The increasing prevalence of mental illness in the United States presents significant challenges for healthcare providers. Non-compliance to treatment remains one of the biggest problems in behavioral health services.
There are, however, proven interventions that can help patients stay on track with treatment. Importantly, strategies to enhance patient adherence don’t have to be complicated. Medication adherence and appointment attendance are two key areas that can have a significant impact on treatment outcomes if successful.
Through a combination of measures, from eliciting information to shared negotiation, planning and improved communication, health professionals can improve compliance behaviors based upon a patient’s needs and wishes.
This blog explores some of the common compliance issues around medication and appointment attendance in behavioral health settings, along with the interventions that can help overcome them.
1. Improving medication compliance
One of the biggest challenges in the treatment of mental illness is when patients suddenly stop taking their medication. This can be very distressing for the patient and their family, particularly if the medication is controlling anxiety, depression or psychotic episodes.
There are two main courses of action healthcare providers can pursue to help address this. The first is the simple use of texting to remind patients to take their meds.
A meta-analysis studied the growing body of evidence for the use of mobile phone text messaging reminders to improve medication adherence in chronic disease. It was concluded that mobile phone text messaging approximately doubles the odds of medication adherence.
In behavioral health, poor adherence to antipsychotic medication is a widespread problem. While electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, less is known about the use of SMS messages in the context of psychotic disorders.
Encouragingly, a study published in the Journal of Psychiatric Research showed that text message reminder intervention did improve medication adherence in bipolar 1 patients. The criteria for inclusion included individuals who had been on a medication plan for 1 year or longer and who were able to receive and read text messages.
More research into the efficacy of text messaging for behavioral health patients is required, but the latest studies do look promising. A recent systematic review of the use of text messaging to improve clinical engagement for individuals with psychosis found overall that SMS text messaging is a low-cost, practical method of improving engagement, although the study recognized that efficacy varies by symptomology and personal characteristics. One recommendation to come from the review was to personalize SMS text messaging interventions.
Secondly, and in addition to texting patients to remind them to take medication, healthcare providers must also do more to understand the motives behind patients’ decisions to stop taking medication and encourage healthy choices without undermining autonomy.
There are many reasons why someone may stop taking medication. These include:
- Side effects
- Denial – patient perceives it to be unnecessary
- Fear of long-term drug regimens
- Complex drug regimens
- Negative attitude to medications
- Lack of autonomy
- Unintentional practical problems
- Isolated – a lack of family or social support
- Poor provider-patient communication
- Patient-physician discordance (decreased patient satisfaction)
- Inadequate knowledge about a drug and its use
- The patient’s ability to read and understand medication instructions
As can be seen from the list above, the reasons a patient might stop taking their medication are complex.
Patients, health care providers, and health care systems, all have a role to play in improving medication adherence. A single measure is unlikely to provide a magic solution, instead a combination of various adherence techniques should be implemented. These could include:
- Involving patients more in decision-making (better patient engagement)
- Adopting the most simplified medication regimen
- Explaining key information when prescribing
- Offering behavioral support
- Using additional aids, such as drug cards, medication charts or pill boxes
- Monitoring adherence at follow-up appointments and addressing any issues
- Identifying barriers and discussing these with the patient
2. Reducing appointment no shows
Missed appointments are a problem in all types of outpatient clinics, including those providing mental healthcare. In behavioral health, patients miss appointments for a variety of reasons but forgetting is the most common.
Other reasons include long intervals between scheduling and appointment day, leaving care against medical advice, and problems with substance abuse.
Missed appointments are a serious concern, particularly in behavioral health, since there is always the worry that the patient missing the appointment may be in distress. The missed appointment could, for example, indicate worsening depression or the need for a safety check.
As with medication, the use of text appointment reminders is one solution that is proven to help with compliance.
A Pilot Intervention in the UK across four London-based psychiatric clinics found SMS reminders to be effective in reducing rates of non-attendance. Text message reminders were delivered seven and five days and seven and three days before scheduled psychiatric appointments.
In behavioral health, more personalized approaches may be required. Staff in each clinic should consider the needs of their patients and what method or methods might be effective in helping them keep their clinic appointments.
For follow-up appointments after in-patient care, staff should ideally check the preferred method for communicating. Providing patients with clinician contact information prior to discharge may also improve willingness to attend. It may be appropriate to offer more than one form of appointment reminder, such as a text followed up with a phone call.
For patients who will be attending a clinic for the first time, orientation letters can help. Information regarding appointment time, doctor’s name, brief description of the clinic and the clinic routine, a map, and what patients need to bring (i.e. their medications), as well as a reminder that the patient can attend with a family member or friend, can all help to reassure.
3. Offering complete visibility through improved patient flow
Another area to consider is patient flow. Patient flow matters in all healthcare environments. But in behavioral settings, any hold-up in the patient journey can add unnecessary stress and worry to the people who are least able to manage it. Carefully managing patient flow can help to improve the patient experience.
Improving patient flow should be a priority in clinical settings for behavioral health as a negative experience could have even greater impact on patient compliance. A busy, noisy waiting room, for example, could put a patient off attending their next appointment, and a long wait time could force a patient to leave before they are seen. Visibility and forward planning are key in behavioral health settings where patients can present with complex needs.
COVID-19 has changed the format of appointment attendance with virtual waiting rooms enabling patients to wait outside a healthcare facility until they are ready to be seen. This could be a check-in method that is extended to behavioral health patients beyond the pandemic, thus avoiding the return to busy waiting areas.
Patient Engagement Solutions from PatientTrak create an optimal environment for the treatment of behavioral health patients. Contact our expert team now – we are here to help you ensure your patients receive the treatment they need.