Cook Paul F, Emiliozzi Suzie, Waters Corey, El Hajj Dana
College of Nursing, University of Colorado Denver, Aurora, CO 80045, USA.
Am J Manag Care. 2008 Dec;14(12):841-6.
To determine whether ScriptAssist, a telehealth nursing program using psychological techniques, reduced emergency department (ED) utilization and improved adherence among Medicaid health plan members with serious and persistent mental illness (SPMI).
Nonrandomized controlled trial.
Of 210 eligible Medicaid health plan members with SPMI, 59 (28%) were contacted by phone and 51 (86%) participated. Participants received an average of 3.5 calls over 9 months, with 2.1 attempts per completed call. Participants had clinically significant levels of impairment; medication switching, polypharmacy, and medical comorbidities were common. Intervention group participants' results were compared with those of nonparticipants to rule out regression to the mean, history, and maturation effects. Intervention group participants' results also were compared with baseline data to rule out selection bias.
Program participants had fewer ED visits during the intervention than a comparison group, and reduced their ED use and hospitalization rate compared with the previous year. Participants also had better medication adherence based on pharmacy and interview data.
Cognitive-behavioral and motivational-interviewing techniques can improve antipsychotic medication adherence. Telehealth may be a useful strategy for disseminating these evidence-based techniques. Lessons learned included the importance of real-time referral data, a need to address polypharmacy, and a need to overcome contact difficulties resulting from disease processes and "unknown caller" IDs. Despite these difficulties, using a disease management model, the program was feasible, and the reduced number of ED visits indicated potential cost-effectiveness.
确定使用心理技术的远程医疗护理项目ScriptAssist是否能减少患有严重持续性精神疾病（SPMI）的医疗补助健康计划成员的急诊科（ED）就诊次数，并提高其依从性。
非随机对照试验。
在210名符合条件的患有SPMI的医疗补助健康计划成员中，通过电话联系了59人（28%），其中51人（86%）参与。参与者在9个月内平均接到3.5个电话，每次完成的电话有2.1次尝试。参与者有临床显著水平的功能损害；药物转换、多种药物治疗和医疗合并症很常见。将干预组参与者的结果与未参与者的结果进行比较，以排除均值回归、历史和成熟效应。还将干预组参与者的结果与基线数据进行比较，以排除选择偏倚。
与对照组相比，项目参与者在干预期间的急诊科就诊次数更少，与上一年相比，他们的急诊科就诊次数和住院率有所降低。根据药房和访谈数据，参与者的药物依从性也更好。
认知行为和动机访谈技术可以提高抗精神病药物的依从性。远程医疗可能是传播这些循证技术的有用策略。吸取的经验教训包括实时转诊数据的重要性、解决多种药物治疗问题的必要性，以及克服疾病过程和“未知来电者”身份识别导致的联系困难的必要性。尽管存在这些困难，但采用疾病管理模式，该项目是可行的，急诊科就诊次数的减少表明了潜在的成本效益。
