Details

Autor(en) / Beteiligte

• Velligan, Dawn
• Sajatovic, Martha

Titel

26.1 MULTI-LEVEL FACILITATION OF LONG-ACTING ANTIPSYCHOTIC USE/MAP IN ENGAGEMENT FOCUSED CARE

Ist Teil von

• Schizophrenia bulletin, 2019-04, Vol.45 (Supplement_2), p.S131-S132

Ort / Verlag

US: Oxford University Press

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract Background The costs of serious mental illness (SMI) are $317 billion annually in the U.S. Antipsychotic medications are evidence-based treatments for SMI that improve health outcomes and reduce costs. However, rates of non-adherence can exceed 60%. Poor adherence is associated with relapse, homelessness, hospitalization, and increased costs of care. ITreatment guidelines for SMI recommend long acting injectable (LAI) medications for a wide range of patients who have trouble taking daily oral medications. However, LAI is vastly underused, with less than one in five eligible individuals receiving treatment. If adherence with antipsychotic medication in people with schizophrenia could be increased by as little as 20%, the estimated Medicaid annual savings in re-hospitalization alone would be in the order of $7,500 million. Improving adherence and the appropriate use of antipsychotic medication in people with SMI is thus a matter of critical public health importance. Methods We describe an approach to increasing the appropriate use of LAI for individuals with schizophrenia; Multi-level facilitation of long-acting AntiPsychotic use/MAP. MAP is a novel behavior change intervention drawn from evidence-based approaches and designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer 2) the provider and 3) the administrator and uses a variety of techniques including peer support, academic detailing, incentives and feedback to increase the appropriate use of LAI for individuals who are not receiving optimum benefit from current antipsychotic therapy. For administrators MAP focuses on getting buy-in by providing information on how appropriate use of LAI may help them maximize quality of care. Administrators nominate “key change champions” who take on the role of working with prescribers to meet clear behavioral objectives. Academic detailing for prescribers is provided by international experts and the local change champion and uses the repetition of digestible key messages to address common misconceptions about LAI and ways of making good offers of LAI which focus on the potential benefits for the consumer’s recovery goals To increase the ease of identifying patients for whom a medication change to LAI may be helpful, we developed a very brief checklist to use at clinic appointments to help prescribers recognize individuals who may not be receiving optimal benefit (NOB) from antipsychotic medication. The NOB checklists asks only 5 questions (Is the person missing any doses of medication? Are they being treated with two antipsychotic medications? Are there frequent antipsychotic medication changes? Has the person been hospitalized or had an emergency/crisis visit? Is the person dissatisfied with their current treatment?) If any of the questions are answered “yes” the clinician is then asked whether they have offered and LAI. Consumers receive support from a peer specialist currently on LAI who shows them a video about Shared Decision Making prior to the visit. The video outlines the importance of telling the prescriber key information, asking questions, choosing a plan, and researching and reviewing progress. The peer provides them with a decision tool and answers any questions about his own experience with LAI. Four clinics in Texas and Ohio were randomized to use the NOB checklist only or to the entire MAP program with the NOB, academic detailing and patient peer support. Results Patients appreciate and enjoy the video which follows a patient through a visit and describes the use of shared-decision making. After viewing pros and cons of LAI versus tablets, many individuals ask their prescriber for LAI. Prescribers were initially somewhat resistant to using the NOB checklist believing that they always had LAI at the forefront of their thinking. However, they were surprised to learn the percentage of individuals on LAI versus oral. In offers of LAI they were not tying the offer to patient desired outcomes and recovery goals. Conclusions The purpose of the implementation of the MAP program is to determine whether the appropriate use of LAI can be increased by targeting all stakeholders. We will examine LAI versus oral antipsychotic prescribing at both control and MAP clinics. Results will be discussed with an eye toward barriers to implementation and dissemination.