Reduction of Prescription Non-Adherence and Non-Attendance through Mobile Technologies
Medication and attendance non-adherence is a common phenomenon among patients suffering from chronic psychiatric conditions such as schizophrenia (Thomas, Olotu & Omoaregba, 2019), and this results in low productivity, poor health outcomes, and increased healthcare costs.
Non-adherence to prescribed medications has been reported to affect 40-50% of patients suffering from chronic conditions in general (Kleinsinger, 2018), and in 35% of patients with chronic psychiatric conditions (Thomas et al., 2019).
Project Purpose Statement
The purpose of this project is to improve the health outcomes of patients with chronic psychiatric conditions such as schizophrenia through the implementation of mobile health technology with features such as reminders for scheduled appointments and communication capabilities.
The overarching aim of this project is to reduce the rate of hospitalization of patients with chronic psychiatric conditions at ABC Medical Center by enhancing medication and scheduled appointment adherence through mobile health technology.
- To improve medication adherence by patients with chronic psychiatric conditions by at least 40% over a 12-month period.
- To identify and launch at least one mobile health technology for the reduction of non-adherence to medication within the next 6 months.
- To train all staff and at least 80% of the patients suffering from chronic psychiatric conditions and being managed by the hospital by the end of one year.
- Education of healthcare staff concerning the use of the identified technology.
- Patient education on technology use.
- Administration of the technology to patient and staff groups for implementation and monitoring.
Plan for Sustainability
The sustainability of the project will be ensured through continuous training of staff and patients, as well as cost sharing with the patients on subscriptions to reduce the financial constraints that may arise.
A report on the performance of ABC Medical Center recently showed poor health outcomes among patients with chronic psychiatric conditions; the medical records of individual patients showed a high prevalence of non-adherence to scheduled appointments and medication by those patients.
The key stakeholders in this project will include patients, healthcare providers, such as nurses, general physicians, and specialists, patient families, and hospital administrative staff who will finance its implementation.
Alignment with Hospital Mission, Vision, and Goals Statements
The project will promote progress towards organizational mission, vision, and goals statements by enhancing the quality of care, patient safety, and delivering patient-centered care.
Medication non-adherence is a significant challenge in healthcare that remains unmet. Research by Thomas et al. (2019) showed that nearly 35% of patients with chronic psychiatric conditions exhibit non-adherence to scheduled appointments and a similarly high number fail to adhere to scheduled medication, which leads to negative patient health outcomes and increased healthcare costs. Studies by Kim, Combs, Downs, and Tillman III (2018) and Lee et al. (2018) indicate that most research on medication non-adherence focuses on the barriers with the assumption that non-adherence is an aberration.
The challenge of non-adherence to scheduled appointment and medication needs to be addressed hence the proposed project. Promoting adherence to medication is one of the strategies for improving health outcomes as non-adherence has been linked to poor health outcomes and low productivity (Harrison, 2018; Addo, Sencherey, & Babayara, 2018). Non-adherence to scheduled appointments on the other hand, is reported to be linked to factors such income levels and education (Lucca et al., 2015), hence the need to address the issue through the use of technology.
The proposed intervention is the use mobile health technologies embedded with reminders and prescription managers in healthcare to improve schedule and medication adherence. Marcolino et al. (2018) reported the effectiveness of such technology. Silva et al. (2015) also described the advancement of mobile health technologies with the expansion of information technology application in healthcare.
The Self-Care Theory of Dorothy Orem
Quality Improvement Model
The Plan-Do-Study-Act (PDSA Cycle
Among patients with chronic psychiatric illnesses, how effective is mobile health technology compared with no intervention for the reduction of non-attendance of scheduled appointments and enhancement adherence to medication?
Implementing mobile health technologies can help to improve health outcomes of patients with chronic psychiatric conditions such schizophrenia, reduce the rates of readmission among the patient group, and generally increase the quality of life of those patients.
Addo, B., Sencherey, S., & Babayara, M. N. K. (2018). Medication noncompliance among patients with chronic diseases attending a primary health facility in a periurban district in Ghana. International Journal of Chronic Diseases.https://www.hindawi.com/journals/ijcd/2018/7187284/
Harrison, E. (2018). The cost of not taking our medicine: The complex causes and effects of low medication adherence. The American Journal of Accountable Care, 6(4), 411-e13. https://www.ajmc.com/journals/ajac/2018/2018-vol6-n4/the-cost-of-not-taking-our-medicine-the-complex-causes-and-effects-of-low-medication-adherence
Kim, J., Combs, K., Downs, J., & Tillman III, F. (2018). Medication adherence: The elephant in the room. U.S. Pharmacist. https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room
Kleinsinger, F. (2018). The unmet challenge of medication nonadherence. The Permanente Journal, 22, 18-033. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/#:~:text=This%20nonadherence%20to%20prescribed%20treatment,physician%20or%20health%20system%20problem.
Lee, S-Q., Raamkumar, A. S., Li, J., Cao, Y., Witedwittayanusat, K., Chen, L., & Theng, Y-L. (2018). Reasons for primary medication non-adherence: A systematic review and metric analysis. Journal of Managed Care & Specialty Pharmacy, 24(8), 778-794. https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.8.778
Lucca, J. M., Ramesh, M., Parthasarathi, G., & Ram, D. (2015). Incidence and factors associated with medication nonadherence in patients with mental illness: A cross-sectional study. Journal of Postgraduate Medicine, 61(4), 251-256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943371/
Marcolino, M. S., Oliveira, J. A. Q., D’Agostino, M., Ribeiro, A. L., Alkmim, M. B. M., & Norvillo-Ortiz, D. (2018). The impact of mHealth interventions: Systematic review of systematic reviews. JMIR mHealth and uHealth, 6(1), e23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792697/
Silva, B. M. C., Rodrigues, J. P. C., de la Torre Diez, I., Lopez-Coronado, M., & Saleem, K. (2015). Mobile-health: A review of current state in 2015. Journal of Biomedical Informatics, 56, 265-272. https://www.sciencedirect.com/science/article/pii/S1532046415001136
Thomas, F. I., Olotu, S. O., & Omoaregba, J. O. (2018). Prevalence, factors and reasons associated with missed first appointments among out-patients with schizophrenia at the Federal Neuro-Psychiatric Hospital, Benin City. BJPsyche Open, 4, 49-54. https://www.researchgate.net/publication/323344389_Prevalence_factors_and_reasons_associated_with_missed_first_appointments_among_out-patients_with_schizophrenia_at_the_Federal_Neuro-Psychiatric_Hospital_Benin_City