An Attempt to Improve Antipsychotic Medication Adherence by Feedback of Medication Possession Ratio Scores to Prescribers

Abstract

Poor medication adherence is well documented for patients with severe and persistent mental illness. The State of Missouri implemented an early alert system to notify caregivers when patients fail to refill essential prescriptions in a timely manner and as an educational resource for providers on best practices for improving treatment adherence. Missouri Medicaid patients who were prescribed at least 1 of 9 orally-administered antipsychotic medications and who had at least 1 medication possession ratio (MPR) score below 0.8 were included in the adherence intervention group. Their prescribing clinicians and case managers were messaged electronically 2 times per week at the point that failure to refill the targeted prescription was identified. Notification occurred when the prescription had lapsed at 7 days, 30 days, and 45 days, and occurred in real time. In addition, MPR scores were provided monthly for the most recent 6-month period. Change in MPR scores was measured for the intervention group and for a matched control group. Trends in MPR scores were analyzed for both groups pre, during, and post intervention. In both the intervention and postintervention periods, there was a significant difference in the MPR scores between the two groups. The intervention group had a significantly greater increase in MPR score between preintervention and intervention periods. After the conclusion of the intervention, the MPR score decreased somewhat but was still higher than during the preintervention period. Results suggest that clinicians and patients need specific data about adherence in order to address the issue.

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

“…Finally, objective measurements such as pharmacy refills (A.8.1) or insurance claims (A.8.2), which do not directly capture medication administration data but may provide indirect indices of medication possession and adherence, have been used to assess adherence behaviors over the long term (n=3). Overall, 2 studies calculated medication possession ratios and used them in feedback interventions to enhance as well as measure adherence: one with antipsychotics [111] and one with PTSD medications [112]. Another study incorporated barcodes attached to pill containers (A.8.3).…”

“…The data given to the clinician was sourced from many of the previously listed medication measurement components (direct visualization, smart pill dispenser, self-report, etc). Multiple studies (n=31) explicitly mentioned such systems [40,42,44-46,49,51,53,63,65,91,93,95,104,105, 107,108,111,112,114,116,118-120,123,125,138,139,144,145,147], which fell under 3 major categories (not mutually exclusive): “portal” real-time monitoring (n=15), periodic reporting (n=9), and alerts (n=16). Real-time monitoring (B.5.2.1) allows the clinician to, at any time they choose, examine their participants’ medication adherence data, almost always through Web portals [40,44-46,63,65,95,104,105,107,108,116,118,120,147].…”

Talking About Sexuality With Consumers of Mental Health Services

“…The nurse participants noted sexual side effects from psychiatric medications as a topic raised by consumers when discussing sexuality. Medication adherence is a significant clinical concern (Anderson et al., 2010; Patel, Ni, Clayton, Lam, & Parks, 2010); sexual side effects from psychiatric medications have been recognized as a major contributor to nonadherence, but this does not appear to have influenced clinical practice to any significant degree (Cort, Attenborough, & Watson, 2001; McCann, 2010). Nurse participants described examples of advocating the consumer's concerns to the treating psychiatrists contributing to a treatment decision that might lead toward the resolution of the consumer's sexual concerns.…”

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

“…Feedback to prescribers on whether patients collect prescriptions is not routinely used as an intervention to aid adherence. However, one US study reported a system in which prescribing clinicians and case managers were electronically messaged in real time if a patient prescription lapsed by 7 days, with further alerts following after longer lapse periods 79. They were also regularly sent MPR scores.…”