Using Innovative Methods to Conduct a Cost Analysis of Clinical Labor Related to Medication Monitoring for Persons with Severe Mental Illness

Background and Purpose: Individuals suffering from Severe Mental Illnesses (SMI) often suffer chronic health and mental health conditions that require ongoing medication treatment often managed through intensive community-based service delivery programs such as assertive community treatment (ACT) programs. To our knowledge, there is no existing literature regarding the cost of medication management tasks conducted by providers. As such we used innovative methods to generate a detailed understanding of how time is spent monitoring medications to persons with SMI, producing evidence to calculate a cost effectiveness analysis of medication monitoring activities related to clinical labor involved in medication monitoring.

Methods: Using an observational approach guided by the Work Observation Method by Activity Timing (WOMBAT) method, we used video recordings of clinical and administrative tasks related to medication management to measure staff time and then use labor costs to calculate the cost of the activity. Using key informant interviews, we developed a comprehensive classification system to capture the complexity of tasks, including administrative and general work tasks related to procuring medications from the pharmacy and creating medication tracking documents as well as direct clinical observation of SMI persons taking and counting their medications. All video recordings were coded using the classification system in NVIVO. Time stamps applied to each code were then transferred to STATA for the analysis.

Results: Using pilot data from 76 unique observations from 2 different community mental health organizations we estimated costs associated with direct observation of medication consumption and the related MAR documentation, shift accounting of controlled medications, weekly medication packing of medication pill box, and the administration of the monthly medication administration record (MAR). Analyses were based on an average client who takes three medications taken twice a day with one medication being a controlled medication such as a benzodiazepine or opiate. Estimates found that each month providers spend 3.9 hours on direct observation and documenting medication consumption, 1.5 hours on tracking controlled medications, 1.1 hours on medication packing and 1.1 hours on monthly MAR accounting. Thus, medication management takes 7.6 hours per month per client.

Conclusions and Implications: This is one of the first studies, to our knowledge, to analyze the costs associated with medication management in community mental health treatment centers. Study findings identify the medication administration tasks in which community mental health staff engage and estimate the cost of clinical labor involved in medication monitoring. Overall, these findings demonstrate that client use of the Medherent device could free agency staff of one full workday per client each month. The cumulative effect may be significant when considering agency staff caseloads can range from 5 to 20 clients. This “extra” staff time can be reallocated to provide additional forms of care that improve therapeutic relationships and clinical outcomes for clients. This cost analysis helps build a foundation for understanding the cost effectiveness of medication monitoring devices such as Medherent™.