Interventions for Adherence to Oral Antipsychotic Medications in Schizophrenia

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DESCRIPTION (provided by applicant): Poor adherence to antipsychotic medication can lead to relapse, rehospitalization and poor outcomes for schizophrenia patients. We have demonstrated that the use of environmental supports (signs, alarms, organization of belongings) in a program known as Cognitive Adaptation Training (CAT) and its counterpart PharmCAT which focuses only on medication adherence improve adherence and outcomes. PharmCAT involves weekly home visits to establish and maintain environmental supports that bypass cognitive and situational problems and cue the taking of medication as prescribed. Our goal is to develop the most cost effective ways of improving adherence. New technologies such as the Med-eMonitor(tm) a specialized pill container (capable of cueing the taking of medication, warning patients when they are taking the wrong medication or taking it at the wrong time, recording side effect complaints, and through automatic download to a secure website promptly alerting treatment staff of failures to take medication as prescribed) is an electronic analog to what is done in PharmCAT treatment. Using the MM which relies more on technology and less on in-home visits by treatment staff may help to make environmental supports available to a wider range of patients. We will randomly assign 150 patients taking atypical antipsychotics to one of 3 treatment groups for a period of 9 months: 1) PharmCAT, 2) Med-eMonitor (MM) or 3) standard treatment (SO). Primary outcome variables will include compliance to antipsychotic medication, compliance to concomitant medication, and community outcomes. Repeated Measures Analyses of Covariance for mixed models, will be utilized to examine group differences on the outcome variables during treatment with pretreatment scores used as covariates. We hypothesize that both MM which identifies adherence problems almost immediately and PharmCAT which provides a high degree of personal contact will improve adherence and outcomes in comparison to standard treatment. In a preliminary manner, we will compare patient satisfaction and the direct costs of delivering PharmCAT and MM treatment. This study will lead to the refinement of interventions targeting improved adherence in this population. Maximum benefits of effective medication cannot be achieved without appropriate adherence. The public health implications include effective disease management, maximizing long-term outcomes, and containing health care costs for schizophrenia.