title: Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.
abstract: Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.
authors: RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA 15213, USA. stein@rand.org
authors: Bradley D
authors: BD
authors: Stein
authors: Jane N
authors: JN
authors: Kogan
authors: Mark J
authors: MJ
authors: Mihalyo
authors: James
authors: J
authors: Schuster
authors: Patricia E
authors: PE
authors: Deegan
authors: Mark J
authors: MJ
authors: Sorbero
authors: Robert E
authors: RE
authors: Drake
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000458:organization & administration; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D010358:Patient Participation; D018802:Patient-Centered Care; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D011619:Psychotropic Drugs