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BACKGROUND/RATIONALE:
Efficacious antipsychotic medication treatments for schizophrenia are available; however, antipsychotic regimens frequently do not achieve their potential because of poor medication adherence. In response to this problem, we developed a patient-centered adherence intervention based on patient-identified barriers, facilitators, and motivators (BFMs) for medication adherence.
OBJECTIVE(S):
The short-term objectives are to refine and test a patient-centered medication adherence intervention for VA patients with schizophrenia and specifically to: I. 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 13001 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 of 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.
METHODS:
BFM intervention refinement will be accomplished in five phases. Phase one will include reducing the number of items in the patient BFM survey by administering the expanded survey to at least 50 patients with schizophrenia and using standard psychometric item-reduction strategies to create a shorter instrument. 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 existing technology. 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 test the test/re-test reliability of the survey and preference assessment in a new sample of 30 patients. BFM intervention implementation will include a stratified randomization of mental health providers 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 site trial with 200 patients (100 intervention and 100 usual care). Phase one will use item reduction methods including inter-item correlation and Cronbach's alpha methods. Phase two will use qualitative focus group methods. Phase three will use touch screen computer programming. Phase four will use cognitive debriefing methods. Phase five will use Kappa statistic and percent agreement. The intervention feasibility, acceptability, and outcomes will be tested using multiple regression methods.
FINDINGS/RESULTS:
We have completed the five phases of the Intervention mapping process. We began implementing the Intervention phase in March 2007. In this phase, we anticipate recruiting 200 subjects: 100 subjects in the intervention group and 100 subjects in the control group.
IMPACT:
N/A
PUBLICATIONS:
None at this time.
DRA:
Mental Illness
DRE:
none
Keywords:
Behavior (patient), Schizophrenia
MeSH Terms:
none
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