Regular telephone calls and personalized communication improved medication adherence in patients with severe mental illness in a randomized controlled trial, according to study findings published in Psychiatric Services.

Telemedicine, which includes any computer- or phone-based clinical communication, can be a cheap, accessible alternative to in-person psychiatric appointments. The researchers used telephone calls and text messages to improve patient adherence to antipsychotic medication regimens, as 1-year adherence rates for such medications have been reported to be as low as 50%.

The researchers identified 120 adult outpatients (mean age 42) at 3 psychiatric hospitals from January 2015 to October 2017. The diagnosis of schizophrenia (80% of patients) or bipolar disorder (20% of patients) was confirmed through the German version of the Structured Clinical Interview for DSM-IV Axis I Disorders, and patients were randomly assigned to intervention or control groups. The German version of the Medication Adherence Report Scale was also used.

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Patients who exhibited suicidal tendencies, were unreachable by phone, or had inpatient treatment scheduled within the following 6 months were not included in the study.

The intervention was administered by 3 trained nurses; later analyses revealed no impact of the individual nurse on treatment effectiveness. In the 6 months following hospital discharge, patients in the intervention group received telephone calls every second week plus short messages. The content of these communications consisted of standardized questions about medication adherence and suicidal ideation, plus discussion of patients’ personal lives, such as hobbies, families, and work. Follow-ups occurred at 3 and 6 months.

Throughout the study, patients received an average of 7.22 calls and 12.13 text messages. Follow-up at 6 months was conducted in 88 patients (42 intervention, 46 control). The effectiveness of the intervention became apparent at 6 months, with an odds ratio of medication adherence of 4.11 (P =.007).

The researchers noted that future research would benefit from alternatives to self-reporting medication adherence, such as pill counting, measuring serum antipsychotic levels, and electronic monitoring.

Reference

Schulze LN, Stentzel U, Leipert J, et al. Improving medication adherence with telemedicine for adults with severe mental illness [published online January 17, 2019]. Psychiatr Serv. doi:10.1176/appi.ps.201800286