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Prescriber Fidelity to a Medication Management Evidence-Based Practice in the Treatment of Schizophrenia
Psychiatric Services, 07/02/09

Howard PB et al. - Implementation and monitoring of MedMAP were feasible in these community mental health settings. Additional implementation projects are crucial for advancing evidence-based practice in clinical settings.

• This three-year longitudinal intervention study implemented MedMAP in six community mental health centers in Kentucky.
• Nine psychiatrists and five advanced practice psychiatric nurses with prescriptive authority participated in the study.
• Prescribers were trained in the use of MedMAP about one month before implementation, and MedMAP principles were reinforced throughout the study.
• Four posttraining assessments were conducted at each site at approximately four-month intervals over a period of 30 months.
• An 18-item scale was used to assess baseline and posttraining prescriber fidelity over a period of 30 months in 900 randomly selected medical records.

• Average fidelity scores improved significantly over baseline at each of the four postimplementation fidelity assessments.
• Training effects were most evident at the second posttraining fidelity assessment, but effects persisted over the course of the study.
• There was considerable variability in scores across items both at baseline and subsequently.
• Posttraining improvement was greatest in patient education, documentation of illness and medication history, and simplification of medication regimen.

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