Referring Adult Depressed Psychiatric Patients From Primary Care To Mental Health Specialist To Improve Medication Compliance

Referring adult depressed psychiatric patients from primary care to mental health specialist to improve medication compliance
Student Name: Benjamin A. Omaiye
Professor: M. Hill
Course Title:Signature assignment Statistics 701
Date: 10/13/17
Abstract
Depression is a chronic illness which is most often first noticed within primary care settings, placing clinicians in these settings in a unique position to offer early diagnosis as well as management (Lingam & Scott, 2014). Nonadherence to antidepressant medications contributes very much to the under treatment of depression in psychiatric patients within primary care settings (Chong, Aslani & Chen, 2011). The purpose of this clinical scholarly project is to look into whether referring adult depressed psychiatric patients from primary care to mental health specialists helps in improving patient medication compliance. The population being addressed in the research comprises adult depressed psychiatric patients. The sample size is forty (n = 40). The data collected was analyzed using SPSS software. The overall results of the study showed that the rate of medical adherence for the depressed psychiatric patients rose by 30% from 42.5% at the primary care setting to 72.5% after they were referred to a mental health specialist. The implication is that adult psychiatric patients who have depressive disorders in primary care should always be referred to mental health specialists as this helps to improve their adherence to medicines.
Referring adult depressed psychiatric patients from primary care to a mental health specialist to improve medication compliance
Overview
This chapter of the paper introduces the problem and summarizes the significance. The problem being investigated in this clinical scholarly project is whether referring adult depressed psychiatric patients from primary care to mental health specialists helps in improving their adherence to medications. Non-adherence to medications for depression is a major impediment to successfully treating depression in clinical practice (Chong, Aslani & Chen, 2011). Adherence is understood as the degree to which the behaviour of an individual is consistent with the medical advice provided (Chong, Aslani & Chen, 2011). There are 2 major facets of adherence problems with the antidepressant medicines: medication non-compliance, which is the lack of consistency with the treatment regime in the context of ongoing use, and medication non-persistence or premature discontinuation of antidepressants (Lingam & Scott, 2014).
Depression is a chronic illness which is most often first noticed within primary care settings, placing clinicians in these settings in a unique position to offer early diagnosis as well as management (Rowland & Bower, 2010). Researchers have reported that a lack of experience and training, a lack of access to mental health specialists, and time constraints greatly increase primary care clinicians’ discomfort levels whenever they work with depressed patients (Rowland & Bower, 2010). Nonadherence to antidepressant medications contributes very much to the undertreatment of depression in psychiatric patients within primary care settings. Nonadherence to medication adherence is a notable reason for under treatment (Tamburrino, Nagel & Lynch, 2012).
According to Tamburrino, Nagel and Lynch (2012), poor adherence to depression medications in primary care has been associated with insufficient patient education, fear of stigma, lack of insurance, as well as concerns regarding cost of medication. On the other hand, belief in the medication’s effectiveness, shared decision in the choice of treatment, preference for antidepressant medicine, and trust in the doctor are the main factors linked to medication adherence (Hoffman, Enders & Luo, 2013; Lin, Korff & Ludman, 2011). The significance of the research study is that it would shed light on whether referring adult depressed psychiatric patients from the primary care setting to mental health specialists is effective in improving the rate of medication compliance of these patients. The findings would inform medical professionals in primary care settings on referring such patients to mental health specialists to help solve the problem of non-adherence to medications faced by psychiatric patients who have depressive disorders.
Purpose Statement
The purpose of this clinical scholarly project is to investigate whether referring adult depressed psychiatric patients from primary care to mental health specialists helps in improving patient medication compliance.
The research question is as follows:
Does referring adult depressed psychiatric patients from primary care to mental health specialists help in improving their medication compliance?
Data
Population
The population being addressed in the research comprises adult depressed psychiatric patients. These patients are in primary care settings and due to various reasons, they have poor compliance to their medications. They are generally careless with regard to taking their antidepressant medicines, are less satisfied with their doctors, they are more worried regarding the medications’ side effects, and it is very likely that they requested for a particular antidepressant medicines (Tamburrino, Nagel & Lynch, 2012).
Sample
The sample/subset of the population of interest consists of psychiatric patients in 3 different primary care settings who have depressive disorders. The patients have a history of being prescribed an antidepressant medicine for at least a period of four months. The sample size is forty (n = 40), although 50 respondents were approached and 10 of them, or 20%, refused to take part in the study. The characteristics of the patients are illustrated in Table 1.
The overall sample comprised 23 females and 17 males. Also 31 of the total participants were white, 5 were Latino, and 4 were African American. They were aged 25 – 40 years. Every participant was given $10 for participating. Since the sample size is relatively small, it might have some impact on the generalizability of the study findings, although not major negative impacts. All in all, the findings may be generalized to a larger population that comprises adult psychiatric patients with depressive disorders who may be referred to mental health specialists from primary care settings in order to improve their rate of medication adherence.
In recruiting the patients for the study, psychiatric patients in the primary settings whose charts indicate a diagnosis of depression as well as a history of being prescribed a medication for depression for at least 4 months were approached to take part. The researcher then met with each of the study subjects interested to participate and notified them about the requirements of the study and obtained written informed consent from them. The level of medication adherence of these 40 adult psychiatric patients was determined while they were in the primary care settings before they were referred to a mental health specialist, where their level of medication adherence was again determined after a period of 4 months.
Instrumentation
The process used to select/design the data collection process entailed the use of a demographic survey instrument which was used to identify the household income range, marital status, race, education level, age and gender of the patient. Other instruments used are the Medication Adherence Scale (MAS) and a single-item Likert-scaled assessment of medication adherence from the Medical Outcomes Study (MOS). This process was used since it helps to measure the level of medication adherence of depressed psychiatric patients.
Data Collection
Data was collected through the use of quantitative questionnaire surveys that were used to measure adherence before and after referral from primary care setting to mental health specialist. The first tool that was used to collect data is the Medication Adherence Scale (MAS), which is a self-report scale created by Brooks and associates to determine medication adherence level of patients with asthma (Brooks, Richards & Kohler, 2005). To construct the Medication Adherence Scale, Brooks, Richards and Kohler (2005) mixed two adherence scales. Through their work, they were able to demonstrate the validity and reliability of this instrument and then recommended its utilization for measuring the level of patient medication adherence in other settings (Brooks, Richards & Kohler, 2005). The other data collection tool that was used to measure the patients’ adherence to antidepressants before and after the referral was the single-item Likert-scaled assessment of medication adherence from the MOS. It is notable that this particular data collection tool asked: How regularly have you been taking your medicines for depression in the last 1 month? (Sherbourne, Hays & Ordway, 2007).
Variables
In this study, the main outcome measure was the patients’ self-reported adherence to antidepressant medicines. The adherence score of the patients was the dependent variable. This dependent variable would measure the rate of patient’s adherence to the depression drugs prescribed to him/her by a healthcare professional (Lin, Korff & Ludman, 2011). On the other hand, the independent variables include patient education, supportive home visits, counselling, family support, telephone and mail reminders, dosage modifications, behavioural modelling, skill building and practice activities, telephone instructions, mailed material, the use of audiovisual and written material, as well as group and one-to-one teaching. These independent variables are predictors of medication adherence.
Research Design
The project employed a single group pre/post design or pretest – posttest design in this quasi-experimental research study. Using this study design, a control group was not necessary. The single group is tested for medication adherence before the treatment or intervention is administered, and then tested again after the treatment/intervention is administered (Salkind, 2010). Pre-post designs, also referred to as quasi-experimental designs, are often utilized in evaluating the benefits of particular interventions (Salkind, 2010).
The interventions used in the study were categorized as affective interventions, behavioural interventions, and educational interventions. Affective interventions are aimed at influencing adherence to medications through appeals to emotions and feelings or social supports and social relationships (Katon, Korff & Lin, 2013). These str...