Background
Depression and schizophrenia are illnesses with multiple other health impacts that require strict adherence to treatment for the best outcomes. In the US, the health system cost of depression is estimated to be $210.5 billion, with schizophrenia $155 billion. High indirect economic impacts include unemployment, productivity loss, and in the worst case, suicide (not to mention the immeasurable personal cost to caregivers and loved ones). For patients living with mental illnesses, traditional healthcare approaches are often unsuccessful, which led to this collaboration.
Challenge
The challenge of how best to reach a younger population who are out and about, working and travelling was a big question and led to others. Would they accept an in-home med dispenser? Would they engage meaningfully with questions from a remote care team on the device, and what would their perception be? We wanted to avoid making young, healthy people feel confined to their home or 'sick' because of a device or engagement that they saw out of step with their life. We wondered, could we see success with a younger group of individuals who due to their mental illnesses are typically very difficult to engage?
44
Participants
91%
Medication adherence
97%
Felt service would benefit others
93%
Response rate
While mental illnesses are common and affect tens of millions of people each year, only half of people with mental illnesses receive treatment. Our findings showed that people would engage with a device to answer questions even about highly personal mental health questions.
Kristen, Director Clinical Outcomes
Solution
To introduce connected in-home medication dispensing technology to understand medication adherence and to gain health insights that would give case managers a better understanding of what and when the needs are of this elusive patient population. We collaborated to develop a set of inclusion / exclusion criteria, the plan contacted people to see if they were interested, referred to our team to share additional info & intro to a participating pharmacy for a personalized health consult, comprehensive med review, education on in-home med dispenser. Followed by real-time adherence monitoring & intervention, home delivery of meds, questions about mood and mental health for trending along with one-time questions related to HEDIS scores, i.e. dentist and flu shot. Real-time medication adherence dashboards kept pharmacists in the know, with our team remote monitoring - an extra clinical layer to analyze data and providing additional insight.
Results
Six community pharmacies worked with 44 patients using spencers, data was collected over a six month period.
*Tim - 38-yr old with depression taking meds for seizures, reported that depression had “gotten worse” along with feelings of sadness / hopelessness. Working with pharmacist on non-pharmacological options (patient preference) to better manage. 95% average adherence
*Janice - 42-yr old with depression & schizophrenia, reported feeling restless & having poor sleep. Follow-up appointment scheduled with physician. HEDIS question led to flu vaccination by pharmacy. 100% average adherence
*Maria - 37-yr old with depression frequently missed noon doses. Pharmacist adjusted times to accommodate work schedule, adherence improved by 18%. Achieved 84% adherence
People achieved excellent medication adherence at 91%, and demonstrated a willingness to engage with spencer by responding to sensitive, health-related questions. Some shared the preference for answering on the device vs in-person as they felt less judged and more inclined to tell the truth without having to offer any immediate follow-up explanation. Pharmacists identified and adjusted mediation schedules to improve adherence - one individual worked a night shift, didn't get home until later in the day, 8am meds were re-scheduled for 10am, helping him to maintain a clinically appropriate schedule that fit with his life. In most cases, adjusting dosing times to align with individual schedules immediately improves adherence. In other cases, while adherence to medication was high, other issues were brought to light when responding to questions about well-being, mood and other measures such as sleep quality, triggering the need for additional support.
63% of those who answered 'no' to a flu shot subsequently received one as part of our service - we asked the question, informed pharmacies about people responding 'no,' and they reached out to the patient to schedule.
There is great potential for digital tools to influence downstream acute events, decrease direct and indirect health care costs, and increase quality of life for people living with depression, schizophrenia and other chronic health conditions. Flagging health-related issues early, benefitted the individual and the care team in their ability to make intervention decisions (based on patient reported outcomes). These tools offer the care team the ability to influence health outcomes well beyond medication adherence.
*Stories and impact are real, names and photos are fictional.