Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients
01 Jun 2008-Journal of the American Psychiatric Nurses Association (SAGE Publications)-Vol. 14, Iss: 3, pp 217-224
TL;DR: Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk of schizophrenia, according to results of this study.
About: This article is published in Journal of the American Psychiatric Nurses Association.The article was published on 2008-06-01. It has received 48 citations till now. The article focuses on the topics: Psychiatric medication & Telenursing.
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TL;DR: An animated, conversational computer agent designed to promote antipsychotic medication adherence among patients with schizophrenia is described and results from a pilot evaluation study indicate that it is accepted and effective.
180 citations
Cites background from "Telenursing Intervention Increases ..."
...Patients receiving the intervention had significantly greater medication adherence compared to a control group (Beebe et al., 2008)....
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TL;DR: The literature between 2000 and 2009 was searched for randomized controlled trials which compared a psychosocial intervention with another intervention or with treatment as usual in patients with schizophrenia, with a large heterogeneity in design, adherence measures and outcome variables.
151 citations
TL;DR: Based on the limited data available, the use of modalities involving the telephone, internet and videoconferencing appears to be feasible in patients with schizophrenia and preliminary evidence suggests these modalities appear to improve patient outcomes.
Abstract: Background: Telehealth technology has become more available to providers as a means of treating chronic diseases. Consideration of the applicability of telehealth technology in the treatment of schizophrenia calls for a review of the evidence base in light of the special needs and challenges in the treatment of this population. Our aims are to assess the types and nature of distant interventions for patients with schizophrenia, either telephone-based, internet-based or video-based telehealth systems. Methods: The following databases—MEDLINE, PsycINFO, CINAHL, the Cochrane Library, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and EMBASE— were searched for the following terms alone or in combination with schizophrenia: telepsychiatry or telemedicine or telepsychology or satellite communication or remote communication. Inclusion criteria were: 1) articles dealing with telephone-, internet- or video-based interventions and 2) studies emphasizing development of an intervention, feasibility or clinical trials. Exclusions included were: 1) single case reports and 2) papers not written in English. With our search terms, we retrieved a total of 390 articles, of which 18 unique articles were relevant. Results: Based on the limited data available, the use of modalities involving the telephone, internet and videoconferencing appears to be feasible in patients with schizophrenia. In addition, preliminary evidence suggests these modalities appear to improve patient outcomes. Discussion: More research is needed. Investigators need to improve existing telehealth systems. In addition, researchers need to focus on developing newer interventions and determining whether these approaches can improve patient outcomes.
89 citations
TL;DR: Results suggest that e-mental health services are at least as effective as usual care or nontechnological approaches and may support self-management among service users with psychotic disorders.
Abstract: Online therapies, Web-based self-management systems, and Internet forums are rapidly becoming part of the mental health services repertoire, but can they be effective for individuals with psychotic disorders? This literature review indicates that people with psychotic disorders are able and willing to use e-health services. In fact, e-health interventions for this population are at least as effective as standard, non–technology-based care. Their greatest benefit, the authors said, may be to reduce health care costs for service providers as well as service users.
88 citations
Cites background from "Telenursing Intervention Increases ..."
...This finding is based on two studies (38,40)....
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...(40) described a nursing telephone intervention to support problem solving....
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TL;DR: A literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders is developed and applied to multicomponent interventions across mental health disorders.
Abstract: Background: Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. Objective: The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. Methods: This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. Results: The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. Conclusions: Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
71 citations
Cites background from "Telenursing Intervention Increases ..."
...1), for example, early warning signs of psychosis [105], illicit drug cravings [115], withdrawal symptoms [70,90], mood [107,116], or PTSD symptoms [112]....
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...Some of the studies compared medication adherence (and other outcomes) between telecare and care as usual [158-161], whereas others evaluated the effects on adherence of novel standardized intervention protocols delivered over telephone or videoconference [50,53,65,96,112,115,119,122, 127,143,146,149,152,154-157,162]....
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References
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11 Jun 2013
113,134 citations
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01 May 1979
1,694 citations
"Telenursing Intervention Increases ..." refers background in this paper
...The classic definition of adherence refers to the degree to which a person’s behavior aligns with medical or health advice (Haynes, 1979); thus, adherence may be conceptualized on a continuum from 0% to 100% concordance with treatment recommendations....
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...…schizophrenia; telephone; medication adherence The classic definition of adherence refers to the degree to which a person’s behavior aligns with medical or health advice (Haynes, 1979); thus, adherence may be conceptualized on a continuum from 0% to 100% concordance with treatment recommendations....
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TL;DR: Efforts to improve medication adherence in patients with schizophrenia should target relevant risk factors, including poor insight, negative attitude or subjective response toward medication, previous nonadherence, substance abuse, shorter illness duration, inadequate discharge planning or aftercare environment, and poorer therapeutic alliance.
Abstract: Objective Nonadherence to prescribed antipsychotic medications places patients with schizophrenia at a greatly increased risk of illness exacerbation and rehospitalization. Identification of risk factors for nonadherence is an initial step toward designing effective interventions. This article reviews recent literature on the prevalence of and risk factors for medication nonadherence in patients with schizophrenia. Data sources We searched the MEDLINE/HealthSTAR and PsycINFO databases using combinations of the keywords risk factor(s), adherence, compliance, antipsychotic, neuroleptic, schizophrenia, and psychosis for articles published since 1980 that identified risk factors for medication nonadherence in schizophrenia patients. We included reports that (1) were published in English and (2) specifically examined risk factors for medication nonadherence. Thirty-nine articles met our selection criteria. Data synthesis Among the 10 reports that met a strict set of study inclusion criteria, we found a mean rate of nonadherence of 41.2%; the 5 reports that met a stricter set of inclusion criteria had a mean nonadherence rate of 49.5%. In the 39 articles reviewed, factors most consistently associated with nonadherence included poor insight, negative attitude or subjective response toward medication, previous nonadherence, substance abuse, shorter illness duration, inadequate discharge planning or aftercare environment, and poorer therapeutic alliance. Findings regarding an association between adherence and medication type were inconclusive, although few studies explored this relationship. Other factors such as age, gender, ethnicity, marital status, education level, neurocognitive impairment, severity of psychotic symptoms, severity of medication side effects, higher antipsychotic dose, presence of mood symptoms, route of medication administration, and family involvement were not found to be consistent predictors of nonadherence. Limitations of the published literature are discussed. Conclusion Efforts to improve medication adherence in patients with schizophrenia should target relevant risk factors.
1,271 citations
TL;DR: Because loss of medication efficacy and medication noncompliance act synergistically on relapse, substantial inpatient cost savings can be realized by linking better pharmacologic treatments of schizophrenia with more effective strategies to manage medication non compliance.
Abstract: To estimate the national annual cost of rehospitalization for multiple-episode schizophrenia outpatients, and to determine the relative cost burden from loss of medication efficacy and from medication noncompliance, the yearly number of neuroleptic-responsive multiple-episode schizophrenia inpatients in the United States who are discharged back to outpatient treatment was estimated. The cohort at risk for future relapse and rehospitalization was determined. The research literature on the expected rates of relapse for schizophrenia patients on maintenance antipsychotic medication was reviewed; in particular, monthly relapse rates under the optimal medication conditions of compliant patients taking optimal doses of a depot neuroleptic (optimal neuroleptic dose) and under the less optimal conditions of patients stopping medication (medication noncompliant) was estimated. Using established noncompliance rates from the literature, it became possible to estimate a "real world" rehospitalization rate for this cohort, as well as the relative burden accruing from loss of medication efficacy and from medication noncompliance. Finally, cost estimates for index hospitalizations and rehospitalizations were derived from data on national expenditures for inpatient mental health care. The monthly relapse rates are estimated to be 3.5 percent per month for patients on maintenance neuroleptics and 11.0 percent per month for patients who have discontinued their medication. Postdischarge noncompliance rates in community settings are estimated to be 7.6 percent per month. These estimates were entered into a survival analysis model to determine the real world relapse rate of this cohort. An estimated 257,446 multiple-episode (> or = two hospitalizations) schizophrenia patients were discharged from short-stay (< or = 90 days) inpatient units in the United States during 1986. The estimated aggregate baseline inpatient cost for the index hospitalizations of this cohort was $2.3 billion (1993 dollars). Within 2 years after discharge, the aggregate cost of readmission approached $2 billion. Loss of neuroleptic efficacy accounted for roughly 60 percent of the rehospitalization costs and neuroleptic noncompliance for roughly 40 percent. The economic burden due to loss of efficacy is relatively higher during the first postdischarge year, whereas the burden from noncompliance is higher in the second year. Because loss of medication efficacy and medication noncompliance act synergistically on relapse, substantial inpatient cost savings can be realized by linking better pharmacologic treatments of schizophrenia with more effective strategies to manage medication noncompliance.
689 citations
"Telenursing Intervention Increases ..." refers background in this paper
...…rates of adherence to antipsychotic medications range from 11% to 80%, with average rates of 50%, depending on measures used and definitions of adherence (Dolder, Lacro, Dunn, & Jeste, 2002; Dolder, Lacro, & Jeste, 2003; Lacro, Dunn, Dolder, Leckband, & Jeste, 2002; Weiden & Olfson, 1995)....
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TL;DR: The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode and survival in the community prior to readmission was significantly longer in the compliance therapy group.
Abstract: BACKGROUND:
A randomised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy, a brief pragmatic intervention targeting treatment adherence in psychotic disorders, based on motivational interviewing and recent cognitive approaches to psychosis.
METHOD:
Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit, received 4-6 sessions of either compliance therapy or non-specific counselling, and were followed-up over 18 months. The principal outcome measures were observer-rated compliance, attitudes to treatment, insight and social functioning.
RESULTS:
Significant advantages were found for the compliance therapy group post-treatment on measures of insight, attitudes to treatment and observer-rated compliance which were retained over the follow-up period. Global social functioning improved relatively more over time in the compliance therapy group compared with the control group. Survival in the community prior to readmission was significantly longer in the compliance therapy group.
CONCLUSIONS:
The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode.
524 citations
"Telenursing Intervention Increases ..." refers background in this paper
...The generalizability of some studies is limited because of the use of unique samples (veterans or the elderly); others cited high rates of refusal to participate (Frangou et al., 2005) and significant dropout (Kemp et al., 1998; Razali et al., 2000)....
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