2.50
Hdl Handle:
http://hdl.handle.net/10755/157232
Type:
Presentation
Title:
Adherence and Quality of Life in Serious and Persistent Mental Illness
Abstract:
Adherence and Quality of Life in Serious and Persistent Mental Illness
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Cook, Paul F., PhD
P.I. Institution Name:University of Colorado Denver, College of Nursing
Title:Assistant Professor
Contact Address:13120 E. 19th Ave., Campus Box C288-04, Aurora, CO, 80045, USA
Contact Telephone:303-724-8537
Co-Authors:Dana El-Hajj, RN, Doctoral Student; Suzie Emiliozzi, RN, Director of Quality and Compliance
Purpose/Aims: In previously reported data (Cook et al., 2008), persons with serious and persistent mental illness (SPMI) had improved medication adherence and less emergency department (ED) use after a nurse telehealth intervention. The purpose of this secondary analysis was to determine whether these patients also had improved quality of life (QOL). Background: Although atypical antipsychotic medications reduce the cost of care for persons with SPMI, and many organizations attempt to promote adherence to these treatments, the relationship between medication adherence and QOL for persons with SPMI has rarely been studied. Some consumer advocacy groups ask whether medications for SPMI are over-used, and adverse treatment effects may be a concern. But use of medication may also help consumers self-manage the symptoms of SPMI. It is therefore of interest to determine whether better adherence also impacts consumers' QOL. Participants: Persons with SPMI (N = 210) were recruited from a Medicaid health plan administered by Centene Corporation, and 51 enrolled in a telehealth nurse counseling service. Eligibility criteria were: (a) health plan membership, (b) age cubed 18, and (c) had received a prescription for an atypical antipsychotic medication in the prior six months. Methods: The current analysis considered pre-post change for participants who received the study intervention; no QOL data were available for the original study comparison group. Participants received an initial call from a program nurse, who screened for adherence risk factors and provided information and support. Follow-up calls from the same nurse over the next several months (M = 3.2 calls per participant) reinforced initial messages and addressed additional barriers to adherence using cognitive-behavioral and motivational interviewing strategies. If patients required medical follow-up, their health plan case manager was notified and helped to coordinate needed services. QOL was measured at pre- and post-treatment, and at each call nurses documented patients' reported symptoms of SPMI and adverse events as these related to adherence. Results: Participants' initial scores on the QOL measure were similar to those of outpatients with SPMI in a community sample of homeless individuals. 50% of participants were adherent. Reported adverse events and breakthrough symptoms of SPMI were rare, and were not statistically related to adherence. In line with reported improvements in adherence and ED utilization, repeated-measures t-tests also showed improvement on four QOL items. Although only one of these changes was statistically significant (Perceived Quality of Life, p = .04), improvements in the Activities of Daily Living, Employment, and Social Support domains each approached significance (ps = .12-.16). A measure of Mental Health Symptoms did not show any change, p = .41. Implications: In addition to improving treatment adherence, telehealth nursing has the potential to improve some QOL metrics for SPMI, with few reported adverse effects. Given power limitations in the current study, additional research is recommended on the relationships between treatment adherence and QOL in SPMI.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleAdherence and Quality of Life in Serious and Persistent Mental Illnessen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157232-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Adherence and Quality of Life in Serious and Persistent Mental Illness</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Cook, Paul F., PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Colorado Denver, College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">13120 E. 19th Ave., Campus Box C288-04, Aurora, CO, 80045, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">303-724-8537</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">paul.cook@ucdenver.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Dana El-Hajj, RN, Doctoral Student; Suzie Emiliozzi, RN, Director of Quality and Compliance</td></tr><tr><td colspan="2" class="item-abstract">Purpose/Aims: In previously reported data (Cook et al., 2008), persons with serious and persistent mental illness (SPMI) had improved medication adherence and less emergency department (ED) use after a nurse telehealth intervention. The purpose of this secondary analysis was to determine whether these patients also had improved quality of life (QOL). Background: Although atypical antipsychotic medications reduce the cost of care for persons with SPMI, and many organizations attempt to promote adherence to these treatments, the relationship between medication adherence and QOL for persons with SPMI has rarely been studied. Some consumer advocacy groups ask whether medications for SPMI are over-used, and adverse treatment effects may be a concern. But use of medication may also help consumers self-manage the symptoms of SPMI. It is therefore of interest to determine whether better adherence also impacts consumers' QOL. Participants: Persons with SPMI (N = 210) were recruited from a Medicaid health plan administered by Centene Corporation, and 51 enrolled in a telehealth nurse counseling service. Eligibility criteria were: (a) health plan membership, (b) age cubed 18, and (c) had received a prescription for an atypical antipsychotic medication in the prior six months. Methods: The current analysis considered pre-post change for participants who received the study intervention; no QOL data were available for the original study comparison group. Participants received an initial call from a program nurse, who screened for adherence risk factors and provided information and support. Follow-up calls from the same nurse over the next several months (M = 3.2 calls per participant) reinforced initial messages and addressed additional barriers to adherence using cognitive-behavioral and motivational interviewing strategies. If patients required medical follow-up, their health plan case manager was notified and helped to coordinate needed services. QOL was measured at pre- and post-treatment, and at each call nurses documented patients' reported symptoms of SPMI and adverse events as these related to adherence. Results: Participants' initial scores on the QOL measure were similar to those of outpatients with SPMI in a community sample of homeless individuals. 50% of participants were adherent. Reported adverse events and breakthrough symptoms of SPMI were rare, and were not statistically related to adherence. In line with reported improvements in adherence and ED utilization, repeated-measures t-tests also showed improvement on four QOL items. Although only one of these changes was statistically significant (Perceived Quality of Life, p = .04), improvements in the Activities of Daily Living, Employment, and Social Support domains each approached significance (ps = .12-.16). A measure of Mental Health Symptoms did not show any change, p = .41. Implications: In addition to improving treatment adherence, telehealth nursing has the potential to improve some QOL metrics for SPMI, with few reported adverse effects. Given power limitations in the current study, additional research is recommended on the relationships between treatment adherence and QOL in SPMI.</td></tr></table>en_GB
dc.date.available2011-10-26T19:41:07Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:41:07Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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