No. Little Rock,
Efficacious antipsychotic medication treatments for schizophrenia are available; however ,
antipsychotic regimens frequently do not achieve their potential because of poor medication
adherence. To date, medication adherence interventions have not been widely adopted or
sustained in "real-world" practice settings. One reason for this is the substantial
resource investment necessary to implement and sustain available interventions. In response
to these problems, we developed a patient-centered adherence intervention based on
patient-identified barriers, facilitators, and motivators (BFMs) for medication adherence.
The intervention includes a BFM survey (checklist and preference weighting exercise to
determine the patient's most important BFM) and a brief list of adherence enhancing
suggestions (Options List) tailored to the patient-identified BFMs and compatible with CPRS.
The long-term objective of this proposed research is to improve antipsychotic medication
adherence and clinical outcomes for patients with schizophrenia using a cost-effective
medication adherence intervention. The short-term objectives are to refine and test a
patient-centered medication adherence intervention for VA patients with schizophrenia and
specifically to: 1. Enhance the feasibility and acceptability of the BFM intervention by
reducing the burden on patients and mental health providers through BFM checklist item
reduction, provider intervention input, and patient intervention input. We hypothesize that
our use of end-user input will result in at least 80% of intervention patients having
documentation of a BFM intervention in CPRS. 2. Compare the effects of the BFM intervention
versus usual care on changes in medication adherence and schizophrenia symptom severity. We
hypothesize that the intervention will result in a) greater medication adherence and b)
lower schizophrenia symptom severity than usual care. 3. Exploratory objective: compare
the effects of the BFM intervention versus usual care on changes in patient health-related
quality of life. We hypothesize that the intervention will result in greater health-related
quality of life than usual care.
BFM intervention refinement will be accomplished in five phases. Phase one will include
reducing the number of items in the BFM checklist by administering the expanded checklist to
at least 50 patients with schizophrenia and using the standard psychometric item-reduction
strategies to create a shorter checklist. In phase two we will conduct mental health
provider focus groups to discuss the content of the Options List and the delivery of the
intervention. In phase three we will automate the BFM intervention using an existing
web-based computer touch-screen platform. In phase four we will conduct individual patient
debriefing interviews with 30 patients to evaluate the understandability of the BFM survey.
In phase five we will evaluate the test/re-test reliability of the survey in a new sample of
30 patients. BFM intervention implementation will include a stratified randomization of
patients to the BFM intervention or usual care. BFM intervention evaluation will include
testing the feasibility, acceptability, and outcomes associated with the intervention versus
usual care in a single trial with 200 patients (100 intervention and 100 usual care).
- medical chart diagnosis of schizophrenia or schizoaffective disorder;
- currently prescribed outpatient antipsychotic medication (oral or depot);
- patient must have adequate capacity to provide informed consent, understand the
nature of the study, and sign an informed consent document.
- significant cognitive impairment as indicated by a score > 10 on the Blessed
Orientation-Memory-Concentration (BOMC) Test.