DEFINITION OF TERMS BACKGROUND. APNA 27th Annual Conference Session 2023: October 10, Boardman 1

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1 A problem solving based peer support program for enhancing adherence to oral antipsychotic medication in consumers with schizophrenia Dr. Gayelene Boardman Lecturer, Discipline Leader Mental Health Nursing and Community Supervisors: Prof Terence McCann & Dr Deb Kerr The speaker has no conflicts of interest to disclose DEFINITION OF TERMS Consumer is an individual who is a patient of a public mental health service. In Australia, an individual with a mental illness is commonly referred to as a mental health consumer Peer is an individual who has a history of mental illness and has experienced significant improvement in his or her psychiatric condition, and who then offers support to other individuals with a serious mental illness Non adherence in this study refers to when the consumer has missed taking prescribed oral antipsychotic medication on five or more occasions in the past four weeks. BACKGROUND Schizophrenia accounts for 80% of psychiatric admissions in Australia and 2.3% of the global burden of disease and disability (Jablensky, 2011). Non adherence can range from 50% in first psychiatric admission to 74% as the illness progresses (Baloush Kleinman et al., 2011). Poor adherence is associated with poor functional outcomes, including readmission to hospital, greater use of psychiatric emergency services, poorer life satisfaction and increase in substance use problems (Ascher Svanum et al., 2006). Boardman 1

2 OBJECTIVE To assess if consumers with schizophrenia had improved adherence to their oral antipsychotic medication after participation in a problem solving based peer support program METHODS Design Mixed methods Quasi experimental time series design (3 collection points) Qualitative semi structured interviews Setting Large Area Mental Health Service in Melbourne Participants 28 Consumers and 6 Peers Study period Feb 2010 April 2011 Intervention Telephone based Data Collection Demographic information, adherence and mental state Personal photo Boardman 2

3 INCLUSION CRITERIA Consumer Diagnosis of schizophrenia/ schizoaffective disorder Over 18 years Receiving public outpatient treatment Oral antipsychotics Self reported partial or non adherence past 4 weeks Access to telephone Peer Diagnosis of schizophrenia/ schizoaffective disorder Over 18 years Discharged from public mental health service Oral antipsychotics Attending regular appointments with doctor or psychiatrist Self reported adherence 206 individuals were identified with a diagnosis of schizophrenia. Exclusion (n=148) 102 Adherent 37 Depot medication only 9 Non-English speaking Eligible for study participation (n=58) Declined to participate (n=30) No reason given (n=15) Pending discharge (n=5) Difficulty with telephone contact (n=4) Too busy (n=2) Unwell (n=2) Full-time employment (n=1) Pending birth (n=1) Agreed to participate (n=28) Assessment time Baseline n=28 Week 8 n=21 Week 14 n=22 CORE ELEMENTS OF PROGRAM Telephone based intervention Peers contacted consumers weekly by telephone for a 20 minute conversation for eight weeks Used the problem solving approach to address adherence issues (ADAPT) (Nezu, Nezu & D Zurilla, 2007) A = ATTITUDE D = DEFINE A = ALTERNATIVE P = PREDICT T = TRYOUT Provided verbal support and social contact Boardman 3

4 /cellular phones RESULTS Consumer participants Males 67% Age (median 35, range 21 to 53) No paid employment 86% Resided with others 82% Used recreational substances 82% Alcohol (46%), Nicotine (75%), illicit drugs (14%) Duration of illness (mean 12 years, range 2 30) Rates of medication adherence at all time-points. n Mean SD Min Max p¹ B W8² B W14³ W Baseline Week < Week <0.001 Legend ¹p value is derived from Wilcoxon Signed Rank Test and pair-wise comparisons between Baseline and Week 8²; Baseline and Week 14 3 ; Week 8 and Week Boardman 4

5 BPRS E symptoms, including positive, negative and depressive symptoms, measured over three timepoints. Total score Positive symptoms Negative symptoms Depressive symptoms n Mean SD Mean SD Mean SD Mean SD Baseline Week Week Legend BPRS E total scores range from 24 (not present) to 168 (extremely severe); positive symptoms (7 to 42); negative symptoms (5 to 35); depressive symptoms (6 to 42). MAIN THEMES Motivation to participate in study Previous life experience Altruism Experience of peer support program Preparation for the role Operational experience Research experience Rewards and Challenges of peer experience Personal rewards Personal challenges PEER CHALLENGES I would make arrangements to ring on a certain time and they weren t home. (P3) Some of them I couldn t get off the phone. (P3) I might have been like that years ago and I don t know, it s hard to, look back at your life, but when you meet some people like that, you see where they are going. (P5) Boardman 5

6 PEER REWARDS They eventually opened up to me whereas it can take a long time for people to do that. (P5) When you start hearing good things coming back, you realise, they were taking it [what was discussed] in. (P2). Felt good, helping people that have gone through the same things that I have gone through over the years. (P3) LIMITATIONS & STRENGTHS Limitations No control group or randomisation Self reporting of adherence Attrition Strengths o Inclusion of non adherence criteria o Problem solving program CONCLUSION Peer support is an effective adjunct intervention for promoting medication adherence for patients with schizophrenia Provides insight into complex issue of medication adherence, Adherence does not exist in a vacuum, it can be influenced by a range of factors. Boardman 6

7 QUESTIONS??? /drugs REFERENCES Ascher Svanum, H., Faries, D. E., Zhu, B., Ernst, F. R., Swartz, M. S., & Swanson, J. W. (2006). Medication adherence and long term functional outcomes in the treatment of schizophrenia in usual care. Journal of Clinical Psychiatry, 67(3), Baloush Kleinman, V., Levine, S. Z., Roe, D., Shnitt, D., Weizman, A., & Poyurovsky, M. (2011). Adherence to antipsychotic drug treatment in early episode schizophrenia: A six month naturalistic follow up study. Schizophrenia Research, 130(1 3), Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), Chinman, M., Weingarten, R., Stayner, D., & Davidson, L. (2001). Chronicity reconsidered: Improving person environment fit through a consumer run service. Community Mental Health Journal, 37(3), Falloon, I. R. H., Barbieri, L., Boggian, I., & Lamonaca, D. (2007). Problem solving training for schizophrenia: Rationale and review. Journal of Mental Health, 16(5), Hibbard, M. R., Cantor, J., Gundersen, N., Charatz, H., Gordon, W. A., & Brown, M. (2005). Mentoring partnership program manual: Planning and implementing a peer mentoring program for individuals with brain injury and their families [ Jablensky, A. (2011). Diagnosis and revision of the classification systems. In W. Gaebel (Ed.), Schizophrenia: Current science and clinical practice (pp. 1 26). Oxford, UK: Wiley Blackwell. Lawn, S., Smith, A., & Hunter, K. (2008). Mental health peer support for hospital avoidance and early discharge: An Australian example of consumer driven and operated service. Journal of Mental Health, 17(5), Nezu, A. M., Nezu, C. M., & D'Zurilla, T. J. (2007). Solving Life's Problems: A 5 Step Guide to Enhanced Well Being. New York: Springer Publishing Company. Üçok, A., Çakır, S., Duman, Z., Dişcigil, A., Kandemir, P., & Atli, H. (2006). Cognitive predictors of skill acquisition on social problem solving in patients with schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 256(6), Xia, J., Merinder, L. B., & Belgamwar, M. R. (2011). Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews(6), Boardman 7