Background: Fifteen minutes is the typical length of an outpatient medication management appointment for people with serious mental health conditions. These brief interactions with prescribers are frequently provider driven with less than enough time focused on the patient's individual needs and personal recovery. Shared decision making is a strategy that could improve this interaction. Although strategies to support shared decision making in mental health care exist, little is known about their impact on outcomes that matter most to patients with serious mental illness. Our study explores how technology can be used in the care process to amplify the voice of the patient, support shared decisions, and improve treatment outcomes.
Objectives: Building on prior work, we will compare two ways for patients and prescribers to engage in shared decision making around medication treatment appointments in community mental health clinics: person-centered care and measurement-based care. Our research addresses three questions that patients have identified as important to them:
- Are there ways I can be more involved in my care that will result in better outcomes?
- How likely am I to benefit from improved communication with my prescriber? and
- How will shared decision making support my personal recovery and overall wellness?
Our study aims will answer these questions. Aims 1 and 2: Compare the effectiveness of measurement-based care vs. person-centered care on a range of patient-centered outcomes. Aim 3: Examine differences in patient-centered outcomes depending upon an individual's experience with medication treatment, level of intervention use, and the severity of their mental illness.
Methods: Our study will include up to 3,000 adults who have Medicaid as their health insurance and receive medication treatment at one of 14 community mental health clinics across Pennsylvania. Over 2 years, each clinic will provide one of the two shared decision-making approaches for medication treatment. We will collect information from patients at several points in time during the study. Patients will be asked to complete questionnaires, and additional data on their service use will be used. Some patients and providers will also be interviewed about their experiences with care. We will examine these data to learn if, how, and why the new services improve outcomes. This information will help us to understand patient and other stakeholder views about the new approaches and, if appropriate, ensure their continued and/or expanded availability.
Patient Outcomes: Patients determined the following outcomes to be most important to include in this study: the experience of medication treatment, involvement in shared decision making, activation and empowerment, engagement in outpatient mental health services, management of medication side effects, mental health symptom severity, functional status, and quality of life.
Johnson-Kwochka A, Carpenter-Song E, Griesemer I, et al. First-Person Perspectives on Prescriber-Service User Relationships in Community Mental Health Center Psychiatric Services (June 2017).
Torrey WC, Griesemer I, Carpenter-Song EA., Beyond "Med Management", Psychiatric Services (March 2017).