Assessing Treatment Compliance Self-Reports Self-reports are commonly used to assess compliance. Examples include Likert scale questionnaires, handheld computers, and phone diaries.
Full Answer
What is the Guide to medication compliance in mental health patients?
Guide to Medication Compliance in Mental Health Patients 1 The Importance of Medication Compliance in Mental Health. ... 2 Patient Survey: Top Reasons for Noncompliance. ... 3 5 Best Practices for Noncompliance Intervention. ... 4 New Technologies for Improved Medication Compliance. ... 5 Conclusions and Next Steps. ...
How do you measure patient compliance?
A third method of measuring compliance is through reports by family and healthcare providers. Although this method is rarely used, except with young children, it can be valuable to compare self-reports to reports from third parties. Compliance increases when patients believe treatments are necessary and important.
How can we measure and improve quality of mental health care?
Several innovations are underway worldwide for measuring and improving quality of mental health care. These initiatives combine advances in technology or measurement‐based care with concerted efforts to obtain patient and provider buy‐in towards continuous quality measurement and improvement.
Why is treatment compliance important for individuals with comorbid mental illness?
Poor treatment compliance can worsen the prognosis and significantly increase health care costs. Effective methods to improve treatment compliance for individuals with comorbid mental illness and SUDs will translate in better outcome for the patients and significant health care cost savings.
How do you assess treatment compliance?
Medication adherence can be measured by several methods, including (a) self-report questionnaires or structured interviews, (b) therapeutic drug monitoring (TDM), (c) electronic devices, and (d) pick-up/refill rates.
How do you measure patient compliance?
Methods to measure adherence Indirect methods include patient questionnaires, patient self reports, pill counts, rates of prescription refills, assessment of patient's clinical response, electronic medication monitors, measurement of physiologic markers, as well as patient diaries.
How do we define treatment compliance?
Treatment compliance, according to an article in the European Society of Hypertension Scientific Newsletter, defined as "… the degree to which the patient conforms to medical advice about lifestyle and dietary changes as well as to keeping appointments for follow up and taking treatment as prescribed."
What is compliance in mental health?
Compliance with treatment, or treatment adherence, is a very important clinical issue. In prescribing medication, compliance usually means "the extent to which the patient takes the medication as prescribed" (Fawcett, 1995). Many mental disorders require more than just a brief medication intervention.
What is treatment adherence or compliance?
Medication adherence is the "act of filling new prescriptions or refilling prescriptions on time." Medication compliance is the "act of taking medication on schedule or taking medication as prescribed."
What is the most accurate method of measuring adherence?
Pharmacy records are accurate, inexpensive and easy and practical for adherence and persistent assessment. The two, most commonly, measured parameters in pharmacy claim databases are Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC).
What is the importance of treatment compliance?
Adherence and compliance are pivotal in ensuring an improved health outcome for the patient especially if he is suffering from a chronic condition and needs prolonged medical attention. Examples in this category include those with cardiovascular complications, diabetes and different forms of cancer.
Why is treatment compliance important?
Taking your medicine as prescribed or medication adherence is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being. A personal connection with your health-care provider or pharmacist is an important part of medication adherence.
How can patients comply with treatment regimens?
The following are ten strategies that providers can use to boost medication compliance.Understand each patient's medication-taking behaviors. ... Talk about side effects. ... Write it down. ... Collaborate with patients. ... Consider the financial burden to the patient. ... Assess health literacy. ... Reduce complexity. ... Follow up with patients.More items...•
What are the barriers to compliance?
Barriers are multifactorial and include treatment-related issues (e.g., side effects), mental health problems, and health system factors (e.g., lack of care coordination). In recent years, the role of social determinants of health has also become clear.
Why is medication compliance important in mental health?
Medication adherence is important to achieve your goals of treatment and ensure that medications work correctly. Not taking medications how they are prescribed could cause you to get sicker, decrease your quality of life, and increase your visits to the clinic or hospital.
What is the third method of measuring compliance?
Collateral Reports. A third method of measuring compliance is through reports by family and healthcare providers. Although this method is rarely used, except with young children, it can be valuable to compare self-reports to reports from third parties.
What is treatment compliance?
Treatment compliance is defined as the degree to which patients’ behaviors (e.g., attending follow-up appointments, engaging in preventive care, following recommended medical regimens) correspond with the professional medical advice prescribed. The terms compliance and adherence are often used interchangeably; however, because compliance may carry a negative connotation, some prefer to use adherence to emphasize patients’ active roles in healthcare management as opposed to the submissiveness suggested in the definition of compliance. This distinction in definition acknowledges that patients and providers can move away from the patriarchal model of health care, promotes patient autonomy, and takes into account evidence suggesting that those who adhere steadfastly to providers’ instructions may not be the healthiest psychologically or physically. While the patient’s active role is considered vital in committing to a treatment regimen, for the purposes of this overview, the term compliance is utilized to maintain consistency.
How does treatment compliance affect adolescents?
For children and adolescents, treatment compliance is influenced by numerous factors. In general, females are more compliant than males, and adolescents are less compliant than younger children. Among adolescents, researchers report that compliance may be related to adolescents’ needs for independence combined with their willingness (or lack thereof) to accept the authority of healthcare providers. For example, research suggests that a cancer diagnosis coupled with cognitive impairments resulting from aggressive treatments predicts poorer decision-making abilities, including higher incidences of high-risk behaviors (e.g., smoking, drug use). Self-esteem, cognitive and social functioning, lower socioeconomic status, lower parent education, feelings of invincibility, illness knowledge, perceived vulnerability, treatment complexity, emotional problems, and prevailing psychiatric illness also relate to compliance.
What are some examples of predictors of compliance?
Examples of predictors of compliance are readily available. Online surveys find that most cancer patients and providers believe good communication promotes compliance; unfortunately, relatively few providers are comfortable discussing alternative or complementary therapies. Additionally, research among HIV/AIDS (acquired immune deficiency syndrome) patients suggests that poor social support, underestimation of illness severity, lack of factual information (e.g., not knowing the difference between HIV and AIDS), healthcare system distrust, side effects, and beliefs that medications are ineffective all decrease compliance.
How does home health care improve compliance?
Home health care increases compliance by increasing satisfaction with staff and decreasing treatment administration wait times. As com-pared to home health care, similar improvements in compliance are identified through educational interventions aimed at enhancing disease and treatment knowledge and through behavioral interventions, which assist with pain management and pill-taking procedures. Healthcare providers often also emphasize relaxation therapy and systematic desensitization to control side effects and promote compliance, although these approaches are less empirically supported.
Why is compliance with asthma so problematic?
For example, among children with asthma, compliance is often problematic, because the disease can be unpredictable with long symptom-free periods.
How does compliance increase?
Compliance increases when patients believe treatments are necessary and important. Healthcare providers play a critical role in this process by helping patients weigh the risks and benefits while taking into consideration social contexts and perceived barriers. Successful compliance also requires that an individual develops the motivation and self-efficacy required to confront a long-term stressor.
Why is it important to practice medication compliance?
However, Gartner’s analysts say it’s particularly important for people with behavioral disorders and chronic conditions to practice medication compliance because noncompliance can lead to “worsening clinical status, emergency department visits and hospitalization.”
What are the best practices for noncompliance?
Here are five best practices that mental health professionals should incorporate into their medication noncompliance intervention strategies: 1. Practice empathy. Arauz says coming to terms with a psychiatric diagnosis can feel like “an absolute atom bomb for a lot of people” because it impacts their sense of self.
How to help patients with side effects?
To help patients withstand pain or discomfort due to side effects, practice empathy while discussing their symptoms. Also consider employing an SDM care model when adjusting their dosage or switching to an alternative prescription.
What is the importance of evaluating a patient's attitude toward medication?
Therefore, it’s important to evaluate whether someone has preconceived notions, fears, goals and/or hopes regarding a particular drug.
Is cognitive behavioral therapy the end all of recovery?
No matter how effective a medication may be at abating symptoms, it’s not the be-all and end-all of mental health recovery. Researchers recommend psychiatric patients leverage therapeutic support services, such as cognitive behavioral therapy, to create a more multifaceted approach to their well-being.
Do patients need a long term relationship with prescription drugs?
Not every patient requires a long-term relationship with prescription drugs, but those that do resent it. After all, 13 percent of our survey respondents cited a “fear of dependency” as a reason for their nonadherence.
Can a patient portal be integrated into a mental health EHR?
Consider investing in patient portal software, which can either be integrated into a mental health EHR system or purchased as a stand-alone system. For more detailed information on patient portal selection, implementation and engagement, read our full report here.
Why is adherence to treatment important?
Optimal treatment adherence is essential for the management of chronic conditions and the effectiveness of prescribed therapies. A World Health Organisation (WHO) report underlines the fact that adherence to chronic treatments is as low as 50% [1].
Why are different tools and measurements developed and validated?
Different tools and measurements have been developed and validated in order to effectively and accurately assess adherence and persistence in a wide range of diseases. Each has advantages and disadvantages that should be thoroughly taken into consideration when designing and choosing a suitable method.
What is the effect of low adherence in chronic conditions?
A low rate of adherence in chronic conditions is associated with poor outcome and decreased quality of life , which constitutes an additional burden for the healthcare systems.
What is adherence measured as?
Adherence is usually measured over a period of time and reported as a percentage, offering information about dose taking behavior in relation to what was prescribed. In some cases adherence is reported as dichotomous variable (adherent/ non-adherent) or classifying levels of adherence (low/high adherers) and even as a mean value.
Why is it important to increase adherence?
Being able to correctly identify and estimate treatment adherence has become a research focus in many chronic conditions, and the importance of increasing the effectiveness of adherence interventions is considered to “have a far greater impact on the health of the population than any improvement in specific medical treatments” [1,8]. However, effective interventions to improve treatment adherence can only be developed if research can also provide additional information about predictors and factors related to adherence, for a better understanding of the individual causes.
What is direct method?
Direct methods. Direct methods include measurements of the drug(or a metabolite) concentration in body fluids. Although it may be considered as being an adequate and precise method, which can offer strong evidence of the ingestion of the drug, there are some variables that should be considered.
What is non-invasive monitoring?
Non-invasive, patients not aware that they are being monitored
What affects treatment compliance in psychiatry?
In psychiatry, treatment compliance may be affected by factors associatedwith the therapist's characteristics, the service, the nature of the treatmentand the patient's idiosyncrasies. The therapist may not adhere to therecommended treatment guidelines or the therapy manual.
How does compliance affect psychiatry?
In psychiatry, treatment compliance may be affected by factors associatedwith the therapist's characteristics, the service, the nature of the treatmentand the patient's idiosyncrasies . The therapist may not adhere to therecommended treatment guidelines or the therapy manual. The services may affectcompliance if they are hard to access or have long wait times, long lapsesbetween appointments or complex administrative procedures. Treatments thatinvolve complex procedures, are hard to follow, have unpleasant side effects,take a while to produce the desired effect, and are either unavailable ordifficult to access may increase the chances of poor compliance. Thecharacteristics of the patient, such as the presence of comorbidmental illness and substance use disorders (SUDs),can greatly affect treatment compliance.
Why is bipolar disorder noncompliance?
For patients with bipolar disorder (BD), noncompliance was significantlyassociated with the presence of a comorbid SUD, andthe most common reported reason was denial of need for treatment. In a study byWeiss et al. (1998), compliance was significantly associated with treatmentwith divalproex (Depakote),compared to treatment with combined lithium (Eskalith,Lithobid). The study also showed that patients withBD and SUD who were prescribed benzodiazepines, neurolepticsand tricyclic antidepressants tended to take moremedication than prescribed.
Why are adolescents with comorbid mental illness and substance abuse a unique clinical population?
Adolescents with comorbid mental illness andsubstance abuse are a unique clinical population because of the high risk thatthe problems will continue or worsen during adulthood. A retrospective recordreview of one year of admissions to a residential adolescent substance abusetreatment program showed that patients with attention-deficit/hyperactivitydisorder and those with conduct disorder had the lowest treatment compliance (Wise et al., 2001).
How does poor treatment compliance affect health care?
Poor treatment compliance can worsen the prognosis and significantly increase health care costs. Effective methods to improve treatment compliance for individuals with comorbid mental illness and SUDs will translate in better outcome for the patients and significant health care cost savings. Compliance is a crucial determinant ...
What percentage of SUDs have compliance problems?
A survey of psychiatrists showed that 40% of their patientswith SUDs had treatment compliance problems (Herbeck et al., 2005). Both clinical and nonclinical factors appeared to be associated withtreatment compliance problems. Among the clinical factors, patients with lowtreatment compliance were more likely to have personality disorders, lowerglobal assessment of functioning scores and medication side effects than thosewithout treatment compliance problems (Herbeck etal., 2005).
How do clinicians, services, patients and treatment regimens work in tandem?
Clinicians, services, patients and treatment regimens should work in tandemto meet the particular clinical needs of patients with comorbiddisorders. Patients need to be supported and not blamed or punished withadministrative discharges for poor treatment compliance. Innovative approachesto improve treatment compliance for patients with comorbidmental illness and SUD can be cost-effective and make a significant publichealth contribution.
Abstract
The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines.
Background
Interest in evidence-based medicine (EBM) has grown exponentially. The focus has been on helping clinicians, patients and policy maker to use the best scientific evidence in their decision-making [ 1 ]. Several studies stress the difficulties of implementing EBM and the challenges of achieving performance change in health care [ 2 – 4 ].
Methods
The hypothesis to be tested were: the overall depression care quality score is higher for patients treated in implementation clinics than in control clinics and the overall suicidality care quality score is higher for patients treated in implementation clinics than in control clinics.
Results
At baseline 122 patient records were included at the implementation clinics and 61 at the control clinics. There were no age or gender differences between patients from the intervention and control clinics.
Discussion
This study showed that six months compliance to clinical guidelines for the treatment of depression and the management of suicide attempters measured by indicators of required clinical practice was enhanced by an active implementation. The clinics, to which the guidelines were only disseminated, showed no improvement.
Conclusion
The findings in this study suggest that compliance to clinical guidelines measured by indicators of required clinical practice was enhanced by an active implementation. The active implementation included four dimensions: strategic, cultural, technical and structural.
Acknowledgements
This research was supported by the Stockholm County Council, Sweden. The authors wish to express their thanks to all the participants in the implementations process and Susanne Wicks, statistician.
What is the lack of reliable and useful quality measures for mental and behavioral health services?
The lack of reliable and useful quality measures for mental and behavioral health services has been frequently cited by State policymakers. This section tries to address these concerns through a review of two national mental health initiatives that target or include children's mental health needs.
Who develops measures in the database?
Measures included in the database have been developed by government agencies, researchers, clinical and professional organizations, accreditors, health systems and facilities, employer purchasers, consumer coalitions, and commercial organizations.
What is the National CAHPS Benchmarking Database?
The National CAHPS Benchmarking Database (NCBD) is developing a national database of ECHO™ results.
How many questionnaires are required for CAHPS?
The CAHPS family of surveys requires a sample large enough to yield 300 completed questionnaires. Larger sample sizes may be required to get valid information on specific subpopulations. The CAHPS Survey and Reporting Kit proposes several sampling alternatives that can be applied to the child version of ECHO™.
What are the results of an indicator search of the database?
Results of an indicator search of the database include a description of the measure, appropriate data sources to use for the numerator and denominator of rates, and the developer of the measure.
What is the Child Health Toolbox?
The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children.
What is evidence level?
Evidence level, which is a rating by AHRQ as to the level of evidence. Treatment, including medication, psychotherapy, and case management. Domain of quality, such as access, prevention, and treatment. Clinical setting, such as inpatient, outpatient, home, and community.
What is outcome measurement in therapy?
Outcome measurement tools in mental health therapy also allow counselors to measure the impact of treatment over the course of time. If little-to-no progression occurs, the client and clinician can tweak the course of therapy to see better results.
How to assess effectiveness of therapy for OCD?
For example, one way to assess the effectiveness of therapy for a client with OCD is to monitor the frequency and/or amount of times she washes her hands. If her baseline for hand-washing at the start was 1-2 minutes at a time, or over 25 times a day, and through the course of treatment it decreased to twenty seconds at a time , or only ten times throughout the day, the process is proving successful.
Why are standardized instruments important?
Standardized instruments were developed to monitor whether or not treatment is effective, and measuring results aids both the client and clinician through the treatment process, regardless of whether you use self-reporting or performance-based measures. By setting goals with new clients, they can track their own progress over time, giving them the motivation to continue treatment and celebrate successes along the way.
How to use outcome methods in private practice?
The first step to using outcome methods in your private practice is to determine which specific standardized assessments suit your demands. Individual therapists will prefer different evaluation methods, so find the one you are most comfortable using. Then, create the goals—working with your new clients—to measure treatment effectiveness.
What is modern counseling?
Modern counseling has evolved to be a diverse practice with clinicians who embrace various methods, theories, and populations. In your private practice, while you may subscribe to a particular model, such as cognitive behavioral therapy, holistic health, strength-based, or others, you still temper treatments based on an individual client needs. ...
Is client-therapist alliance a predictor of positive clinical outcome?
A 2001 study published in Frontiers in Psychology found that “the quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measure.”.
Can you use the same outcome measurement tools in mental health?
Regardless of the method chosen, stick with the same outcome measurement tools in mental health treatment, instead of using one to start, and changing to a different one later. That would be comparing apples to oranges, and no significant value could be determined.
What is a mental health treatment plan?
At the most basic level, a mental health treatment plan is simply a set of written instructions and records relating to the treatment of an ailment or illness. A treatment plan will include the patient or client’s personal information, the diagnosis (or diagnoses, as is often the case with mental illness), a general outline ...
What is the part of effective mental health?
Part of effective mental health treatment is the development of a treatment plan. A good mental health professional will work collaboratively with the client to construct a treatment plan that has achievable goals that provide the best chances of treatment success. Read on to learn more about mental health treatment plans, how they are constructed, ...
What is the treatment contract?
Treatment Contract – the contract between the therapist and client that summarizes the goals of treatment. Responsibility – a section on who is responsible for which components of treatment (client will be responsible for many, the therapist for others)
Why do we need treatment plans?
Treatment plans can reduce the risk of fraud, waste, abuse, and the potential to cause unintentional harm to clients. Treatment plans facilitate easy and effective billing since all services rendered are documented.
What are the sections of a treatment plan checklist?
The checklist breaks down treatment plans into five sections: Problem Statements, Goals, Objectives, Interventions, and General Checklist.
What is intervention in therapy?
Interventions – the techniques, exercises, interventions, etc., that will be applied in order to work toward each goal. Progress/Outcomes – a good treatment plan must include space for tracking progress towards objectives and goals (Hansen, 1996)
What is blended care in therapy?
Blended care involves the provision of psychological services using telecommunication technologies.
How are measures of psychotherapy delivered?
Measures of whether specific psychotherapy content was delivered could be based on data collected through consumer or provider–reported surveys. When used for accountability purposes, such measures would have to consider the optimal timing and recall periods and the ability of consumers and providers to accurately report the content of treatment. In this section, we describe the strengths and limitations of measures that require consumers or providers to report the content of treatment; in the next chapter we discuss consumer-reported outcomes.
What are the three types of measures in psychotherapy?
We briefly describe some of the evidence supporting the most common psychotherapies and discuss three types of measures: (1) structure measures, which gauge the capacity of providers and health systems to deliver evidence-based psychotherapy; (2) process measures, which assess the delivery of psychotherapy, including whether the content and duration of psychotherapy resembles the treatment tested in efficacy trials; and (3) outcome measures, which assess improvements in symptoms and functioning among individuals receiving psychotherapy. For each type of measure, we discuss its potential benefits and the feasibility of using different data sources that could support it, focusing particularly on the extent to which each type of measure would inform quality improvement efforts for a broad group of stakeholders relative to its potential data collection and reporting burden (Teague et al. 2012). We then propose short-term, medium-term, and long-term opportunities for developing and implementing quality measures addressing psychotherapy.
What is the best treatment for PTSD?
Several types of psychotherapy can benefit individuals with the most prevalent mental disorders, including depression, anxiety, and post-traumatic stress disorder (PTSD). These psychotherapies include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), psychodynamic therapy, and several others. Although the strength of the evidence supporting each varies, these therapies have generally demonstrated positive outcomes for adults and children (Jakobsen et al. 2012; Cape et al. 2010). Several clinical guidelines for the treatment of depression, anxiety, and PTSD recommend psychotherapy either alone or in combination with medications (National Institute for Health and Clinical Excellence 2005, 2009, 2011; American Psychiatric Association 2006).
Why are structure measures important?
Structure measures are appealing as an initial step for setting expectations related to how providers should implement evidence-based psychotherapies and monitor consumer symptoms and functioning over time. This is particularly useful given the very limited information on the use of evidence-based therapies in routine settings and concerns that where the therapies are implemented they are not being done with sufficient adherence to protocols demonstrated to be efficacious in research trials. Furthermore, as described in a later chapter, processes for outcomes monitoring are critical because even in randomized trials showing the benefit of evidence-based treatment, many participants do not benefit and efforts to adjust treatment are needed. Structure measures are likely to serve best as building blocks to guide the delivery of care and as complements to other measures.
What is efficacy trial?
Efficacy trials of psychotherapy typically include a certain number of visits or an expected progression through phases of treatment. As psychotherapies move from efficacy trials to practice, the content and duration of treatment is often adapted to the provider's clinical orientation or the context of the treatment setting. In addition, treatments may be tailored to the consumer's illness severity, past experience with treatment or other characteristics. Adhering to the treatment protocols tested in trials may be challenging for a variety of practical reasons.
What are the benefits of psychotherapy?
Various types of psychotherapy can benefit people who experience depression, anxiety, and other common mental disorders. However, the extent to which these psychotherapies are available and delivered effectively is largely unknown. In the context of health care reforms that encourage performance measurement, a strong set ...
How long does psychodynamic therapy last?
Psychodynamic therapy is traditionally delivered over a relatively long period of time, sometimes years; recently, however, there has been greater interest in short-term psychodynamic therapy, which is generally a maximum of 40 sessions (Leichsenring 2005).
