Enhanced Medication Reconciliation For Serious Mental Illness

Lack of adherence to medications is an identifiable and growing problem in the United States
and can result in disease progression, disease complications, treatment failure, a lower
quality of life, and increased morbidity and mortality. Medication-related problems and
medication nonadherence have been estimated to cost $177 billion annually in total direct and
indirect U.S. health care costs. Moreover, medication adherence rates are poor for
individuals diagnosed with chronic conditions such as diabetes, depression, and
schizophrenia, which require long-term therapy. Recent publications have estimated that
nearly 50% of patients in the U.S. being treated for chronic conditions are non-adherent to
their medication regimens. Although increased medication adherence may lead to increased
spending on drug therapy, it is associated with greatly reduced total health care costs and
usage, and better patient outcomes.

Persons diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar
disorder are at higher risk than the general population for medication nonadherence,
cardiovascular mortality, and medical co-morbidities such as diabetes, hypertension,
dyslipidemia, obesity, nicotine dependence, and coronary heart disease. Poor adherence to
complex medication regimens, decreased access to care, and uncoordinated care between
psychiatry and medical care teams, have been identified as key contributors to the
disparities experienced by this patient population.

The United States healthcare system is complex and healthcare is fragmented, particularly for
those with serious mental illness who are often prescribed multiple medications from numerous
providers. One unifying piece of information that is of critical importance for optimizing
patient care is the patient medication list. Unfortunately, appropriate medication
reconciliation to obtain the correct medication list and information about medication
adherence is a complex and imperfect process. Using patient pharmacy records, electronic
health record (EHR), and patient interviews, discrepancies have been found with over one
third of patients upon hospital admission. Therefore, it can be expected that most
polypharmacy patients (defined as taking five or more medications) have errors in their
medical record.

National and world health associations have identified several opportunities for health
professionals to provide services that aim to increase medication adherence and decrease
medication related problems. Several of the recommendations emphasize the use of coordinated
multidisciplinary efforts to provide patients with the most access to care and the highest
quality education about their medications. Pharmacists are among the most accessible health
care professionals and have specialized training to identify, prevent, and resolve
drug-related problems (DRPs). As medication experts, pharmacists are important members of the
multidisciplinary team and are uniquely positioned to impact medication-related health
outcomes through accurate medication reconciliation, comprehensive mediation reviews (CMR),
and interventions to improve medication safety and adherence.

An objective measure of what medications patients are actually taking would enable healthcare
teams to better identify and tailor interventions to each specific patient situation. Using a
novel therapeutic drug monitoring assay and empirical clinical decision support tool, Sano
has shown that errors in patient medication lists are prevalent and poorly reflect patient
adherence to the intended medication regimen and actual medication exposure. For example, in
a cohort of psychiatry patients, only 37% were fully adherent to all medications in their
treatment regimen and roughly one in five medications detected was not in the medical record.
We anticipate that when medication reconciliation is performed by a pharmacist using Sano's
clinical decision support tool, medication adherence will improve and more drug therapy
problems will be identified and resolved. As a result, we expect to see an improvement in
patient outcomes and a reduction in healthcare spending (i.e. post-hospitalization unplanned
healthcare utilization).

Inclusion Criteria:

- Current insurer is UPMC Health Plan

- Currently active in CRS clinic

- Prescribed four or more medications as indicated by pre-study Health Plan Medication
List

- Able to provide informed consent for present study

Exclusion Criteria:

- Not competent to give informed consent in the opinion of the investigator

- Having had a previous medication reconciliation by the clinical pharmacist