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.
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.
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.
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.
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.
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Mental, Cognitive and Behavioral Disorders, Health Systems