disorders. 2006 Jun 1; 8(3):232-41.
  8. Kreyenbuhl J, Valenstein M, McCarthy JF, Ganoczy D, Blow FC. Long-term combination antipsychotic treatment in VA patients with schizophrenia. Schizophrenia Research. 2006 May 1; 84(1):90-9.
  9. Milner KK, Valenstein M. A comparison of guidelines for the treatment of schizophrenia. Psychiatric services (Washington, D.C.). 2002 Jul 1; 53(7):888-90.
Conference Presentations

  1. Valenstein MV. Medication Adherence: Sampling Issues. Methodological Challenges in Mental Health Treatment Adherence Research. Paper presented at: National Institute of Mental Health Mental Health Services Research Annual Conference; 2007 Sep 27; Bethesda, MD.
  2. Kales HC, Valenstein MV, Kim HM, McCarthy JF, Ganoczy DG, Cunningham F, Blow FC. Causes of Death in Patients with Dementia Using Antipsychotics Versus Other Psychiatric Medications. Paper presented at: Albert J. Silverman Research Annual Conference; 2007 Jun 6; Ann Arbor, MI.
  3. Kales HC, Valenstein M, McCarthy J, Ganoczy D, Cunningham F, Blow FC. Causes of Death Among Patients with Dementia Taking Antipsychotics Versus Other Psychiatric Medications. Presented at: American Association for Geriatric Psychiatry Annual Meeting; 2007 Mar 4; New Orleans, LA.
  4. Kales HC, Valenstein MV, McCarthy JF, Ganoczy DG, Blow FC. Cause of Death Among Elders Receiving Antipsychotic Medication. Paper presented at: American Association for Geriatric Psychiatry Annual Meeting; 2007 Mar 1; New Orleans, LA.
  5. Valenstein MV. The Impact of a Pharmacy-Based Intervention on Antipsychotic Adherence Among Patients with Serious Mental Illness. Plenary Session. Paper presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.
  6. Kales HC, Valenstein M, Katz I, McCarthy J, Ganoczy D, Blow FC. The Use of Atypical and Typical Antipsychotics in Dementia: Is there an increased risk of mortality? Paper presented at: American Association for Geriatric Psychiatry Annual Meeting; 2006 Mar 12; Puerto Rico.
  7. Valenstein M, Ganoczy D, McCarthy J, Blow FC, Kim M, Lee T. The Stability of Medication Adherence Among Patients with Schizophrenia. Paper presented at: VA HSR&D National Meeting; 2006 Feb 15; Arlington, VA.
  8. Kreyenbuhl J, Valenstein M, McCarthy JF, Ganoczy D, Blow FC. Patterns of combination antipsychotic treatment for veterans with schizophrenia. Poster session presented at: International Congress on Schizophrenia Research; 2005 Apr 1; Savannah, GA.
  9. Valenstein M, McCarthy JF, Ignacio RV, Dalack G, Stavenger T, Blow FC. Diffusion of a new antipsychotic in a large health system: patient and facility factors. Poster session presented at: International Congress on Schizophrenia Research; 2005 Apr 1; Savannah, GA.
  10. Zeber J, Valenstein M, Woltmann E, Kavanagh J, Schraner P. Efforts to Recruit Patients with Serious Mental Illness into a Research Study. Paper presented at: AcademyHealth Annual Research Meeting; 2004 Jun 1; San Diego, CA.
  11. Grabowski J, Schraner P, Valenstein M, Woltmann E, Kavanagh J, Zeber J. VA Administrative Diagnoses of Schizophrenia Versus Chart Diagnoses. Paper presented at: VA HSR&D National Meeting; 2004 Mar 1; Washington, DC.


DRA: Health Systems, Mental, Cognitive and Behavioral Disorders
DRE: none
Keywords: Pharmaceuticals, Schizophrenia
MeSH Terms: none

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.