Use of a Computerized Medication Shared Decision Making Tool in Community Mental Health Settings: Impact on Psychotropic Medication Adherence
- 1.2k Downloads
Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.
KeywordsPsychotropic medication Medication adherence Shared-decision making Computer intervention Recovery
This research was funded by Community Care Behavioral Health Organization and the West Foundation. The authors would like to thank Laura Greenberg and Amanda Ayers for assistance in manuscript preparation.
Conflict of interest
Dr. Deegan is the owner of the CommonGround software program. The remaining authors have no interests to disclose.
- Amador, X., & Johanson, A. L. (2000). I am not sick, I don’t need help! Helping the seriously mentally ill accept treatment. Peconic, NY: Vida Press.Google Scholar
- Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st Century (Trans Committee on Quality of Health Care in America). Washington, D.C.: National Academies Press.Google Scholar
- Joosten, E. A. G., DeFuentes-Merillas, L., de Weert, G. H., Sensky, T., van der Staak, C. P. F., & de Jong, C. A. J. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77(4), 219–226.PubMedCrossRefGoogle Scholar
- Morgan, M. W., Deber, R. B., Llewellyn-Thomas, H. A., Gladstone, P., Cusimano, R. J., O’Rourke, K., et al. (2000). Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease. Journal of General Internal Medicine, 15(10), 685–693.PubMedCrossRefGoogle Scholar
- New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Rockville, MD: Final Report.Google Scholar
- O’Connor, A. M., Llewellyn-Thomas, H. A., & Flood, A. B. (2004). Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Affair (Millwood), Supplement Web Exclusives, VAR63-72.Google Scholar
- Roberts, L. W., Warner, T. D., Brody, J. L., Roberts, B., Lauriello, J., & Lyketsos, C. (2002). Patient and psychiatrist ratings of hypothetical schizophrenia research protocols: assessment of harm potential and factors influencing participation decisions. American Journal of Psychiatry, 159(4), 573–584.PubMedCrossRefGoogle Scholar
- Rotondi, A. J., Sinkule, J., Haas, G. L., Spring, M. B., Litschge, C. M., Newhill, C. E., et al. (2007). Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness. Psychological Services, 4(3), 202.CrossRefGoogle Scholar
- Rotondi, A. J., Anderson, C. M., Haas, G. L., Eack, S. M., Spring, M. B., Ganguli, R., et al. (2010). Web-based psychoeducational intervention for persons with schizophrenia and their supporters: One-year outcomes. Psychiatric Services, 61(11), 1099–1105. doi: 10.1176/appi.ps.61.11.1099.PubMedCrossRefGoogle Scholar
- SAS Software. (2004). Version 9.1 of the SAS System for windows. Cary, NC: SAS Institute Inc.Google Scholar
- Substance Abuse and Mental Health Services Administration. (2008). Examples of Mental Health Decision Aids. http://www.samhsa.gov/consumersurvivor/pdf/SAMHSA_Decision_Aid_Chart_Jan08.pdf. Accessed March 22, 2010.
- van Roosmalen, M. S., Stalmeier, P. F., Verhoef, L. C., Hoekstra-Weebers, J. E., Oosterwijk, J. C., Hoogerbrugge, N., et al. (2004). Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers. Journal of Clinical Oncology, 22(16), 3293–3301.PubMedCrossRefGoogle Scholar
- Velligan, D. I., Weiden, P. J., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., et al. (2010). Strategies for addressing adherence problems in patients with serious and persistent mental illness: Recommendations from the expert consensus guidelines. Journal of Psychiatric Practice, 16(5), 306–324.PubMedCrossRefGoogle Scholar
- Wilson, S. R., Strub, P., Buist, A. S., Knowles, S. B., Lavori, P. W., Lapidus, J., et al. (2010). Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. American Journal of Respiratory and Critical Care Medicine, 181(6), 566–577. doi: 10.1164/rccm.200906-0907OC.PubMedCrossRefGoogle Scholar