Outcomes Research Division, Caremanagement Technologies , White Plains, NY 10605, USA.
Popul Health Manag. 2010 Oct;13(5):269-74. doi: 10.1089/pop.2009.0053.
Poor medication adherence is well documented for patients with severe and persistent mental illness. The State of Missouri implemented an early alert system to notify caregivers when patients fail to refill essential prescriptions in a timely manner and as an educational resource for providers on best practices for improving treatment adherence. Missouri Medicaid patients who were prescribed at least 1 of 9 orally-administered antipsychotic medications and who had at least 1 medication possession ratio (MPR) score below 0.8 were included in the adherence intervention group. Their prescribing clinicians and case managers were messaged electronically 2 times per week at the point that failure to refill the targeted prescription was identified. Notification occurred when the prescription had lapsed at 7 days, 30 days, and 45 days, and occurred in real time. In addition, MPR scores were provided monthly for the most recent 6-month period. Change in MPR scores was measured for the intervention group and for a matched control group. Trends in MPR scores were analyzed for both groups pre, during, and post intervention. In both the intervention and postintervention periods, there was a significant difference in the MPR scores between the two groups. The intervention group had a significantly greater increase in MPR score between preintervention and intervention periods. After the conclusion of the intervention, the MPR score decreased somewhat but was still higher than during the preintervention period. Results suggest that clinicians and patients need specific data about adherence in order to address the issue.
严重和持续的精神疾病患者的药物治疗依从性很差，这是有据可查的。密苏里州实施了一个早期警报系统，当患者未能及时补充必需的处方时，通知护理人员，并为提供者提供提高治疗依从性的最佳实践的教育资源。被规定至少服用 9 种口服抗精神病药物中的 1 种且至少有 1 次药物持有率（MPR）评分低于 0.8 的密苏里州医疗补助患者被纳入依从性干预组。当确定未补充目标处方时，他们的开处方临床医生和病例经理每周会收到 2 次电子信息。通知发生在处方过期 7 天、30 天和 45 天时，并实时发生。此外，还每月提供最近 6 个月的 MPR 得分。干预组和匹配对照组的 MPR 得分变化进行了测量。分析了两组在干预前、干预期间和干预后的 MPR 得分趋势。在干预组和干预后组中，两组之间的 MPR 得分均有显著差异。干预组在干预前和干预期间的 MPR 得分显著增加。干预结束后，MPR 得分有所下降，但仍高于干预前。结果表明，临床医生和患者需要关于依从性的具体数据来解决这个问题。
