Paper
Friday, July 13, 2007
Implementation and Outcomes of an Evidence-Based Medication Management Algorithm Project in the Treatment of Schizophrenia: Results of a 3-Year Study
Patricia B. Howard, PhD, RN, CNAA1, Peggy El-Mallakh, PhD, RN1, Andrew T. Cooley, MD2, Alexander L. Miller, MD3, and Gary R. Bond, PhD4. (1) College of Nursing, University of Kentucky, Lexington, KY, USA, (2) Medical Services, Central State Hospital, Louisville, KY, USA, (3) Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA, (4) Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| Learning Objective #1: identify prescriber fidelity to the critical elements of an evidence-based medication management algorithm in clinical practice. |
| Learning Objective #2: identify prescriber perspectives on factors that influence fidelity to an evidence-based medication management algorithm in an outpatient clinical setting.
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Evidence-based practices are clinical interventions that demonstrate scientific evidence for efficacy and improved patient outcomes. The purpose of this presentation is to report findings from a SAMHSA-funded Medication Management Algorithm Project (MedMAP) that investigated prescriber fidelity, or degree of implementation, of a medication algorithm in 6 community mental health clinics in a south-eastern state of the US. MedMAP Fidelity Tools for prescriber interviews and chart audits were used during data collection over a 3 year period. The study sample consisted of 9 physicians and 5 advanced practice psychiatric nurses with prescriptive authority who provided mental health services to consumers diagnosed with schizophrenia. The MedMAP Fidelity Scale Outpatient Chart Review Form was used to measure prescriber fidelity to 15 critical ingredients of the medication algorithm. Quantitative data were collected in audits of 900 randomly selected patient charts at the 6 participating sites. Qualitative data were obtained from collection and analysis of 70 prescriber interviews. Results suggest that fidelity scores were high for comprehensive documentation of treatment (83-100% fidelity), use of recommended dose ranges (73-100% fidelity), simplification of medication regimen (73-93% fidelity) and patient involvement in treatment decisions (77-100% fidelity). Overall scores for patient education were lower (23-93% fidelity). Fidelity scores were lowest for documentation of illness and medication history (3-38% fidelity), linkage of medication use with treatment goals (0-7% fidelity), monitoring medication side effects (0-17% fidelity), and the use of quantitative outcome assessment tools to measure patient symptoms and functioning (0-33% fidelity). Prescribers reported that several factors influenced the degree of implementation, including billing issues, Medicaid requirements for pre-authorization of medications, time constraints when seeing patients, cost of medications, and lack of ongoing education about the algorithm.