Antipsychotic medications are effective treatments for schizophrenia; however, adherence rates are frequently reported at 50%. In response to this challenge we developed a patient-centered medication adherence intervention based on patient-identified barriers, facilitators, and motivators (BFMs) for medication adherence.
The objectives of this study were to: 1) enhance the feasibility and acceptability of the barriers, facilitators, and motivators (BFM) for taking antipsychotic medication checklist intervention by obtaining provider and patient input up front and 2) compare the effects of the BFM intervention versus usual care on changes in medication adherence, schizophrenia symptom severity, and health-related quality of life.
BFM intervention refinement was accomplished in five phases. Phase one: reduce the number of items in the patient BFM survey using standard psychometric item-reduction strategies. Phase two: conduct mental health provider focus groups to discuss the content of the Options List and the delivery of the intervention. Phase three: automate the BFM intervention using existing technology. Phase four: conduct patient debriefing interviews to evaluate the understandability of the BFM survey. Phase five: evaluate the test/re-test reliability of the BFM checklist. The final intervention was tested using a randomized control trial design. Patient interview data was collected at baseline, 6-, and 12-months.
Phase one started with the 260-item BFM Checklist. A series of item reduction steps resulted in a final 76-item BFM checklist. Clinician focus groups also generated Adherence Tips to address patient-identified barriers and detailed input on intervention implementation. The BFM checklist and intervention was automated using an audio computer-assisted self-interviewing computer platform. The final sample size for the intervention study was 69 (30 intervention and 39 usual care). Ninety percent (62/69) completed 6- and 12-month follow-ups.
After adjusting for covariates (baseline adherence, depression, extrapyramidal side effects, and other side effects) that met criteria of p<0.2 in bivariate analyses with the dependent variable, the effect of the intervention on 6-month self-report adherence was significant (p=0.03). The effect of the intervention at 12-months on adherence was not significant (p=0.09). Antipsychotic medication adherence results using medication possession ratios from VA administrative data are pending.
In an adjusted model using the same covariate selection approach described above, the effect of the intervention on total Positive and Negative Syndrome Scale (PANSS) remained not significant (p=0.08). However, using the same adjusted model, there was a significantly greater decrease on the PANSS general psychopathology subscale for the intervention group (p=0.045). The effect of the intervention at 12-months on PANSS scores was not significant. The intervention effect on the Quality of Well-Being scale (QWB) was not significant controlling for baseline QWB or for baseline QWB and other covariates at 6- or 12-months.
The BFM intervention is effective and not resource intensive. These data may support future testing in a larger trial.
External Links for this Project
- Pyne JM, Fischer EP, Mittal D, Owen R. A Patient-Centered Antipsychotic Medication Adherence Intervention: Results From a Randomized Controlled Trial. The Journal of nervous and mental disease. 2018 Feb 1; 206(2):142-148. [view]
- Pyne JM, Fischer EP, Gilmore L, McSweeney JC, Stewart KE, Mittal D, Bost JE, Valenstein M. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention. Health education & behavior : the official publication of the Society for Public Health Education. 2014 Jun 1; 41(3):315-24. [view]
- Pyne JM, Davis A. AMAIS Web Site. [Website]. 2007 Apr 22. [view]
- Pyne JM, Fischer EP, Gilmore LY, McSweeney J, Steward K, Mittal D, Bost J, Valenstein M. Results from a patient-centered antipsychotic medication adherence intervention. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA. [view]