Session: Evaluation of a Telemedicine Intervention to Improve Adherence Outcomes Among Individuals with Severe Mental Illness (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

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. The tablet monitors medication dispensing activities and populates an electronic medication administration record. The tablet includes an app that can be accessed to monitor dispensing activity and alert when doses are missed. At the time of installation, patients are trained on using the device, and the device is set up with the appropriate dose times; an alarm sounds on the machine to indicate the dose time and will repeat every 15 minutes until medication is dispensed. 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 COVID-19 pandemic has underscored the need for developing effective telemedicine and telemonitoring technologies to serve the unique needs of this vulnerable population in community settings.

Eligibility criteria for participation in the study included: having an SMI (schizophrenia, bipolar disorder, or major depressive disorder), prescribed psychiatric medications, between 18 to 64 years old, and currently receiving mental health services from a community mental health agency. Participants included 185 clients who were recruited and enrolled from 28 regional community mental health agencies between the summer of 2019 and the winter of 2020. Data collection is ongoing and includes a variety of primary and secondary data sources to measure medication adherence, clinical outcomes, and cost-effectiveness of using the device for agencies. Using a stepped wedge randomized cluster design, clients were organized into 7 cohorts and the device rollout was staggered to randomize time from enrollment to treatment.

This symposium presents preliminary findings from three unique data sources gathered through this study, including (1) objective adherence trends from device dispensing data, (2) participant self-reported adherence and clinical outcomes from pre to post-intervention, and (3) an innovative time study method assessing cost-effectiveness of the device. Findings from the first two papers corroborate one another, providing sound evidence for the effectiveness of this telemedicine device to support adherence and key clinical outcomes. The third paper demonstrates the cost-effectiveness of this device for community mental health agency staff. Collectively, the presentations in the symposium demonstrate the benefits and value of the Medherent device for individuals with SMI as well as their service providers. This telemedicine intervention is especially relevant now, given the COVID-19 pandemic and resultant need to safely deliver mental health services to vulnerable populations.