Patients who forget to refill their prescription medication may soon receive help through pharmacy-based intervention — a hands-on approach to encourage mentally ill patients to take their medications.
Marcia Valenstein, associate professor for the University’s Department of Psychiatry, recently led a study that proved the value of such a program.
The randomized trial compared patients who received the MedsHelp pharmacy intervention with those who received usual pharmacy care. Published in this month’s online edition of Schizophrenia Bulletin, the study reported an 86-percent adherence to refill dates for the intervention group — nearly 25 percent greater than that reported for patients without assistance.
“The reason we started the study is because people with serious mental illnesses often have difficulty taking their medications regularly,” Valenstein said. “Working in the VA, we thought about what we could do that would be perceived as non-coercive but also practical.”
The study’s researchers developed a pharmacy-based intervention program called MedsHelp and observed the prescription refill adherence of 118 patients who have been diagnosed with either schizophrenia or bipolar disorder.
“Unit of use” packaging — one notable feature of MedsHelp — groups pills under labels for specific days of the week or months to remind patients when to take their medications. The idea was inspired, in part, by a similar time guide used for individuals taking oral contraceptives and anti-infective medications in developing countries, Valenstein said.
“It’s a very strong visual cue,” said Valenstein, also a research investigator at the Health Services Research and Development division of the Department of Veterans Affairs. “We thought we could try that for people with serious mental illness along with some other ideas at the pharmacy.”
Those other ideas included synchronizing the due date for all of a patient’s prescription drugs and notifying their clinicians if refill dates were not met on time.
MedsHelp relied heavily on pharmacy staff to take an “innovative approach” to patient advocacy, Valenstein said. Minimizing the cost of the intervention program, pharmacy technicians fielded patients’ medication-related inquiries and sent out reminders two weeks in advance of a refill date.
With MedsHelp, Valenstein said, the pharmacy staff often serves as an intermediary between doctors and their patients, especially in cases where patients are unclear about dosage instructions.
“We involved pharmacy people as part of a clinical team, and that hasn’t really been done for people with serious mental illness,” she said.
Because it’s economically feasible and easy to use, pharmacy-based intervention has already seen implementation in five VA facilities.
MedsHelp has not been strictly limited to patients with serious mental illness; it has also has been extended to people with chronic conditions, like diabetes, and geriatric patients who experience difficulty managing their medications.
“Even though our patients are often thought to be different than people with other chronic illnesses, it seems like this kind of simple intervention has a similar effect,” she said. “I think the evidence is accruing that this might be a practical approach for a lot of people who need assistance, including the elderly, individuals living alone and people who have irregular schedules.”