Team Management for Schizophrenics

Schizophrenia patients took medications more consistently with team based treatment

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Sticking to a prescribed medication plan can be tough for some patients with schizophrenia. Having a team of healthcare professionals making sure meds are being taken may help patients stick to the plan.

A recent study looked at whether an intensive team-based program would help a group of schizophrenic patients take their antipsychotic medications as prescribed.

Compared to schizophrenic patients not enrolled in the program, patients in the program took their medications on 20 percent more days over the course of two years than those not in the program.

"Take all medications as prescribed."

Marcia Valenstein, MD, from the US Department of Veterans Affairs Health Services Research and Development Service and the Serious Mental Illness Treatment at the University of Michigan North Campus Research Complex in Ann Arbor, MI, led an investigation into an intensive team-based treatment program to get schizophrenia patients to take their medications.

According to the authors, recent studies have shown that around 40 percent of schizophrenia patients don’t stick to prescribed antipsychotic medication plans.

Previous research has shown that schizophrenics who didn’t take antipsychotic medications as prescribed were up to four times more likely to be hospitalized in a psychiatric facility.

For this study, 763 Veterans Affairs (VA) patients who were diagnosed with schizophrenia and had spent either 30 days in, or were admitted three or more times to, a psychiatric hospital in the last year were enrolled in the Assertive Community Treatment program. Another 763 patients with schizophrenia but who were not enrolled in the assertive community treatment program were also followed for comparison.

The study data was collected from the results of the program between 2001 and 2004.

Assertive community treatment - also called mental health intensive case management - was designed to reduce hospitalization in the VA health system for patients with serious mental illness. Assertive community treatment included:

  • A team-based approach to treatment
  • Low patient-to-staff ratio
  • Individualized services and treatment plans
  • Frequent contact between patients and staff

The assertive community treatment approach takes a hands-on approach to making sure patients are getting and taking their medications. This team-based service may go so far as to refill and deliver medications to patients.

For each patient, researchers tracked antipsychotic prescriptions:

  • When was it prescribed?
  • When was the prescription filled?
  • Was the prescription refilled on time?

Contact between the patients and their assertive community treatment team was also recorded. To be considered “fully participating” in the assertive community treatment program, there had to be a minimum of 42 visits between the team and the patients during the first year.

After six months, 70 percent of patients in the assertive community treatment program were taking their antipsychotic medications as prescribed. After the same period of time, 60 percent of patients not enrolled in the program were taking their medications as prescribed.

After two years, 63 percent of patients in the program were still taking their medications as prescribed, while only 54 percent of patients not in the program were still taking their medications as prescribed.

“In this study, patients who enrolled in assertive community treatment had approximately 20 percent more days with adequate medications on hand," the authors said.

The authors found that participating in the assertive community treatment program during the first year did not reduce the number of days spent in a psychiatric hospital in the second year of the study.  

This study was published in February in Psychiatric Service.

The Health Services Research and Development Service at the US Department of Veterans Affairs provided funding for this project. No conflicts of interest were declared.

Reviewed by: 
Review Date: 
February 26, 2013
Last Updated:
March 4, 2013