Skip to main content

Use of a Computerized Medication Shared Decision Making Tool in Community Mental Health Settings: Impact on Psychotropic Medication Adherence

Abstract

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.

This is a preview of subscription content, access via your institution.

References

  • Adams, J., & Drake, R. (2006). Shared decision-making and evidence-based practice. Community Mental Health Journal, 42(1), 87–105.

    PubMed  Article  Google Scholar 

  • Adams, J. R., Drake, R. E., & Wolford, G. L. (2007). Shared decision-making preferences of people with severe mental illness. Psychiatric Services, 58(9), 1219–1221.

    PubMed  Article  Google Scholar 

  • Alegria, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A., et al. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Medical Care, 46(3), 247–256.

    PubMed  Article  Google Scholar 

  • 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 

  • Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science and Medicine, 44(5), 681–692.

    PubMed  Article  CAS  Google Scholar 

  • Charles, C., Whelan, T., & Gafni, A. (1999). What do we mean by partnership in making decisions about treatment? British Medical Journal, 319(7212), 780–782.

    PubMed  Article  CAS  Google Scholar 

  • Christensen, H., Griffiths, K. M., & Jorm, A. F. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. British Medical Journal, 328(7434), 265. doi:10.1136/bmj.37945.566632.EE.

    PubMed  Article  Google Scholar 

  • Cooper, L. A., Gonzales, J. J., Gallo, J. J., Rost, K. M., Meredith, L. S., Rubenstein, L. V., et al. (2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical Care, 41(4), 479–489.

    PubMed  Google Scholar 

  • Deegan, P. E. (2010). A web application to support recovery and shared decision making in psychiatric medication clinics. Psychiatric Rehabilitation Journal, 34(1), 23–28.

    PubMed  Article  Google Scholar 

  • Deegan, P. E., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57(11), 1636–1639.

    PubMed  Article  Google Scholar 

  • Deegan, P. E., Rapp, C., Holter, M., & Riefer, M. (2008). Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric Services, 59(6), 603–605.

    PubMed  Article  Google Scholar 

  • Diaz, E., Woods, S. W., & Rosenheck, R. A. (2005). Effects of ethnicity on psychotropic medications adherence. Community Mental Health Journal, 41(5), 521–537.

    PubMed  Article  Google Scholar 

  • Drake, R. E., Cimpean, D., & Torrey, W. C. (2009). Shared decision making in mental health: prospects for personalized medicine. Dialogues in Clinical Neuroscience, 11(4), 455–463.

    PubMed  Google Scholar 

  • Drake, R., Deegan, P., & Rapp, C. (2010). The promise of shared decision making in mental health. Psychiatric Rehabilitation Journal, 34(1), 7–13.

    PubMed  Article  Google Scholar 

  • Frosch, D. L., & Kaplan, R. M. (1999). Shared decision making in clinical medicine: past research and future directions. American Journal of Preventive Medicine, 17(4), 285–294.

    PubMed  Article  CAS  Google Scholar 

  • Horvitz-Lennon, M., Donohue, J. M., Domino, M. E., & Normand, S. L. (2009). Improving quality and diffusing best practices: The case of schizophrenia. Health Affairs, 28(3), 701–712.

    PubMed  Article  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 

  • Interian, A., Martinez, I. E., Guarnaccia, P. J., Vega, W. A., & Escobar, J. I. (2007). A qualitative analysis of the perception of stigma among Latinos receiving antidepressants. Psychiatric Services, 58(12), 1591–1594.

    PubMed  Article  Google Scholar 

  • Johnson, B. R., Schwartz, A., Goldberg, J., & Koerber, A. (2006). A chairside aid for shared decision making in dentistry: A randomized controlled trial. Journal of Dental Education, 70(2), 133–141.

    PubMed  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.

    PubMed  Article  CAS  Google Scholar 

  • Jordan, J. L., Ellis, S. J., & Chambers, R. (2002). Defining shared decision making and concordance: are they one and the same? Postgraduate Medical Journal, 78(921), 383–384.

    PubMed  Article  CAS  Google Scholar 

  • Kuno, E., & Rothbard, A. B. (2002). Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. American Journal of Psychiatry, 159(4), 567–572.

    PubMed  Article  Google Scholar 

  • Loh, A., Leonhart, R., Wills, C. E., Simon, D., & Harter, M. (2007). The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Education and Counseling, 65(1), 69–78.

    PubMed  Article  Google Scholar 

  • Ludman, E., Katon, W., Bush, T., Rutter, C., Lin, E., Simon, G., et al. (2003). Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial. Psychological Medicine, 33(6), 1061–1070.

    PubMed  Article  CAS  Google Scholar 

  • Mahone, I. H. (2004). Medication decision-making by persons with serious mental illness. Archives of Psychiatric Nursing, 18(4), 126–134.

    PubMed  Article  Google Scholar 

  • Mann, D. M., Ponieman, D., Montori, V. M., Arciniega, J., & McGinn, T. (2009). The Statin Choice decision aid in primary care: A randomized trial. Patient Education and Counseling, 80(1), 138–140.

    PubMed  Article  Google Scholar 

  • Mistler, L. A., & Drake, R. E. (2008). Shared decision making in antipsychotic management. Journal of Psychiatric Practice, 14(6), 333–344.

    PubMed  Article  Google Scholar 

  • Montgomery, A. A., & Fahey, T. (2001). How do patients’ treatment preferences compare with those of clinicians? Quality in Health Care, 10(suppl 1), i39–i43. doi:10.1136/qhc.0100039.

    PubMed  Google 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.

    PubMed  Article  CAS  Google Scholar 

  • Mueser, K. T., Corrigan, P. W., Hilton, D. W., Tanzman, B., Schaub, A., Gingerich, S., et al. (2002). Illness management and recovery: a review of the research. Psychiatric Services, 53(10), 1272–1284.

    PubMed  Article  Google 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.

  • O’Connor, A. M., Wennberg, J. E., Legare, F., Llewellyn-Thomas, H. A., Moulton, B. W., Sepucha, K. R., et al. (2007). Toward the ‘tipping point’: Decision aids and informed patient choice. Health Affairs (Millwood), 26(3), 716–725.

    Article  Google Scholar 

  • Patel, U. B., Ni, Q., Clayton, C., Lam, P., & Parks, J. (2010). An attempt to improve antipsychotic medication adherence by feedback of medication possession ratio scores to prescribers. Population Health Management, 13(5), 269–274.

    PubMed  Article  Google Scholar 

  • Paulose-Ram, R., Safran, M. A., Jonas, B. S., Gu, Q., & Orwig, D. (2007). Trends in psychotropic medication use among U.S. adults. Pharmacoepidemiology and Drug Safety, 16(5), 560–570.

    PubMed  Article  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.

    PubMed  Article  Google 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.

    Article  Google 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.

    PubMed  Article  Google Scholar 

  • Sajatovic, M., Ignacio, R. V., West, J. A., Cassidy, K. A., Safavi, R., Kilbourne, A. M., et al. (2009). Predictors of nonadherence among individuals with bipolar disorder receiving treatment in a community mental health clinic. Comprehensive Psychiatry, 50(2), 100–107.

    PubMed  Article  Google Scholar 

  • SAS Software. (2004). Version 9.1 of the SAS System for windows. Cary, NC: SAS Institute Inc.

    Google Scholar 

  • Say, R. E., & Thomson, R. (2003). The importance of patient preferences in treatment decisions–challenges for doctors. British Medical Journal, 327(7414), 542–545.

    PubMed  Article  Google Scholar 

  • Schnittker, J. (2003). Misgivings of medicine?: African Americans’ skepticism of psychiatric medication. Journal of Health and Social Behavior, 44(4), 506–524.

    PubMed  Article  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.

  • Sullivan, G., Wells, K. B., Morgenstern, H., & Leake, B. (1995). Identifying modifiable risk factors for rehospitalization: A case-control study of seriously mentally ill persons in Mississippi. American Journal of Psychiatry, 152(12), 1749–1756.

    PubMed  CAS  Google Scholar 

  • Svarstad, B. L., Shireman, T. I., & Sweeney, J. K. (2001). Using drug claims data to assess the relationship of medication adherence with hospitalization and costs. Psychiatric Services, 52(6), 805–811. doi:10.1176/appi.ps.52.6.805.

    PubMed  Article  CAS  Google Scholar 

  • Teh, C. F., Sorbero, M. J., Mihalyo, M. J., Kogan, J. N., Schuster, J., Reynolds, C. F., et al. (2010). Predictors of adequate depression treatment among Medicaid-enrolled adults. Health Services Research, 45(1), 302–315.

    PubMed  Article  Google Scholar 

  • Toprac, M. G., Rush, A. J., Conner, T. M., Crismon, M. L., Dees, M., Hopkins, C., et al. (2000). The texas medication algorithm project patient and family education program: A consumer-guided initiative. Journal of Clinical Psychiatry, 61(7), 477–486.

    PubMed  Article  CAS  Google Scholar 

  • Valenstein, M., Copeland, L. A., Blow, F. C., McCarthy, J. F., Zeber, J. E., Gillon, L., et al. (2002). Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Medical Care, 40(8), 630–639.

    PubMed  Article  Google Scholar 

  • 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  • Verdoux, H., Lengronne, J., Liraud, F., Gonzales, B., Assens, F., Abalan, F., et al. (2000). Medication adherence in psychosis: predictors and impact on outcome. A 2-year follow-up of first-admitted subjects. Acta Psychiatrica Scandinavica, 102(3), 203–210.

    PubMed  Article  CAS  Google Scholar 

  • Vollmann, J., Bauer, A., Danker-Hopfe, H., & Helmchen, H. (2003). Competence of mentally ill patients: A comparative empirical study. Psychological Medicine, 33(8), 1463–1471.

    PubMed  Article  CAS  Google Scholar 

  • Von Korff, M., Katon, W., Rutter, C., Ludman, E., Simon, G., Lin, E., et al. (2003). Effect on disability outcomes of a depression relapse prevention program. Psychosomatic Medicine, 65(6), 938–943. doi:10.1097/01.psy.0000097336.95046.0c.

    Article  Google Scholar 

  • Weiden, P. J., Kozma, C., Grogg, A., & Locklear, J. (2004). Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatric Services, 55(8), 886–891.

    PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  • Ybarra, M. L., & Eaton, W. W. (2005). Internet-based mental health interventions. Mental Health Services Research, 7(2), 75–87.

    PubMed  Article  Google Scholar 

  • Zito, J. M., Safer, D. J., Zuckerman, I. H., Gardner, J. F., & Soeken, K. (2005). Effect of Medicaid eligibility category on racial disparities in the use of psychotropic medications among youths. Psychiatric Services, 56(2), 157–163.

    PubMed  Article  Google Scholar 

  • Zivin, K., Ganoczy, D., Pfeiffer, P. N., Miller, E. M., & Valenstein, M. (2009). Antidepressant adherence after psychiatric hospitalization among VA patients with depression. Administration and Policy In Mental Health, 36(6), 406–415.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bradley D. Stein.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Stein, B.D., Kogan, J.N., Mihalyo, M.J. et al. Use of a Computerized Medication Shared Decision Making Tool in Community Mental Health Settings: Impact on Psychotropic Medication Adherence. Community Ment Health J 49, 185–192 (2013). https://doi.org/10.1007/s10597-012-9528-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-012-9528-8

Keywords

  • Psychotropic medication
  • Medication adherence
  • Shared-decision making
  • Computer intervention
  • Recovery