Collaborative care for schizophrenic patients in primary care: A double blind, randomized clinical trial of efficacy and safety

Abstract

Background: Schizophrenia is one of the most severe psychiatric illnesses, with a prevalence of approximately 1% in the population. Pharmacists cooperate with the patient and other professionals in designing, implementing and monitoring a therapeutic plan and pharmacotherapy recommendations that will produce specific therapeutic outcomes for such patients. The objective of this study was to assess the role of clinical pharmacists’ involvement in Psychiatry ward for the treatment of schizophrenic patients. Methods: A double blind randomized control study was carried out in Psychiatry ward for a period of one year and three months at Lady Reading hospital, Khyber Pakhtunkhwa, Peshawar, Pakistan. Clinical response was determined in schizophrenic patients i.e. first episode psychosis, with objective rating scales, length of stay, adverse events, and patient compliance with the first clinic visit scheduled after discharge, and patient satisfaction on likert scale. Different scales were used to check the severity of positive, negative and general symptoms of the disorder, adherence to the medication and quality of life. Diary cards were given to the patients’ attendant so that they may remind their patient of their medication. Results: A total of 96 patients were enrolled in which 46 in control 50 in intervention groups. 3 patients in intervention group and 2 patients in control were under-diagnosed. We compared the outcomes of subjects treated in this collaborative care model, 46 in intervention group with 46 controlled group subjects receiving usual hospital care. After 6 months, the intervention group showed a significantly higher drug adherence rate than that of the control group. Morisky medication adherence scale (MMAS) and medication adherence report scale (MARS) showed p-value 0.006 and 0.001, respectively. The positive and negative syndrome scale (PANSS) showed p-value of 0.01 with change scores of -4.8 for intervention group. The SF-12 for quality of life (QOL) questionnaire showed p-value 0.002 in physical component summary (PCS), 0.001 in both mental component summary (MCS) and general health respectively. Patient satisfaction on likert scale showed a mean of 4.45 (SD=0.52) in the intervention group. Conclusion: Medication adherence and the quality of life of the schizophrenic patients were improved. Patients with co-morbidity were identified. Patient education and counseling regarding indication and medication adherence was helpful. Clinical improvement was noted in both groups, but the difference in intervened group was significant.