Effects of telephone counseling on antipsychotic adherence and emergency department utilization.
ABSTRACT 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.
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ABSTRACT: Aim We describe here an innovative scheme in general practice that provides a work-base environment for student counsellors with funding for counselling supervision and co-ordination.Background The reported mental health prevalence rate in the UK among the general population is 23%. Only 76% of the above population visit a general practitioner, and of these only 44% will be diagnosed. Patients that present depressive symptoms, for example, are not always identified, and yet there is an increased recognition of the need for early diagnosis. There is little or no National Health Service (NHS) funding for counselling services in many areas of England. The training received by general practice registrars, to appropriately assess mental health problems within a typical consultation, has been the focus of a long-standing debate.Method This study outlines the proposed counselling model and presents some preliminary feedback on the patient outcomes achieved.Results and Conclusion The provision of a training environment for counsellor students is an option for increasing access of patients to counselling under the NHS.Primary Health Care Research & Development 06/2010; 11(03):215 - 221. DOI:10.1017/S1463423610000010
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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
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ABSTRACT: Adherence is challenging in episodic chronic conditions that require medication during both symptomatic and quiescent periods, such as ulcerative colitis (UC). Adherence for these conditions is under-studied. This study was a preliminary test of telephone nurse counseling to address cognitive and emotional barriers to adherence in UC. 524 people taking mesalamine for UC were referred by their health care providers, and 278 (53%) enrolled. There were no demographic differences between program participants and nonparticipants. Participants reported multiple comorbidities and concomitant medications. All participants received telephone follow-up (M = 2.1 calls) from a registered nurse who used cognitive-behavioral and motivational interviewing counseling techniques. Adherence measured by structured interview was compared to a population baseline using a binomial test. Attrition was 51% over 6 months but was unrelated to adherence. Participants had better adherence than the expected population rate, with a significant dose-response effect. Reasons for nonadherence were primarily psychological or efficacy-related. Adherence following intervention was better than typical mesalamine adherence. Self-efficacy predicted adherence, but demographic and clinical variables did not. Adherent participants reported more adverse events. Attention to patients' cognitive and emotional reactions may help to improve adherence in episodic chronic diseases such as UC.Patient Education and Counseling 11/2010; 81(2):182-6. DOI:10.1016/j.pec.2009.12.010 · 2.60 Impact Factor