The impact of a pharmacist assisted clinic upon medication adherence and quality of life in mental health patients

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Mitsi H. Lizer
Sarah A. Parnapy Jawaid
Wallace A. Marsh
Lakuma Mogili

Keywords

Abstract

Objectives: To determine if a pharmacist assisted psychiatric clinic would improve adherence to medications and quality of life over 6 months. The primary study endpoints were the change from baseline in Medication Adherence Rating Scale (MARS), Brief Evaluation of Medication Influences and Beliefs (BEMIB), World Health Organization Quality of Life - BREF (WHOQOL-BREF) scales as well as hospitalizations and emergency room visits. Secondary endpoints included metabolic and physiologic parameters.

Methods: A prospective, single-center study conducted at an outpatient psychiatric clinic. Subjects were required to attend 3 clinic visits (baseline, 3 and 6 months) with the pharmacist. Subject and medication histories were obtained at each visit. Subjects’ records within the local health system were reviewed for emergency room visits and hospitalizations. Metabolic parameters were assessed at each visit.

Results: Twenty-seven subjects enrolled and twenty subjects completed. Total MARS score at baseline and study end were 7.90 and 8.65, respectively. At baseline, 10 (50%) were nonadherent based on the BEMIB and 9 (45%) were nonadherent at 6 months. Statistically significant improvements were seen in 2 domains of the WHOQOL-BREF. Reductions in both ER visits and hospitalizations were achieved. There were significant improvements in total cholesterol and LDL.

Conclusions: Improvements were seen in two domains of the WHOQOL-BREF – physical capacity and psychological well-being over the 6 month period. While improvements were seen in various rating scales, due to small sample sizes, these were insignificant improvements. Reductions in hospitalizations and ER visits were also seen during the study and up to 6 months post study. Statistically significant improvements were also seen in both total cholesterol and LDL. The lack of improvement in many of the study outcomes reflects the difficulty of the mental health population to adhere to treatment recommendations; but also underscores the need for continued research in this area. This pilot demonstrates the pharmacist’s ability to provide comprehensive medication management services to the psychiatric outpatient.

 

Keywords: Mental Health. Pharmacists. Medication Adherence. Quality of Life. United States.

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References

1. Lopez AL, Mathers CD, Majid Ezzati, Jamison DT, Murray CJ. Measuring the Global Burden of Disease and Risk Factors, 1990-2001. 2006. Global Burden of Disease and Risk Factors, ed., 1-13. New York: Oxford University Press. DOI: 10.1596/978-0-8213-6262-4/Chpt-1.

2. Wang PS, Aguilar-Gaxiola S, Alonso J. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841-850.

3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005; 353(5):487-497.

4. Bucci KK, Possidente CJ, Talbot KA. Strategies to improve medication adherence in subjects with depression. Am J Health-Syst Pharm. 2003;60:2601-2605.

5. Cramer JA, Rosencheck R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv. 1998;49:196-201.

6. Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, Jeste DV. Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. Am J Psychiatry. 2004;161:692-699.

7. Fenton WS, Blyler C, Heinssen RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull.1997;23:637-651.

8. Newcomer JW. Antipsychotic Medications: Metabolic and Cardiovascular Risk. J Clin Psychiatry. 2007;68(Suppl 4):8-13.

9. Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care 2004;27(2):596-601.

10. Adler DA, Bungay KM, Wilson IB, Pei Y, Supran S, Peckham E, Cynn DJ, Rogers WH.The impact of pharmacist intervention on 6-month outcomes in depressed primary care subjects. Gen Hosp Psychiatry. 2004;26(3):199-209.

11. Thompson K, Kulkarni J, Sergejew AA. Reliability and vailidity of a new medication adherence rating scale (MARS for the psychoses). Schizophr Res. 2000;42:241-247.

12. Dolder CR, Lacro JP, Warren KA, Golshan S, Perkins DO, Jeste DV. Brief evaluation of medication influences and beliefs. J Clin Psychopharmacol. 2004;24:404-409.

13. Bonomi AE, Patrick DL. User's manual and interpretation guide for the United States Version of the World Health Organization Quality of Life (WHOQOL) instrument. Seattle, WA: U.S. WHOQOL Center, Seattle, 1997.

14. Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry. 2002;159:1653-1664.

15. McDonald HP, Garg AX, Haynes RB. Interventions to enhance subject adherence to prescription medications. JAMA. 2002;288:2868-2879.

16. Schneiderhan ME, Batscha CL, Rosen C. Assessment of a point-of-care metabolic risk screening program in outsubjects receiving antipsychotic agents. Pharmacotherapy 2009;29(8):975-987.

17. Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in subjects with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002;63:892-909.

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