Effects of telephone counseling on antipsychotic adherence and emergency department utilization

OBJECTIVE: To determine whether ScriptAssist, a telehealth nursing program using psychological techniques, reduced emergency department (ED) utilization and improved adherence among Medicaid health plan members with serious and persistent mental illness (SPMI). STUDY DESIGN: Nonrandomized controlled trial. METHODS: Of 210 eligible Medicaid health plan members with SPMI, 59 (28%) were contacted by phone and 51 (86%) participated. Participants received an average of 3.5 calls over 9 months, with 2.1 attempts per completed call. Participants had clinically significant levels of impairment; medication switching, polypharmacy, and medical comorbidities were common. Intervention group participants' results were compared with those of nonparticipants to rule out regression to the mean, history, and maturation effects. Intervention group participants' results also were compared with baseline data to rule out selection bias. RESULTS: Program participants had fewer ED visits during the intervention than a comparison group, and reduced their ED use and hospitalization rate compared with the previous year. Participants also had better medication adherence based on pharmacy and interview data. CONCLUSIONS: Cognitive-behavioral and motivational-interviewing techniques can improve antipsychotic medication adherence. Telehealth may be a useful strategy for disseminating these evidence-based techniques. Lessons learned included the importance of real-time referral data, a need to address polypharmacy, and a need to overcome contact difficulties resulting from disease processes and "unknown caller" IDs. Despite these difficulties, using a disease management model, the program was feasible, and the reduced number of ED visits indicated potential cost-effectiveness.