Collaborating with patients to maximize adherence to recommended medications

Lack of adherence to prescribed medications (both psychiatric and physical) is one factor associated with increased symptoms, deterioration of functioning and, in severe cases, hospitalization for persons with severe mental illnesses. To assist the Nurse Liaisons at Missouri’s Community Mental Health Centers in identifying patients with decreased medication adherence, CMT uses pharmacy claims to monitor adherence for critical psychiatric and physical medications. A quarterly Medication Adherence Report is prepared that displays a Medication Possession Ratio (MPR) for each agency’s patients for several classes of medications, including antipsychotics, mood stabilizers, diabetes medications, and cardiovascular medications. MPRs provide an estimate of adherence based on frequency of medication refills. By flagging patients with low MPRs, Nurse Liaisons can intervene to specifically address adherence with patients, including discussions of obstacles to adherence such as difficulty getting to the pharmacy, problems scheduling follow-up appointments with prescribers, and bothersome side-effects. By engaging the patient in these discussions, mutually agreed upon solutions can be identified and implemented that can help maintain stability in both psychiatric and medical functioning.