Pharmacy-Based Intervention Improves Antipsychotic Adherence

Employing a pharmacy-based intervention can help increase antipsychotic medication adherence among patients with serious mental illness (SMI), according to a study published by VA researchers. Patients with SMI are often only partially adherent with prescription medications — their illness playing a large role in their inability to track their own medications. These poor adherence rates often result in treatment failure.

VA Health Services Research and Development (HSR&D) researchers in Ann Arbor, MI, looked at 118 VA patients in four VA facilities being treated for schizophrenia, schizoaffective disorder, or bipolar disorder. The patients were all on long-term antipsychotics but had antipsychotic medication possession ratios (MPRs) of less than 0.8 in the prior year. MPR, a common way of determining medication adherence, measures the percentage of time a patient has access to medication by comparing the frequency of the patient refilling the medication to the prescription pill count.

The patients in the VA study had a mean MPR of 0.54. Patients were randomized to usual care or to the Meds-Help pharmacy-based intervention. Patients assigned to Meds-Help were given a medication-education session, mailed refill reminders, and their clinicians were notified if the patient failed to refill the prescriptions after a week.

 When researchers reassessed adherence at six and 12 months, they found that patients in the intervention group had improved at greater rates than the controls. At six months, MPR for the intervention group was 0.91 compared to 0.64 for the control. At 12 months, the MPRs were 0.86 and 0.62.

The researchers concluded that a practical, pharmacy-based intervention increases antipsychotic adherence among patients. However, SMI patients may require additional care management components to significantly improve outcomes over the long term.

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. Schizophr Bull. 2011 Jul;37(4):727-36. Epub 2009 Nov 21. PubMed PMID: 19933540; PubMed Central PMCID: PMC3122282.