Program Enlists Pharmacies in Antipsychotic Adherence

Adherence to an antipsychotic regimen by patients with serious mental illness can be increased by a pharmacy-based intervention that includes education about medication adherence, refill reminders for patients, and electronic notification of clinicians when patients fail to refill prescriptions, along with special medication packaging designed to facilitate compliance (see What's the Bottom Line?).

That was the finding of a randomized, controlled trial examining the effectiveness of a pharmacy-based intervention known as "Meds-Help" in increasing antipsychotic medication adherence among Department of Veterans Affairs (VA) patients. The report, "Using A Pharmacy-Based Intervention to Improve Antipsychotic Adherence Among Patients With Serious Mental Illness," appears in the July 4 Schizophrenia Bulletin.

"The take-home message is that involving pharmacy personnel in providing practical support for medication regimens is likely to improve adherence among patients with serious mental illness," lead author Marcia Valenstein, M.D., told Psychiatric News. "Lower cost but skilled personnel such as pharmacy technicians can make an important difference if they become part of the team. The model we used is ready to go for any VA that wishes to implement the intervention, and private pharmacies and pharmacies that provide services for community mental health patients may also provide the key elements of this intervention."

She is an associate professor of psychiatry at the University of Michigan School of Medicine and senior investigator in the VA.

In the study, 118 patients from four VA facilities with schizophrenia, schizoaffective disorder, or bipolar disorder who were on long-term antipsychotics but had experienced problems with compliance in the prior year were randomized to usual care (n=60) or to "Meds-Help" (n=58).

Medication adherence was determined at baseline and at follow-up as a measure of the "medication possession ratio" (MPR), which is the ratio of the number of outpatient days' supply of medication that a patient has received during the designated period divided by the number of days' supply they needed to receive to take their prescribed dose of antipsychotic continuously during noninstutionalized days. This measure was combined with patient reports and blood levels of medication.

"Usual care" consisted primarily of treatment in VA outpatient mental health clinics and included psychiatrist visits, non-M.D. mental health visits, and group visits.

The Meds-Help intervention consisted of "unit-of-use packaging" that included all patients' medications for psychiatric and general medical conditions, a medication and packaging education session, refill reminders mailed two weeks before refill dates, and notification of clinicians when patients failed to fill antipsychotic prescriptions within seven to 10 days of a fill date.

At six months, mean MPRs were 0.91 for Meds-Help and 0.64 for usual-care patients; at 12 months, they were 0.86 for Meds-Help and 0.62 for usual-care patients. Statistical analysis adjusting for patient factors showed that Meds-Help patients had significantly higher MPRs at both points.

Valenstein explained that the pharmacist conducts the medication- and packaging-education session after receiving permission from the clinician to enroll the patient. Clinicians are notified by e-mail of patient failure to fill and by a note to be countersigned in the electronic medical record.

"The intervention has only been disseminated in five VA facilities," Valenstein told Psychiatric News. "However, in Australia private pharmacies do something very similar, and there are private pharmacies in the U.S. that are willing to provide a service such as this. Some [community mental health] facilities are initiating some similar interventions."