An RCT of Effects of Telephone Care Management on Treatment Adherence and Clinical Outcomes Among Veterans With PTSD

Rosen, Craig S.; Azevedo, Kathryn; Tiêt, Quyên Q.; Greene, Carolyn J.; Wood, Annette; Calhoun, Patrick S.; Bowe, Thomas; Capehart, Bruce P.; Crawford, Eric F.; Greenbaum, Mark A.; Harris, Alex H. S.; Hertzberg, Michael A.; Lindley, Steven E.; Smith, Brandy N.; Schnurr, Paula P.

doi:10.1176/appi.ps.201600069

Cited by 12 publications

(24 citation statements)

References 58 publications

(62 reference statements)

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“…Finally, objective measurements such as pharmacy refills (A.8.1) or insurance claims (A.8.2), which do not directly capture medication administration data but may provide indirect indices of medication possession and adherence, have been used to assess adherence behaviors over the long term (n=3). Overall, 2 studies calculated medication possession ratios and used them in feedback interventions to enhance as well as measure adherence: one with antipsychotics [111] and one with PTSD medications [112]. Another study incorporated barcodes attached to pill containers (A.8.3).…”

Section: Resultsmentioning

confidence: 99%

“…Most of the data were used in clinician monitoring or alert systems, but some were used to tailor patient-specific motivational therapy (eg, in handling specific drug use triggers in substance use disorders) [113,114]. By far, the most commonly collected data were basic psychiatric symptom assessments (A.9.1), for example, early warning signs of psychosis [105], illicit drug cravings [115], withdrawal symptoms [70,90], mood [107,116], or PTSD symptoms [112]. Other studies tracked attitudes toward medication [117] or medication side effects [118,119] to guide motivational interventions (A.9.2).…”

Section: Resultsmentioning

confidence: 99%

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Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

Steinkamp¹,

Goldblatt²,

Borodovsky³

et al. 2019

JMIR Ment Health

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Background Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. Objective The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. Methods This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. Results The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. Conclusions Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

Steinkamp¹,

Goldblatt²,

Borodovsky³

et al. 2019

JMIR Ment Health

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“…In both our and Rosen et al’s (2013, 2017) studies, the lack of advantage for the telephone monitoring condition on outcomes occurred despite having successfully delivered the intervention. In our study, 87% of patients assigned to telephone monitoring completed at least one phone call with the telephone monitor, and a mean of eight phone calls were completed.…”

Section: Discussionmentioning

confidence: 71%

“…Subsequently, Rosen et al (2017) examined whether adding telephone care management (twice-per-month phone calls for three months) to usual outpatient mental health care improved treatment attendance and clinical outcomes of mental health patients; few patients (6% of usual care, and 16% of telephone monitored) had co-occurring substance use disorders. Telephone monitoring patients completed more mental health visits during the intervention period than usual care patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, telephone monitoring and usual care patients did not differ on treatment visits at the last (one-year) follow-up, or on substance use or psychiatric symptoms at any follow-up. Rosen et al (2017) concluded that, even when telephone monitoring increases treatment attendance, treatment outcomes depend upon treatment effectiveness. More broadly, it is possible that, as health care systems prioritize linkage to post-inpatient services, the incremental benefit of brief interventions such as telephone continuing care is diminished.…”

Section: Discussionmentioning

confidence: 99%

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Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Timko

Harris

Jannausch

et al. 2019

Drug and Alcohol Dependence

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Background: Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods: This randomized controlled trial (n=406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (3 months post-baseline) and 9 and 15 months post-baseline (73% followed). Primary outcomes were number of days, out of the past 30, of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results: Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions: Among these patients, improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.

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Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes

Timko

Below

Vittorio

et al. 2019

Journal of Substance Abuse Treatment

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Telehealth interventions have the potential to deter repeated detoxification episodes and improve outcomes. Using a sample of 298 detoxification inpatients, this randomized controlled trial compared Enhanced Telephone Monitoring (ETM) to usual care (UC) on the primary outcome of reducing subsequent detoxification, and secondary outcomes of linking patients to addiction treatment and mutual-help, and patients' experience of improved substance use and mental health outcomes. At the 3-month follow-up (i.e., at the end of the ETM intervention), compared to UC patients, ETM patients were significantly less likely to have received additional inpatient detoxification, but no more likely to have participated in 12-step groups or received outpatient addiction treatment. Even so, ETM patients had better alcohol, drug, and mental health outcomes. In contrast, at the 6-month follow-up, patients in ETM and UC generally did not differ on primary or secondary outcomes. Findings suggest that ETM deters additional detoxification episodes while the intervention is ongoing, but not after the intervention ends. Because telephone monitoring is low-intensity and low-cost, its extension over time may help reduce repeated detoxifications.

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An RCT of Effects of Telephone Care Management on Treatment Adherence and Clinical Outcomes Among Veterans With PTSD

Abstract: TCM improved PTSD patients' treatment attendance but not their outcomes. TCM can enhance treatment engagement, but outcomes depend on the effectiveness of the treatments that patients receive.

Cited by 12 publications

References 58 publications

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Randomized controlled trial of enhanced telephone monitoring with detoxification patients: 3- and 6-month outcomes

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