Mental Health Care Provider's Perspectives Toward Adopting a Novel Technology to Improve Medication Adherence
Abstract
Objective
Methods
Results
Conclusions
Key Points
METHODS
Study Design
Identification and Selection of Study Participants
Questionnaire Design and Development
Recruitment and Participation
Statistical Analysis
RESULTS
Respondent Characteristics
Prescribing clinicians | Non‐prescribing clinicians | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Physicians | Nurses | Social work (case mgr) | Counselor | Psychology | ||||||
N = 104 | N = 27 | N = 66 | N = 37 | N = 16 | ||||||
N | % | N | % | N | % | N | % | N | % | |
Gender | ||||||||||
Female | 52 | 50.0% | 22 | 81.5% | 53a | 80.3% | 32 | 86.5% | 9 | 56.3% |
Male | 50 | 48.1% | 3 | 11.1% | 11 | 16.7% | 5 | 13.5% | 7 | 43.8% |
Other/unknown | 2 | 1.9% | 2 | 7.4% | 2 | 3.0% | 0 | 0.0% | 0 | 0.0% |
Age (mean) | ||||||||||
18–35 | 14 | 13.5% | 5 | 18.5% | 20 | 30.3% | 12 | 32.4% | 1 | 6.3% |
36–55 | 66 | 63.5% | 8 | 29.6% | 31 | 47.0% | 16 | 43.2% | 9 | 56.3% |
56+ | 24 | 23.1% | 14 | 51.9% | 15 | 22.7% | 9 | 24.3% | 6 | 37.5% |
Years practicing | ||||||||||
≤5 years | 4 | 3.8% | 2 | 7.4% | 18 | 27.3% | 11 | 29.7% | 3 | 18.8% |
6–10 years | 26 | 25.0% | 11 | 40.7% | 15 | 22.7% | 10 | 27.0% | 4 | 25.0% |
11–20 years | 36 | 34.6% | 9 | 33.3% | 15 | 22.7% | 11 | 29.7% | 4 | 25.0% |
21+ years | 38 | 36.5% | 5 | 18.5% | 18 | 27.3% | 5 | 13.5% | 5 | 31.3% |
% Of patients on medicaid | ||||||||||
≤25% | 57 | 54.8% | 19 | 70.4% | 22 | 33.3% | 13 | 35.1% | 11 | 68.8% |
26–50% | 23 | 22.1% | 5 | 18.5% | 10 | 15.2% | 5 | 13.5% | 2 | 12.5% |
>50% | 24 | 23.1% | 3 | 11.1% | 34 | 51.5% | 19 | 51.4% | 3 | 18.8% |
Practice setting | ||||||||||
Individual practice | 39 | 37.5% | 8 | 29.6% | 8 | 12.1% | 5 | 13.5% | 4 | 25.0% |
Group office practice | 19 | 18.3% | 10 | 37.0% | 5 | 7.6% | 3 | 8.1% | 4 | 25.0% |
Public psychiatric hospital | 11 | 10.6% | 2 | 7.4% | 4 | 6.1% | 1 | 2.7% | 1 | 6.3% |
Public clinic or outpatient facility | 9 | 8.7% | 2 | 7.4% | 18 | 27.3% | 8 | 21.6% | 1 | 6.3% |
Mental health center | 7 | 6.7% | 1 | 3.7% | 13 | 19.7% | 7 | 18.9% | 1 | 6.3% |
Private psychiatric hospital | 6 | 5.8% | 0 | 0.0% | 1 | 1.5% | 0 | 0.0% | 1 | 6.3% |
Private clinic or outpatient hospital | 4 | 3.8% | 2 | 7.4% | 4 | 6.1% | 0 | 0.0% | 1 | 6.3% |
Private, public general hospital | 4 | 6.1% | 1 | 2.7% | 0 | 0.0% | ||||
Other work setting | 9 | 8.7% | 2 | 7.4% | 9 | 13.6% | 12 | 32.4% | 3 | 18.8% |
Beliefs About Medication Adherence
Question | Prescribing clinicians | Non‐prescribing clinicians | ||||
---|---|---|---|---|---|---|
N = 131 | N = 119 | |||||
N | % | ƒ | % | Odds ratio | 95% CI | |
Drivers of adoption | ||||||
This product is likely to _________________ | ||||||
Increase efficiency | 10 | 7.6% | 17 | 14.3% | 2.1 | (1.1, 3.9) |
Improve outcomes | 102 | 77.9% | 71 | 59.7% | ||
Have no effect | 15 | 11.5% | 21 | 17.6% | ||
Decrease efficiency | 2 | 1.5% | 5 | 4.2% | ||
Decrease outcomes | 2 | 1.5% | 5 | 4.2% | ||
Using the ingestible event marker sensor technology is in my patient's best interest. | ||||||
Agree | 99 | 75.6% | 60 | 50.4% | 3.0 | (1.8, 5.4) |
Disagree | 32 | 24.4% | 59 | 49.6% | ||
This product is likely to ____________ patient engagement with their treatment | ||||||
Increase | 94 | 71.8% | 59 | 49.6% | 2.6 | (1.5, 4.4) |
Decrease | 13 | 9.9% | 28 | 23.5% | ||
Have no effect on | 24 | 18.3% | 32 | 26.9% | ||
Using this technology will ____________ my clinical alliance with patients | ||||||
Enhance | 85 | 64.9% | 63 | 52.9% | 1.6 | (1.0, 2.7) |
Erode | 46 | 35.1% | 56 | 47.1% | ||
This product is likely to decrease inter‐visit contacts with patients | ||||||
Agree | 62 | 47.3% | 49 | 41.2% | NS | |
Disagree | 69 | 52.7% | 70 | 58.8% | ||
Barriers to adoption | ||||||
"I Would not adopt this technology because…" | ||||||
It might require 24/7 monitoring | ||||||
Agree | 39 | 29.8% | 62 | 52.1% | 0.4 | (0.2, 0.7) |
Disagree | 92 | 70.2% | 57 | 47.9% | ||
I'm unsure of my responsibility when using it | ||||||
Agree | 86 | 65.6% | 89 | 74.8% | NS | |
Disagree | 45 | 34.4% | 30 | 25.2% | ||
It's data I do not normally collect | ||||||
Agree | 73 | 55.7% | 78 | 65.5% | NS | |
Disagree | 58 | 44.3% | 41 | 34.5% | ||
I'm unclear on follow‐up actions | ||||||
Agree | 57 | 43.5% | 68 | 57.1% | 0.6 | (0.4, 0.9) |
Disagree | 74 | 56.5% | 51 | 42.9% | ||
It might make it difficult to accept new patients | ||||||
Agree | 38 | 29.0% | 50 | 42.0% | 0.6 | (0.3, 0.9) |
Disagree | 93 | 71.0% | 69 | 58.0% | ||
I lack knowledge about adherence drivers | ||||||
Agree | 28 | 21.4% | 49 | 41.2% | 0.4 | (0.2, 0.7) |
Disagree | 103 | 78.6% | 70 | 58.8% | ||
I would like to be a beta site for this technology | ||||||
Agree | 68 | 51.9% | 59 | 49.6% | ||
Disagree | 63 | 48.1% | 60 | 50.4% | NS |
Barriers and Drivers of Support for the IEM Technology
Prescribing clinicians | Non‐prescribing clinicians | ||||||||
---|---|---|---|---|---|---|---|---|---|
Best interest | Not best interest | Odds ratio | 95% CI | Best interest | Not best interest | Odds ratio | 95% CI | ||
Question to prescriber | 99% | 32% | 60% | 59% | |||||
Clinician characteristics | |||||||||
Clinician | Physician | 82.8% | 68.8% | NS | ‐ | ‐ | |||
Nurse | 17.2% | 31.3% | ‐ | ‐ | |||||
Psychologist | 16.7% | 10.2% | NS | ||||||
Social work | 50.0% | 61.0% | |||||||
Counselor | 33.3% | 28.8% | |||||||
Clinician sex | Female | 55.6% | 59.4% | NS | 75.0% | 86.0% | NS | ||
Male | 41.4% | 37.5% | 25.0% | 14.0% | |||||
Years in practice | 0–5 years | 4.0% | 6.3% | NS | 30.0% | 23.7% | NS | ||
6–10 years | 28.3% | 28.1% | 25.0% | 23.7% | |||||
11–20 years | 34.3% | 34.4% | 26.7% | 23.7% | |||||
21+ years | 33.3% | 31.3% | 18.3% | 28.8% | |||||
Condition managed | MDD | 31.3% | 46.9% | 1 | 25.00% | 44.10% | 1 | ||
Bipolar I disorder | 34.3% | 37.5% | 1.4 | (0.6, 3.4) | 41.70% | 23.70% | 3.1 | (1.2, 7.7) | |
Schizophrenia | 34.3% | 15.6% | 3.3 | (1.1, 10.1) | 33.30% | 32.20% | 1.8 | (0.7, 4.5) | |
Perspectives on adherence | |||||||||
Clinicians influence adherence to oral antipsychotic medication? | Agree | 96.0% | 93.8% | NS | 93.3% | 88.1% | NS | ||
Disagree | 4.0% | 6.3% | 6.7% | 10.2% | |||||
Concerned about self‐reported adherence | Agree | 93.9% | 84.4% | NS | 93.3% | 79.7% | 3.6 | (1.1, 11.8) | |
Disagree | 6.1% | 15.6% | 6.7% | 20.3% | |||||
Adherence reduces consequences of the disorder | Agree | 89.9% | 71.9% | 3.5 | (1.3, 9.6) | 96.7% | 79.7% | 7.4 | (1.6, 34.7) |
Disagree | 10.1% | 28.1% | 3.3% | 20.3% | |||||
Adequate time to assess medication adherence | Agree | 84.8% | 81.3% | NS | |||||
Disagree | 15.2% | 18.8% | |||||||
Assessing adherence important service provided | Agree | 91.7% | 88.1% | NS | |||||
Disagree | 8.3% | 11.9% | |||||||
Concerned about adequately monitor adherence | Agree | 72.7% | 50.0% | 2.7 | (1.2, 6.1) | 53.3% | 50.8% | NS | |
Disagree | 27.3% | 50.0% | 46.7% | 49.2% | |||||
Concerned for patients' well‐being without adequate monitoring | Agree | 97.0% | 75.0% | 10.7 | (2.6, 43.3) | 86.7% | 67.8% | 3.1 | (1.2, 7.8) |
Disagree | 3.0% | 25.0% | 13.3% | 32.2% | |||||
Confident estimating patient's medication adherence | Agree | 64.6% | 71.9% | NS | 75.0% | 64.4% | NS | ||
Disagree | 35.4% | 28.1% | 25.0% | 35.6% |
Prescribing clinicians | Non‐prescribing clinicians | ||||||||
---|---|---|---|---|---|---|---|---|---|
Yes | No | Odds ratio | 95% CI | Yes | No | Odds ratio | 95% CI | ||
Question to prescriber | 68% | 63% | 59% | 60% | |||||
Clinician characteristics | |||||||||
Clinician | Physician | 79.4% | 79.4% | NS | ‐ | ‐ | |||
Nurse | 20.6% | 20.6% | ‐ | ‐ | |||||
Psychologist | 20.3% | 6.7% | NS | ||||||
Social work | 49.2% | 61.7% | |||||||
Counselor | 30.5% | 31.7% | |||||||
Clinician sex | Female | 55.9% | 57.1% | NS | 78.0% | 80.0% | NS | ||
Male | 39.7% | 41.3% | 22.0% | 16.7% | |||||
Years in practice | 0 to 5 years | 5.9% | 3.2% | NS | 27.1% | 26.7% | NS | ||
6 to 10 years | 26.5% | 30.2% | 23.7% | 25.0% | |||||
11 to 20 years | 30.9% | 38.1% | 30.5% | 20.0% | |||||
21+ years | 36.8% | 28.6% | 18.6% | 28.3% | |||||
Condition managed | MDD | 29.4% | 41.3% | NS | 27.1% | 41.7% | NS | ||
Bipolar I disorder | 33.8% | 36.5% | 37.3% | 28.3% | |||||
Schizophrenia | 36.8% | 22.2% | 35.6% | 30.0% | |||||
Perspectives on adherence | |||||||||
Clinicians influence adherence to oral antipsychotic medication? | Agree | 95.6% | 95.2% | NS | 91.5% | 91.7% | NS | ||
Disagree | 4.4% | 4.8% | 8.5% | 8.3% | |||||
Concerned about self‐reported adherence | Agree | 97.1% | 85.7% | 5.5 | (1.1, 26.5) | 94.9% | 78.3% | 5.2 | (1.4, 19.2) |
Disagree | 2.9% | 14.3% | 5.1% | 21.7% | |||||
Adherence reduces consequences of the disorder | Agree | 88.2% | 82.5% | NS | 94.9% | 81.7% | 4.2 | (1.1, 15.9) | |
Disagree | 11.8% | 17.5% | 5.1% | 18.3% | |||||
Adequate time to assess medication adherence | Agree | 80.9% | 87.3% | NS | |||||
Disagree | 19.1% | 12.7% | |||||||
Assessing adherence important service provided | Agree | 91.5% | 88.3% | NS | |||||
Disagree | 8.5% | 11.7% | |||||||
Concerned about adequately monitor adherence | Agree | 79.4% | 54.0% | 3.3 | (1.5, 7.1) | 49.2% | 55.0% | NS | |
Disagree | 20.6% | 46.0% | 50.8% | 45.0% | |||||
Concerned for patients' well‐being without adequate monitoring | Agree | 95.6% | 87.3% | NS | 88.1% | 66.7% | 3.7 | (1.4, 9.6) | |
Disagree | 4.4% | 12.7% | 11.9% | 33.3% | |||||
Confident estimating patient's medication adherence | Agree | 60.3% | 73.0% | NS | 79.7% | 60.0% | 2.6 | (1.2, 5.9) | |
Disagree | 39.7% | 27.0% | 20.3% | 40.0% |
Question | Response | Patients' best interest | Interest in beta testing | ||
---|---|---|---|---|---|
Odds ratio | 95% CI | Odds ratio | 95% CI | ||
Clinician type | Non‐prescriber | 1 | NS | ||
Prescriber | 2.2 | (1.1, 4.5) | |||
MEMS (continuous 1–6 ranking) | 0.76 | (0.6, 0.9) | 0.77 | (0.6, 0.9) | |
Concerned for patients' well‐being without adequate monitoring | Disagree | 1 | NS | ||
Agree | 3.3 | (1.2, 8.7) | |||
Adherence reduces consequences of the disorder | Disagree | 1 | NS | ||
Agree | 3.8 | (1.3, 11.0) | |||
I'm unclear on follow‐up actions | Disagree | 1 | NS | ||
Agree | 0.4 | (0.2, 0.9) | |||
I'm unsure of my responsibility when using it | Disagree | 1 | 1 | ||
Agree | 0.3 | (0.1, 0.8) | 0.5 | (0.2, 0.9) | |
This product is likely to decrease inter‐visit contacts with patients | Disagree | 1 | NS | ||
Agree | 2.07 | (1.0, 4.2) | |||
Using this technology will ____________ my clinical alliance with patients | Erode | 1 | 1.0 | ||
Enhance | 3.1 | (1.5, 6.3) | 6.0 | (3.1, 11.6) | |
Increase patient engagement with treatment | Decrease/no effect | 1 | 1 | ||
Increase | 3.0 | (1.5, 6.2) | 2.3 | (1.2, 4.5) | |
Concerned about self‐reported adherence | Disagree | NS | 1 | ||
Agree | 5.5 | (1.6, 18.8) |
DISCUSSION
Study limitations
CONCLUSIONS
Footnotes
REFERENCES
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