As healthcare is placed under the microscopic to flesh out health reform, one issue that surfaces involves the poor outcomes that accompany patient non-compliance in taking medications.
One solution is for health systems to consider pharmacy-based interventions to aid mental health patients.
A new study in the online edition of Schizophrenia Bulletin implements this recommendation among patients with schizophrenia and bipolar disorder.
The study was led by Marcia Valenstein, M.D., Senior Research Scientist in the VA Health Services Research and Development Service and Associate Professor in the Department of Psychiatry at the U-M Medical School.
“Because 40 percent of patients with schizophrenia and bipolar disorder have difficulty taking their medications regularly, we needed to develop low cost, practical, and non-coercive way to help them become more adherent,” Valenstein says.
The study showed that pharmacists and pharmacy technicians can be an invaluable part of the health care team and can help patients take their medications regularly.
The goal of this study was to determine whether MedsHelp, a pharmacy-based intervention, would improve antipsychotic adherence in patients with serious mental illnesses.
The study enrolled 118 patients with schizophrenia or bipolar disorder in four VA facilities.
The MedsHelp intervention consisted of aligning the dates of all of a patient’s prescriptions so they became due on the same date, a unit of use packaging that included all patient medications for psychiatric and general medical conditions, a medication and packaging education session, refill reminders mailed two weeks before scheduled refill dates, and notification of clinicians when patients failed a fill date.
Pharmacy staff served as contacts for patient questions regarding pharmacy services or doctors prescriptions. Pharmacy technicians, with oversight by pharmacists, completed many of the intervention components.
After 6 months of intervention, MedsHelp patients filled medications for 91 percent of outpatient days compared to 64 percent for patients receiving the usual care.
After 12 months, adherence of patients on MedsHelp intervention filled medications for 86 percent of outpatient days compared to 62 percent for patients receiving usual care.
The study concluded that a low-complexity, pharmacy-based intervention improved antipsychotic adherence among patients with serious mental illnesses, a patient population in which poor adherence is common.
The increase was consistent with results previously reported for patients with diabetes and hypertension who received unit-of-use packaging and refill reminders for medication. Thus, these pharmacy-based intervention components appear to be as effective in increasing adherence for patients with serious mental illnesses as for patients with other chronic medical conditions.
The increase in adherence observed with MedsHelp is also in line with a recent study examining a pharmacy based intervention for elderly patients with coronary risk factors who are taking more than four medications.
Since the study concluded, the Department of Veterans Affairs has implemented this program clinically in five of its health care facilities.