JMIR Publications

ABSTRACT

Background:

Medication adherence is poor among individuals with serious mental illness (SMI). Few studies demonstrated the effectiveness of telehealth adherence intervention among individuals with SMI.

Objective:

To understand medication dispensing rates associated with the use of Medherent device, a telehealth adherence intervention platform, and identify associated demographic and clinical characteristics.

Methods:

In this cohort study, individuals’ characteristics were measured at the baseline and dispensing records were followed from their first use until June 2023. Individuals were eligible to participate if they were having a serious and persistent mental illness, age 18-64, currently being prescribed psychiatric medications, and receiving mental health services from a CMHA. Clients were recruited through a combination of self-selection and referrals from agency staff. There were 240 participants who were eligible to screen and 161 enrolled in the study. Our intervention was the use of the Medherent device. Our measure was participants’ daily medication dispensing.

Results:

The final sample consisted of 99 participants. The mean age of the participants was 49 years (SD=12.08), with 64% identified as men, and 41% as Black/African American. Both the average rate and the weighted person average of dispensing were 92.9%, with 90 individuals having dispensing rates greater than 80%. The results of the hierarchical Bayesian logistic regression model showed that participants adhered better to evening doses compared to morning doses (IRR=1.11, 95% CI=1.06-1.16). Dispensing adherence was poorer on weekends compared to weekdays (IRR=0.87, 95% CI=0.83-0.91). For every additional year on Medherent, the rate of adherence increased by 0.4% (IRR=1.00, 95% CI=1.00-1.00). The rate of dispensing dropped by 19% after the onset of the COVID-19 pandemic (IRR=0.71, 95% CI=0.65-0.77). The rate of dispensing did not differ by age, sex, race and educational attainment, or the level of sadness, emotional and behavioral dyscontrol, cognitive function or prodrome at the baseline.

Conclusions:

The high adherence rate observed, regardless of psychopathology levels, highlights the potential of telehealth to address adherence challenges in SMI populations. The findings support the integration of digital adherence monitoring within mental health services, especially in settings where traditional adherence support may be challenging. Clinical Trial: NCT03775044