Dr. Finnerty, Ms. Layman, Ms. Chen, Dr. Leckman-Westin, and Ms. Bermeo are with the New York State Office of Mental Health (NYSOMH), New York. Dr. Finnerty is also with the Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, where Dr. Hoagwood is affiliated. Ms. Layman is also a doctoral student, Department of Psychology, Fordham University, New York. Dr. Leckman-Westin is also with the Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York. Dr. Ng-Mak is with Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts, and Dr. Rajagopalan is with Sunovion Pharmaceuticals, Inc., Fort Lee, New Jersey.
Psychiatr Serv. 2018 Dec 1;69(12):1215-1221. doi: 10.1176/appi.ps.201800130. Epub 2018 Oct 5.
The authors examined the impact of a Web-based shared decision-making application, MyCHOIS-CommonGround, on ongoing outpatient mental health treatment engagement (all users) and antipsychotic medication adherence (users with schizophrenia).
An intervention study was conducted by comparing Medicaid-enrolled MyCHOIS-CommonGround users in 12 participating mental health clinics (N=472) with propensity score-matched adults receiving services in nonparticipating clinics (N=944). Medicaid claims were used to assess ongoing treatment engagement and antipsychotic adherence (among individuals with schizophrenia) one year prior to and after entry into the cohort. Multilevel linear models were conducted to estimate the effects of the MyCHOIS-CommonGround program over time.
No differences during the baseline year were found between the MyCHOIS-CommonGround group and the matched control group on demographic, diagnostic, or service use characteristics. At one-year follow-up, engagement in outpatient mental health services was significantly higher for MyCHOIS-CommonGround users than for the control group (months with a service, 8.54±.22 versus 6.95±.15; β=1.40, p<.001). Among individuals with schizophrenia, antipsychotic medication adherence was also higher during the follow-up year among MyCHOIS-CommonGround users compared with the control group (proportion of days covered by medication, .78±.04 versus .69±.03; β=.06, p<.01).
These findings provide new evidence that shared decision-making tools may promote ongoing mental health treatment engagement for individuals with serious mental illness and improved antipsychotic medication adherence for those with schizophrenia.
作者研究了基于网络的共同决策应用程序 MyCHOIS-CommonGround 对门诊心理健康治疗参与（所有用户）和抗精神病药物依从性（精神分裂症患者）的影响。
通过比较 12 家参与心理健康诊所的 Medicaid 注册 MyCHOIS-CommonGround 用户（N=472）与在非参与诊所接受服务的倾向评分匹配的成年人（N=944），进行干预研究。使用医疗补助索赔来评估队列进入前一年和进入后一年的持续治疗参与和抗精神病药物依从性（在精神分裂症患者中）。使用多层线性模型来估计 MyCHOIS-CommonGround 计划随时间的影响。
在基线年，MyCHOIS-CommonGround 组和匹配对照组在人口统计学、诊断或服务使用特征方面没有差异。在一年的随访中，MyCHOIS-CommonGround 用户的门诊心理健康服务参与度明显高于对照组（服务月份，8.54±.22 与 6.95±.15；β=1.40，p<.001）。在精神分裂症患者中，MyCHOIS-CommonGround 用户在随访期间的抗精神病药物依从性也高于对照组（药物覆盖天数的比例，.78±.04 与.69±.03；β=.06，p<.01）。
这些发现提供了新的证据，表明共同决策工具可能促进有严重精神疾病的个体持续参与心理健康治疗，并提高精神分裂症患者的抗精神病药物依从性。
