Use of a Web-Based Shared Decision-Making Program: Impact on Ongoing Treatment Engagement and Antipsychotic Adherence

Abstract

The authors examined the impact of a Webbased shared decision-making application, MyCHOIS-CommonGround, on ongoing outpatient mental health treatment engagement (all users) and antipsychotic medication adherence (users with schizophrenia).Methods: An intervention study was conducted by comparing Medicaid-enrolled MyCHOIS-CommonGround users in 12 participating mental health clinics (N=472) with propensity score-matched adults receiving services in nonparticipating clinics (N=944). Medicaid claims were used to assess ongoing treatment engagement and antipsychotic adherence (among individuals with schizophrenia) one year prior to and after entry into the cohort. Multilevel linear models were conducted to estimate the effects of the MyCHOIS-CommonGround program over time.Results: No differences during the baseline year were found between the MyCHOIS-CommonGround group and the matched control group on demographic, diagnostic, or service use characteristics. At one-year follow-up, engagement in outpatient mental health services was significantly higher for MyCHOIS-CommonGround users than for the control group (months with a service, 8.546.22 versus 6.956.15; b=1.40, p,.001). Among individuals with schizophrenia, antipsychotic medication adherence was also higher during the follow-up year among MyCHOIS-CommonGround users compared with the control group (proportion of days covered by medication, .786.04 versus .696.03; b=.06, p,.01).Conclusions: These findings provide new evidence that shared decision-making tools may promote ongoing mental health treatment engagement for individuals with serious mental illness and improved antipsychotic medication adherence for those with schizophrenia.

The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review

“…A positive impact was found on service users’ and care coordinators confidence to explore medication experience, and group-based training was valued Ishii et al (Japan), [ 42 ] Randomized, parallel-group, two-arm, open-label, single-center study N = 24 patients (shared decision making group, N = 11; Usual care group, N = 13); acute psychiatric ward Schizophrenia spectrum disorder according to ICD-10 criteria Patients’ age 16–65 years; no previous psychiatric admission Shared Decision Making group (SDM): 15–20-min weekly intervention provided during the in-patient stay, consisting of three elements: evaluation of patient’s perceptions of on-going treatments; sharing patients’ and medical staffs’ perceptions on the treatments; shared definition of care plan Usual care group: usual psychiatric inpatient care, which mainly include pharmacological treatments Patients in the SDM group reported a higher level of satisfaction towards treatments compared to usual care group, while no differences were found in attitude toward medication, treatment continuation and in the levels of global functioning Hamann et al (Germany), [ 43 ] Randomized-controlled trial, multicenter study N = 264 (intervention group, N = 142; control group, N = 122); acute wards of four participating psychiatric hospitals Schizophrenia, schizoaffective disorder according to ICD-10 criteria Patients’ age 18–60 years Shared Decision Making (SDM): 5-session training (60 min/session) addressing patient competencies for SDM, including sessions on motivational and behavioral aspects (e.g., role plays) and on patient–doctor interaction Control group: 5-session of cognitive training, but with no reference to doctor-patient communication Patients in the SDM group reported an increase in their levels of participation preferences and their wish to take over more responsibility for medical decision. No differences regarding the treatment adherence were found at 6 and 12 months after discharge Finnerty et al (USA), [ 44 ] Multicentre study N = 1416 patients (MyCHOIS–CommonGround, N = 472; control condition, N = 944); 12 Medicaid outpatient clinics Anxiety disorder, bipolar/depressive disorder, post-traumatic stress disorder, schizophrenia spectrum disorder, sleep–wake disorder, substance-related or addictive disorder Adult patients served by MyCHOIS–CommonGround clinics between 2011–2014 MyCHOIS–CommonGround: Web-based shared decision-making application on outpatient mental health treatment engagement and on antipsychotic medication adherence Control group: simple random sample of a...…”

“…Finnerty et al [ 44 ] proposed interventions based on the use of smartphone applications or “apps”, implemented the MyCHOIS-CommonGround, a decision-making Web-based tool. The “My Collaborative Health Outcomes Information System” (MyCHOIS) is part of a Web-based platform for supporting shared decision-making and quality improvement, developed by the New York State Office of Mental Health.…”

“…Regarding the target groups, all experimental interventions specifically addressed to patients [ 38 ,  39 ,  44 , 45 ] resulted in a more active behavior during psychiatric consultations within the hospitalization period. However, no clear effects have been found in terms of adherence rate to pharmacological treatments, evidencing the need for adding decision-support tools and stronger communication skills by mental health professionals in order to achieve this objective.…”

Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review

“…We found 11 studies that implemented peer-delivered interventions supported with technology [9,[34][35][36][37][38][39][40][41][42][43]. These studies included 1 qualitative study [40], 5 pre-post studies [9,34,36,42,43], 3 quasiexperimental studies [35,38,39], and 2 randomized controlled trials [37,41] that aimed to address integrated medical and psychiatric self-management [9], shared decision making [34,43], cognitive enhancement therapy [41], physical well-being [38,39], and weight management [42]. Peer-delivered services were delivered through smartphone apps [38,43], in-person and augmented by a smartphone app [9,40], in-person and augmented by text messaging and a fitness tracker [42], or via a web-based platform with a peer [34,41] (see Multimedia Appendix 3).…”

Shared decision making for adults with severe mental illness: A concept analysis

“…It is the user's own goal, which is individual recovery-oriented (Matthias et al, 2017;Paudel et al, 2018;Woltmann, Wilkniss, Teachout, McHugo, & Drake, 2011;Yamaguchi et al, 2017). Thereafter, both parties share the service user's identified personal goal (Finnerty et al, 2019;Paudel et al, 2018;Yamaguchi et al, 2017).…”