A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Comprehensive Mental Disorder Essay on Schizophrenia

Schizophrenia is a mental disorder that impairs thought processes and patterns, perceptions, emotional responses, and social interactions (NIMH, n.d.). Schizophrenia is persistent and can be severe and disabling when symptoms are not adequately managed (NIMH, n.d.). This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management. Mucci et al. (2020) recommend a person-centered approach to healthcare that encompasses building therapeutic relationships between providers and patients and collaboration between providers when working with schizophrenia patients to achieve compliance. Specifically, the project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients. This DNP Project Manuscript provides the introduction and background, the problem, the project aim and supporting objectives, and the practice question.(Comprehensive Mental Disorder Essay on Schizophrenia)

Problem

Numerous studies have shown a varying prevalence of schizophrenia globally and in the US. The global prevalence of Schizophrenia among non-institutionalized persons ranges between 0.33% and 0.75%, while in the United States, the prevalence of Schizophrenia is 0.25% to 0.64% (NIMH, n.d.). Nonadherence to medication among Schizophrenia patients is well documented in the United States (US) and globally. Per Desai and Nayak (2019), most schizophrenia patients are non-compliant with medication; a national and global problem that affects 70% of patients.(Comprehensive Mental Disorder Essay on Schizophrenia)

Nonadherence increases the use of outpatient and hospital-related resources, while comorbidities and demographic factors exacerbate the problem. Nonadherence affects health outcomes among schizophrenia patients, increasing the risk of premature death compared to the general population, making it a significant health problem at the practicum site. The average life lost in the US due to schizophrenia is about 28.5 years (NIMH, n.d.). Most comorbid conditions associated with schizophrenia, including liver disease, heart disease, and diabetes, increased the risk of premature, go unrecognized. Significantly, over 50% of schizophrenia patients have additional behavioral and mental health problems. According to NIMH (n.d.), an estimated 4.9% of individuals diagnosed with schizophrenia commit suicide, which is significantly higher than the general population, estimated at 14.2 per 100,000 people or 0.0142%.(Comprehensive Mental Disorder Essay on Schizophrenia)

The financial costs associated with the management of schizophrenia increase exponentially with co-occurring mental, physical, and behavioral health conditions. The direct costs include those related to the hospital stay and medication due to worsening symptoms and general health conditions. In contrast, the indirect costs include costs due to social service needs, lost productivity, involvement of criminal justice, and issues beyond healthcare. The total cost of managing schizophrenia and co-occurring health problems averages at $2,004 to 94,229 per person per year (Kotzeva et al., 2022). Per Kotzeva et al. (2022), the indirect costs make up 50-60% of the total cost, making it the primary cost driver, averaging at $1,852 to $62,431 per person per year.(Comprehensive Mental Disorder Essay on Schizophrenia)

Nonadherence to medication among schizophrenia patients is a significant problem at the practicum site, associated with an increased risk of premature death compared to the general population, hospital stays, frequent readmissions, and increased healthcare burden for the family and the system. Currently, family and patient education help address nonadherence, but no evidence indicates desired success because it continues to be a problem among this patient population. There is no documentation of other interventions to address the nonadherence at the practicum site. This project is an opportunity to adopt motivational interviewing and technology, evidence-based interventions with indicated benefits and high success rates in addressing nonadherence.  (Comprehensive Mental Disorder Essay on Schizophrenia)

Project Aim and Supporting Objectives

The aim of the DNP project is to determine the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients. The project objectives are as follows:(Comprehensive Mental Disorder Essay on Schizophrenia)

1. To evaluate the role of technology on medication adherence among inpatient schizophrenia patients.
2. To assess the impact of motivational interviews on medication adherence among inpatient schizophrenia patients.
3. To compare the impact of technology and motivational interviewing on medication adherence and the current interventions of enhancing medication adherence at the practicum site.(Comprehensive Mental Disorder Essay on Schizophrenia)

Practice Question

The following practice question will serve as the basis of the DNP project: For adults with a history of schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication nonadherence (O) in 8-10 weeks (T)? (Comprehensive Mental Disorder Essay on Schizophrenia)

References

Desai, R., & Nayak, R. (2019). Effects of medication nonadherence and comorbidity on health resource utilization in Schizophrenia. Journal of Managed Care & Specialty Pharmacy, 25(1), 37-46. https://doi.org/10.18553/jmcp.2019.25.1.037

Kotzeva, A., Mittal, D., Desai, S., Judge, D., & Samanta, K. (2022). Socioeconomic burden of schizophrenia: A targeted literature review of types of costs and associated drivers across 10 countries. Journal of medical economics, (just-accepted), 1-18. https://doi.org/10.1080/13696998.2022.2157596(Comprehensive Mental Disorder Essay on Schizophrenia)

Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Frontiers in psychiatry, 11, 761. https://doi.org/10.3389/fpsyt.2020.00761

National Institute of Mental health. (No date). Schizophrenia. Available at: https://www.nimh.nih.gov/health/statistics/schizophrenia (Accessed 14 January 2023)