Implementation of the Texas Medication Algorithm Project patient and family education program.
OBJECTIVE
This article describes the implementation and utilization of the patient and family education program (PFEP) component of the Texas Medication Algorithm Project (TMAP). The extent of participation, types of psychoeducation received, and predictors of receiving at least a minimum level of education are presented.


METHODS
TMAP included medication guidelines, a dedicated clinical coordinator, standardized assessments of symptoms and side effects, uniform documentation, and a PFEP. The PFEP includes phased, multimodal, disorder-specific educational materials for patients and families. Participants were adult outpatients of 1 of 7 community mental health centers in Texas that were implementing the TMAP disease management package. Patients had DSM-IV clinical diagnoses of major depressive disorder, with or without psychotic features; bipolar I disorder or schizoaffective disorder, bipolar type; or schizophrenia or schizoaffective disorder. Assessments were administered by independent research coordinators. Study data were collected between March 1998 and March 2000, and patients participated for at least 1 year.


RESULTS
Of the 487 participants, nearly all (95.1%) had at least 1 educational encounter, but only 53.6% of participants met criteria for "minimum exposure" to individual education interventions. Furthermore, only 31.0% participated in group education, and 42.5% had a family member involved in at least 1 encounter. Participants with schizophrenia were less involved in the PFEP across multiple indicators of utilization. Diagnosis, intensity of symptoms, age, and receipt of public assistance were related to the likelihood of exposure to minimum levels of individual education.


CONCLUSIONS
Despite adequate resources and infrastructure to provide PFEP, utilization was less than anticipated. Although implementation guidelines were uniform across diagnoses, participants with schizophrenia experienced less exposure to psychoeducation. Recommendations for improving program implementation and modification of materials are discussed.
Toprac
Marcia G
MG
TX, USA. mtoprac@earthlink.net
Dennehy
Ellen B
EB
Carmody
Thomas J
TJ
Crismon
M Lynn
ML
Miller
Alexander L
AL
Trivedi
Madhukar H
MH
Suppes
Trisha
T
Rush
A John
AJ
D000328:Adult; D000465:Algorithms; D000553:Ambulatory Care; D001714:Bipolar Disorder / Q000534:rehabilitation / Q000628:therapy; D003155:Community Mental Health Centers; D019468:Disease Management; D005192:Family Health; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011618:Psychotic Disorders / Q000534:rehabilitation / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012559:Schizophrenia / Q000534:rehabilitation / Q000628:therapy; D013781:Texas; D016896:Treatment Outcome
D011619:Psychotropic Drugs