(WITHDRAWN) Feasibility and Acceptability of a Telemedicine Device to Improve Adherence Outcomes Among Individuals with Severe Mental Illness

Background/Purpose: Individuals with severe mental illnesses (SMI) are at risk for adverse health and social outcomes, leading to 15 fewer years of life compared to the general population. Pharmacological treatments have limited effectiveness because 50 – 70% of individuals with SMI do not take their medication as prescribed. Lack of real-time information on adherence leads to medication and dosing changes, interfering with patient adherence and patient-provider relationships. In response to these challenges, Terrapin Pharmacy developed the Medherent™ telemedicine platform, which is a small vending machine, installed in consumers’ homes, that incorporates a networked tablet and is loaded with up to a 30-day supply of medications in multi-dose packets. In 2018, Terrapin Pharmacy and the University of Maryland School of Social Work collaborated on a NIMH funded SBIR to conduct a clinical trial of the device with community mental health agencies. The current study includes two phases: Phase I examined the feasibility and acceptability of the device; Phase II is underway and will evaluate the adherence and clinical outcomes of the device. This presentation will discuss findings from Phase I, enrollment data from Phase II, and updates on the progress of the Phase II study.

Method: In Phase I, 20 consumers using the device and 20 case managers from participating agencies were interviewed with structured usability assessments and open-ended interviews. Qualitative data were coded and analyzed using NVIVO. Dispensing data were also collected from the devices to examine adherence rates using multilevel models. In Phase II, 147 clients were recruited and consented. We conducted enrollment interviews for all participants using the study instrument which measured self-reported psychiatric symptoms, medication adherence, and therapeutic relationships. Using a stepped-wedge randomized design, clients were organized into 5 cohorts and device rollout was staggered. Each participant has/will be interviewed at baseline, one, six and 12-month follow-up. At present, we have completed installations and baseline interviews for Cohorts 1 through 4, and one-month follow-ups for Cohorts 1, 2, and 3.

Results: Phase I qualitative data indicate that clients found the device simple to use and had positive attitudes toward the device. Consumers that stopped using the device reported residential instability and difficulty incorporating the device into their schedule as reasons for discontinuing use. Case managers expressed satisfaction and optimism for the device’s potential to improve workflow and consumer outcomes. Quantitative data from machine dispensing records indicate that 88% of doses were dispensed. Descriptive analysis of enrollment data indicate that our phase II sample had slightly higher depressive symptoms, lower cognitive function and lower emotional and behavioral dyscontrol compared to the general population.

Implications: Phase I data suggest that community mental health consumers using the device have high rates of medication dispensing, suggesting positive adherence outcomes. Phase II will test whether the intervention can be implemented in community mental health agencies and improve delivery of care. We hypothesize that the Medherent™ platform’s ability to accurately monitor medication adherence and health status between patient encounters will improve agency responsiveness, increase service efficiency and optimization, and foster greater consumer independence.