2048. Optimizing a Medication
Adherence Intervention for Schizophrenia
TJ Hudson, Center for Mental Healthcare and Outcomes Research and University of Arkansas for Medical Sciences, RR Owen, Center for Mental Healthcare and Outcomes Research and University of Arkansas for Medical Sciences, CR Thrush, Center for Mental Healthcare and Outcomes Research and University of Arkansas for Medical Sciences, X Han, Centers for Mental Health Research and University of Arkansas for Medical sciences
to medication continues to be a major cause of hospital readmission and
increased cost for veterans with schizophrenia. This study uses qualitative and quantitative methods to
identify strategies to optimize a medication adherence intervention.
Methods: These data were
drawn from a multi-site study that compared a usual guideline implementation
strategy with an enhanced strategy in which nurses worked individually with
subjects to identify and overcome medication adherence barriers. The Positive
and Negative Symptom Scales (PANSS), the Schizophrenia Outcomes Module, the
SF-36, and the Barnes akathesia scale (BAS) were completed at baseline and at
6-month follow-up. The study nurse completed a barrier assessment at baseline
and every 30 days. Using baseline data, demographic and clinical characteristics
and medication adherence data, subjects
with low barriers (<2) were compared to those with high barriers (>2).
Risk for non-adherence was modeled with logistic regression analysis.
Qualitative interviews were completed with study nurses (n=3).
Results: Data were
available from 153 veterans who were a mean age of 45; 94% were male, 75% were
African American, 22% were Caucasian, and 20% were married. Using baseline
measures, veterans with >2 barriers had significantly higher BAS (3.8 vs 2.7
p<.05) and PANSS total scores (89.8 vs 82.3 p<.05), were more likely to
use drugs or alcohol (53.6% vs 34.8% p<.05) and were less adherent based on
patient report (56.6% vs 79.7% p<.05) and on medical records (28.6% vs 49.3%)
compared to patients with low barriers. Logistic regression showed that lower
education level (OR=5.05, p<0.05), high barriers for subjects with PANSS
scores ¡Ü 81 (OR is greater than 2.5, p<0.05), substance abuse, and higher
total PANSS scores for people with < 2 barriers (OR=1.052, p<0.05) were
associated with increased risk of non-adherence. Qualitative results suggested that building trust and tools
such as pill organizers, behavioral tailoring and patient education are
important components of an adherence intervention.
results suggest that greater symptom severity and current substance abuse are
associated with having two or more barriers to adherence. Future strategies to
improve medication adherence should incorporate assessment of adherence
Impact: The adherence intervention will be modified and tested in a subsequent project. The intervention components and results of the current study will be disseminated nationally.