Thursday, October 11, 2018

Shared Decision Making With Patients Can Improve Treatment Engagement, Medication Adherence

Providing patients with a computer-based, shared decision-making tool may promote ongoing treatment engagement and adherence to antipsychotic medication regimens, according to a study in Psychiatric Services in Advance.

Shared decision making is a model of patient-provider communication that requires the active participation of both patient and clinician in information sharing, leading to a treatment decision made and agreed upon by both parties. It combines evidence on treatment options with the values and preferences of patients and their families.

This study focused on a specific tool called CommonGround, an offering on the My Collaborative Health Outcomes Information System (MyCHOIS), a web-based platform developed by the New York State Office of Mental Health (NYSOMH). Molly T. Finnerty, M.D., of NYSOMH and colleagues examined the effects of MyCHOIS-CommonGround on treatment engagement, and for patients with schizophrenia, adherence to antipsychotic medication regimens.

Some 472 Medicaid patients completed shared decision-making reports using MyCHOIS-CommonGround, summarizing their symptoms, functioning, and concerns, with the help of peer staff. Later, during a medication appointment, the clinician and patient reviewed the report and worked together to develop a shared decision. Also studied were 944 similar Medicaid patients who did not use the program. Among participants, schizophrenia was the most prevalent diagnosis (40%), and about one-third of the patients had a comorbid substance use disorder.

While there were no differences between the two groups at baseline, during the follow-up year, the MyCHOIS–CommonGround users had a higher level of ongoing engagement in outpatient mental health service compared with the control group (months with use of a service, 8.54 versus 6.95), the researchers wrote. Furthermore, at the one-year follow-up, there was a significant increase in ongoing treatment engagement for the MyCHOIS–CommonGround users group and a significant decrease in engagement for the control group. Patients with schizophrenia who used MyCHOIS-CommonGround were also found to be significantly more adherent to their antipsychotic regimen during the follow-up year than those in the control group (9% more days with medication).

“It is important to establish the benefit of shared decision making beyond the ethical considerations upon which it was founded, in part to inform implementation decisions. Implementation of shared decision-making programs, such as CommonGround, can be challenging and requires leadership and staff commitment and upfront and ongoing resources,” Finnerty and colleagues wrote. “Shared decision making is a promising approach to enhancing patient-centered care, improving the use of services, and ultimately improving outcomes of care.”

For related information, see the Psychiatric Services article “Consumer Outcomes After Implementing CommonGround as an Approach to Shared Decision Making.”

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