Boost compliance for patients on antipsychotics
Work closely to make sure they get every dose
Patients with psychological disorders who have been prescribed anti-psychotic drugs, such as mood stabilizers, may really want to take their medication as prescribed but need a lot of help to do so, asserts Dawn Velligan, PhD, associate professor at the department of psychiatry at the University of Texas Health Science Center at San Antonio.
She is lead researcher on a five-year study funded by the National Institute of Mental Health to determine adherence to oral antipsychotic medications.
If these patients don’t take their medication, about half will end up in the hospital within three to nine months.
"Most are willing to take it but are doing a bad job," Velligan says.
Case managers who handle care for patients on antipsychotic drugs should bear in mind that when patients say they are taking their medication, that is an indication that they are willing to take it but it doesn’t mean they are in full compliance, she says.
Among the first 70 patients studied, at three months, measuring blood level data, only 23% are taking their medication correctly. By pill count data, only 40% are taking a reasonable amount.
"Adherence rates are very low despite the fact that 55% of patients say they take every course the doctor prescribes," Velligan adds.
She suggests that case managers have in-depth discussions with the patients about when they take their medicine, where they keep it, and what kind of reminders they have in place. Give them regular reminder calls to take their medicine.
Also, help them work on ways to improve compliance. For instance, if they usually forget their dose at night, give them a pill container and a bottle for water to put on their bedside table.
If you see the patients in person, set up pill containers for them and have the patients bring them back to every visit.
Patients taking antipsychotic medications have a number of problems that contribute to noncompliance, Velligan says.
They don’t have a daily routine, so they can’t anchor taking medication to a specific time, such as when they get up, when they go to bed, or mealtime.
Many of the prescriptions call for doses at 8 a.m. and 8 p.m. Many of these patients sleep until 3 p.m. and miss every morning dose. "When they’re awake, they’re doing what the doctor says," Velligan adds.
"What is really clear is that these patient forget or are distracted, or are too tired at night to take their evening dose. There are a lot of things in the environment that are really barriers to medication," she says.
There also are system barriers. For instance, Medicaid has a cap on the number of prescriptions it will cover. If someone is on multiple medications for diabetes and schizophrenia, he or she may not be getting the needed medicine because it isn’t covered.
For her research project, Velligan goes into patients’ homes and sets up things so it will be easier for them to take their medication.
"Most don’t have calendars or watches. We give them pill containers and special alarms where a recording of their own voice reminds them to take their medication," she says.
When patients get out of the hospital, the researchers monitor them closely for two weeks, watch them take every dose of medication, and get a baseline blood level.
They wait three months before seeing the patients again, then show up unexpectedly, take blood to check the blood level, check pharmacy records, and check the pills remaining in the house.
In the first check, the researchers found that only four of 70 patients were taking their medicine absolutely correctly, but most were taking at least some of their medicine.
Researchers also learned that patients who are discharged to boarding care homes miss their medication unless they stand in the facility’s medication lines.
Among the initial patients in the study, patients in boarding care facilities got about 60% of their medications. As a result, 25% were readmitted to the hospital in the first three months after discharge, and 10% ended up in jail.
Many patients who are taking the older antipsychotic medications quit taking them because of their side effects.
Pharmaceutical companies claim that the newer generations of drugs don’t have as many side effects, which should improve adherence, but that hasn’t happened, Velligan says. Studies have shown that, even with the new medications, the compliance rate is about 50% to 60%.
"The number of days the patients are failing to take their medication is slightly better with the new medications, but it is still very bad," she says.
Patients with psychological disorders who have been prescribed anti-psychotic drugs, such as mood stabilizers, may really want to take their medication as prescribed but need a lot of help to do so, asserts Dawn Velligan, PhD, associate professor at the department of psychiatry at the University of Texas Health Science Center at San Antonio.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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