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While approximately 40% of patients with schizophrenia have been partly or entirely nonadherent with antipsychotic medications, patient adherence improved dramatically when Veterans Affairs pharmacy staff coordinated these patients' medications, according to a new study.
"Although the inclusion criteria for the study required patients to have a mental health diagnosis, many of the veterans in the study also had co-morbid conditions, such as hypertension or diabetes," said Agnes Jensen, a pharmacy technician who assisted Dr. Valenstein throughout the trial. "So we'd pack medications such as atenolol in blister packs, along with patients' psychotropic medicines," Jensen said. "This made things easier for patients, and they really liked it."
To further boost compliance, Jensen conducted medication and packaging education sessions for all patients in the trial. She also mailed patients refill reminders 2 weeks before scheduled refill dates. If patients didn't fill their antipsychotic prescriptions within 7 to 10 days of a fill date, she alerted patients' clinicians.
She added that "between 6 to 12 months, adherence among patients in the intervention group dropped slightly, with patients filling prescriptions covering 86% of their outpatient days, versus 62% of outpatient days among patients not receiving the Meds-Help intervention. Although this was somewhat lower than the level of adherence at the 6-month point, this rate of adherence is still very high," Dr. Valenstein said.
Dr. Valenstein based the idea of improving compliance among mentally ill veterans on an earlier study, which found that compliance among patients who suffered from hypertension and diabetes significantly improved when pharmacists bundled the drugs in blister packages.
As a result of the promising findings arising from Dr. Valenstein's research on mentally ill patients, the VA no longer considers the Meds-Help program to be investigational; it is now an established program in the Ann Arbor Health System and in four other VA facilities served by the Ann Arbor staff.
Suit Hing Moy-Sandusky, the clinical pharmacist who manages the Meds-Help program, said there are now more than 200 mentally ill veterans enrolled. She added that in the future, the pharmaceutical intervention may be expanded to include veterans with post-traumatic stress disorder, dementia, and traumatic brain injury.
"Our veterans in the Meds-Help program take an average of 14 prescriptions a day," Moy-Sandusky said. "Can you imagine having to remember to take all this medication, sometimes up to three to four times a day, without anyone to help you?"
"When a patient's adherence with medications improves," said Dr. Valenstein, "the doctor and patient can both make decisions about whether a medicine is actually working. The intervention also saves money, since fewer medications are wasted."
LYNN SHAPIRO is a freelance writer in New York City.