Objectives. To compare approaches to maintaining medication compliance between two hospital-based intensive case management programs addressed to the severely mentally ill. Methods. Program staff filled out a questionnaire including the Multnomah Community Ability Scale (MCAS) and questions on their clinical activities, for all their clients. Staff also filled out "contact sheets" designed to capture essential elements of all contacts made with or on behalf of clients over a one-month period. Results. Program A delivered medications daily or almost to 45% of its clients (26/58), and administered injections to 21% (12/58). Program B delivered medications daily or almost to 7% of its clients (4/57) and administered injections to 44% (25/57). Contact sheet data indicate that program A staff spent 45% of their clinical time delivering medications and observing the client taking medications, compared to 1% for program B (p<0.001). Program B's clients had significantly lower MCAS scores than Program A's (p<0.01), indicating lower overall levels of functioning; yet staff ratings of medication compliance were similar between the two programs. Program B staff spent a greater proportion of time in clinical and psychosocial evaluation (26% vs. 6%) and money management (10% vs. 3%) activities. Conclusions. The results suggest that more or less labor-intensive approaches can be equally effective in maintaining medication compliance. Less frequent medication deliveries allows more time for other forms of intervention. We are exploring the implications of this for patient outcomes and levels of job satisfaction and burnout.
Learning Objectives: At the conclusion of this session, the participant in this session will be able to: 1. Apply the methods described to the analysis of approaches to maintaining medication compliance in intensive case management programs for the severely mentally ill 2. Recognize the potential impacts of alternative approaches to maintaining medication compliance in such programs
Keywords: Sever Mental Illness, Case Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Douglas hospital PACT team
Montreal General Hospital Community Link Program
Both intensive case management programs in Montreal, Canada
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employed by Douglas Hospital Research Centre and McGill University
Research funded by peer-reviewed Québec government grant