Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients

<div><p>Background</p><p>In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy.</p><p>Methods</p><p>269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013) received usual care, whereas intervention patients (05/2013-12/2013) underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component) during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component). Adherence was measured by the “Medication Adherence Report Scale” (MARS) and the “Drug Attitude Inventory” (DAI).</p><p>Results</p><p>The improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73–1.93) higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15–2.72) more for intervention patients.</p><p>Conclusion</p><p>These two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program.</p><p>Trial Registration</p><p>German Clinical Trials Register <a href="https://drks-neu.uniklinik-freiburg.de/DRKS00006358" target="_blank">DRKS00006358</a></p></div

Trial profile.

<p>ITT, Intention To Treat. Flow chart of control and intervention patients from allocation to group to analysis of date.</p

Additional file 1: of Advances in clinical pharmacy education in Germany: a quasi-experimental single-blinded study to evaluate a patient-centred clinical pharmacy course in psychiatry

Results of the OSCE. Spreadsheet showing the results of the OSCE assessment (raw data). (XLSX 16 kb

MARS scores.

<p>Development of MARS Scores with median and interquartile ranges for control and intervention group from baseline to follow-up three months after discharge. MARS, Medication Adherence Report Scale.</p

Fraction of adherent patients measured by the DAI.

<p>Fraction of adherent patients in control group (open circle) and intervention group (filled circle) measured by the DAI. DAI, Drug Attitude Inventory.</p

Description of the individual items of the DAI.

<p>CI, Confidence Interval. DAI, Drug Attitude Inventory. SD, Standard Deviation.</p><p>*Estimated treatment effect from statistical regression model, adjusted for sex, age, comorbidities, number of medications at admission and the baseline DAI score.</p><p>Description of the individual items of the DAI.</p

Distribution of MARS scores at follow-up.

<p>Distribution of MARS scores in control and intervention group at follow-up three months after discharge. MARS, Medication Adherence Report Scale.</p

Description of the individual items of the MARS.

<p>CI, Confidence Interval. MARS, Medication Adherence Report Scale. SD, Standard Deviation.</p><p>*Estimated treatment effect from statistical regression model, adjusted for sex, age, comorbidities, number of medications at admission and the baseline MARS score.</p><p>Description of the individual items of the MARS.</p

Pharmacist-Led Medication Reviews to Identify and Collaboratively Resolve Drug-Related Problems in Psychiatry – A Controlled, Clinical Trial

<div><p>Aim of the study</p><p>This prospective, controlled trial aimed to assess the effect of pharmacist-led medication reviews on the medication safety of psychiatric inpatients by the resolution of Drug-Related Problems (DRP). Both the therapy appropriateness measured with the Medication Appropriateness Index (MAI) and the number of unsolved DRP per patient were chosen as primary outcome measures.</p><p>Methods</p><p>Depending on their time of admission, 269 psychiatric patients that were admitted to a psychiatric university hospital were allocated in control (09/2012-03/2013) or intervention group (05/2013-12/2013). In both groups, DRP were identified by comprehensive medication reviews by clinical pharmacists at admission, during the hospital stay, and at discharge. In the intervention group, recommendations for identified DRP were compiled by the pharmacists and discussed with the therapeutic team. In the control group, recommendations were not provided except for serious or life threatening DRP. As a primary outcome measure, the changes in therapy appropriateness from admission to discharge as well as from admission to three months after discharge (follow-up) assessed with the MAI were compared between both groups. The second primary outcome was the number of unsolved DRP per patient after completing the study protocol. The DRP type, the relevance and the potential of drugs to cause DRP were also evaluated.</p><p>Results</p><p>The intervention led to a reduced MAI score by 1.4 points per patient (95% confidence interval [CI]: 0.8–2.0) at discharge and 1.3 points (95% CI: 0.7–1.9) at follow-up compared with controls. The number of unsolved DRP in the intervention group was 1.8 (95% CI: 1.5–2.1) less than in control.</p><p>Conclusion</p><p>The pharmaceutical medication reviews with interdisciplinary discussion of identified DRP appears to be a worthy strategy to improve medication safety in psychiatry as reflected by less unsolved DRP per patient and an enhanced appropriateness of therapy. The promising results of this trial likely warrant further research that evaluates direct clinical outcomes and health-related costs.</p><p>Trial Registration</p><p>Deutsches Register Klinischer Studien (DRKS), <a href="https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006358" target="_blank">DRKS00006358</a></p></div

Potential to cause DRP of the 10 most commonly prescribed drugs.

<p>DRP, Drug-Related Problems</p><p>*The potential was calculated by dividing the number of caused DRP by the number of prescriptions at admission.</p><p>Potential to cause DRP of the 10 most commonly prescribed drugs.</p