Effects of telephone counseling on antipsychotic adherence and emergency department utilization

College of Nursing, University of Colorado Denver, Aurora, CO 80045, USA.
The American journal of managed care (Impact Factor: 2.26). 01/2009; 14(12):841-6.
Source: PubMed


To determine whether ScriptAssist, a telehealth nursing program using psychological techniques, reduced emergency department (ED) utilization and improved adherence among Medicaid health plan members with serious and persistent mental illness (SPMI).
Nonrandomized controlled trial.
Of 210 eligible Medicaid health plan members with SPMI, 59 (28%) were contacted by phone and 51 (86%) participated. Participants received an average of 3.5 calls over 9 months, with 2.1 attempts per completed call. Participants had clinically significant levels of impairment; medication switching, polypharmacy, and medical comorbidities were common. Intervention group participants' results were compared with those of nonparticipants to rule out regression to the mean, history, and maturation effects. Intervention group participants' results also were compared with baseline data to rule out selection bias.
Program participants had fewer ED visits during the intervention than a comparison group, and reduced their ED use and hospitalization rate compared with the previous year. Participants also had better medication adherence based on pharmacy and interview data.
Cognitive-behavioral and motivational-interviewing techniques can improve antipsychotic medication adherence. Telehealth may be a useful strategy for disseminating these evidence-based techniques. Lessons learned included the importance of real-time referral data, a need to address polypharmacy, and a need to overcome contact difficulties resulting from disease processes and "unknown caller" IDs. Despite these difficulties, using a disease management model, the program was feasible, and the reduced number of ED visits indicated potential cost-effectiveness.

8 Reads
  • Source
    • "TN has been used in different ways, settings, and purposes. A comprehensive search of the literature revealed numerous articles related to TN: on triage [45-48]; state and national help lines [49-51]; follow-up of specific health conditions such as pregnancy [52,53]; post-operative care [54,55]; medication adherence [56,57]; and chronic illness [58-60]. Most studies concerned adults, but some also involved pediatrics. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Pediatric rheumatic diseases have a significant impact on children’s quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. Methods/Design This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children’s and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox’s Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. Discussion The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. Trial registration identifier: NCT01511341 (December 1st, 2012).
    BMC Pediatrics 06/2014; 14(1):151. DOI:10.1186/1471-2431-14-151 · 1.93 Impact Factor
  • Source
    • "13 Several meta-analytic reviews14,15 demonstrate MI’s utility for health behavior problems including nonadherence: It has been successfully used by primary care practitioners to promote healthy behaviors,16 by diabetes specialists to increase physical activity,17 and by dentists to improve oral health behaviors.18 In addition, nurse-delivered telephonic counseling using MI has been found to improve medication adherence for endometriosis,19 osteoporosis,20 serious and persistent mental illness,21 HIV,22 and ulcerative colitis.23 MI may be particularly helpful to patients from minority cultural groups.24 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Adherence to glaucoma treatment is poor, potentially reducing therapeutic effects. A glaucoma educator was trained to use motivational interviewing (MI), a patient-centered counseling style, to improve adherence. This study was designed to evaluate whether MI was feasible in a busy ophthalmology practice. Feasibility was assessed using five criteria from the National Institutes of Health Behavior Change consortium: fidelity of intervention components to MI theory; success of the training process; delivery of MI-consistent interventions by the glaucoma educator; patient receipt of the intervention based on enrollment, attrition, and satisfaction; and patient enactment of changes in motivation and adherence over the course of the intervention. A treatment manual was designed by a multidisciplinary team with expertise in health psychology, public health, and ophthalmology. The glaucoma educator received 6 hours of training including role-play exercises, self-study, and individual supervision. His MI-related knowledge and skills increased following training, and he delivered exclusively MI-consistent interventions in 66% of patient encounters. 86% (12/14) of eligible patients agreed to be randomized into glaucoma educator support or a control condition. All 8 patients assigned to the glaucoma educator completed at least 2 of 6 planned contacts, and 50% (4/8) completed all 6 contacts. Patients assigned to the glaucoma educator improved over time in both motivation and adherence. The introduction of a glaucoma educator was feasible in a busy ophthalmology practice. Patients improved their adherence while participating in the glaucoma educator program, although this study was not designed to show a causal effect. The use of a glaucoma educator to improve glaucoma patients' medication adherence may be feasible at other ophthalmology clinics, and can be implemented with a standardized training approach. Pilot data show the intervention can be implemented with fidelity, is acceptable to patients and providers, and has the potential to improve adherence.
    Clinical Ophthalmology 10/2010; 4:1091-101. DOI:10.2147/OPTH.S12765 · 0.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antiretroviral therapy remains a challenge for persons living with HIV (PLWH), who must maintain high levels of adherence to prevent viral resistance and treatment failure. This effectiveness study examined a telephonic nursing program to translate well-validated cognitive-behavioral and motivational interviewing adherence counseling into routine clinical care. Participants were 98 PLWH who were followed for up to 6 months after recruitment from HIV care settings across the United States. Each participant received telephone counseling (Mdn =three sessions) from a trained nurse who followed up with the participant over time. Nurses assessed participants' readiness for adherence, provided support to overcome identified barriers, and offered information based on participants' questions. At 6 months after the start of treatment, a greater percentage of participants had adherence at or above 95% than expected for this population, based on a clinical interview. Self-efficacy was related to baseline medication adherence, whereas other clinical and demographic variables were not. Attrition was a concern but was unrelated to adherence, self-efficacy, or clinical severity measures. Telephone counseling was associated with a relatively high percentage of participants reaching target antiretroviral therapy adherence levels and may be an effective method to disseminate psychologically based counseling into a broad range of care settings.
    The Journal of the Association of Nurses in AIDS Care: JANAC 07/2009; 20(4):316-25. DOI:10.1016/j.jana.2009.02.008 · 1.27 Impact Factor
Show more