Encouraging Medication Compliance in Patients

In the conclusion of his 2007 article published in Psychiatric Times entitled, “Understanding Medication Discontinuation in Depression,” Dr Alex J. Mitchell stated, “both partial non-adherence and discontinuation [of antidepressant medications] can be helped by enhanced collaborative care for depression.” These findings have continued to find support in the conclusions of a growing body of research seeking to improve treatment outcomes and reduce the direct and indirect costs of depression. While most of the major findings have come from studies focusing on treatment of depression in the primary care setting, our own observations have been that many of the problems associated with low rates of adherence and high rates of discontinuation are common to other treatment settings and providers.

In the years since PsychCoverage first began providing after-hours and vacation coverage for psychiatrists, we’ve had the opportunity to interact with many patients in the initiation phase of treatment. We have learned from them that despite the education they’ve received through the Informed Consent process and the additional education and coaching they’ve received from their treating psychiatrist, the early onset of side effects or the delayed onset of efficacy requires reinforcement of that initial education, and many times additional support is indicated, particularly in the initiation phase.

In their comprehensive literature review, Dr Mitchell’s team found that among the most promising interventions that improved medication compliance were those that involved access: follow-up, support and encouragement. We have found these interventions to be highly effective in reducing the avoidable anxiety induced by not being able to answer the simple question, “what is happening to me?” These types of patient calls account for nearly 40-50% of the after-hours clinical calls we receive at PsychCoverage. This experience has immeasurably improved our own understanding of what can be accomplished simply by having a trained RN Care Manager available to calmly de-escalate the patient, answer questions and try to re-frame the commonly held belief that they are headed in the wrong direction by continuing to take their medications.

Endorsement From Our First Client

Our private practice psychiatric group, PsyCare, Inc., in San Diego, CA, has been relying on the weekend/vacation and after hours on call services as provided by PsychCoverage, under the leadership of Jack Coughlin, RN, for the past 17 years. The eighteen psychiatrists in our group have been 100% satisfied with the services provided by PsychCoverage. Their system is well organized, efficient and designed for immediate patient access and follow up. Our patients are treated with compassion and respect and their safety is always paramount.  The PsychCoverage RN’s are consistently generous with the time taken to speak with our patients and their family members.

PsychCoverage provides support and reassurance when needed, answers questions and concerns about symptoms, medications or side effects, can assess if a patient requires urgent or emergent intervention, and will make all necessary arrangements, as well as communicate their interventions and status updates with our psychiatrists for our records. Our patients, their families and our physicians have offered only positive feedback and consistent complete satisfaction with the services provided by PsychCoverage. Our psychiatrists are able to take time off on evenings, weekends and vacations to have a chance to relax and recharge, knowing with full confidence that their patients’ after hours needs and concerns will be addressed and resolved professionally.

The PsychCoverage team will modify their services to meet the individual needs of the physician with regard to how they would like their patients’ concerns handled.  The service provided by PsychCoverage undoubtedly enhances the quality of care that our physicians provide for our patients, as well as the quality of life for our psychiatrists.

Rob Friedman, M.D.
President / CEO
PsyCare, Inc.
San Diego, California
(858) 279-1223 Ext. 412

PsychCoverage – Company Background

PsychCoverage was started in 1995 by Jack and Jill Coughlin, 2 Psychiatric Registered Nurses in San Diego, CA. Jack and Jill began providing weekend coverage to 7 Psychiatrists from Psycare, then a small but growing outpatient Psychiatry Group Practice in San Diego. PsyCare is now one of the largest outpatient practices in San Diego County, and PsychCoverage continues to provide weekend and vacation coverage and triage services to 18 of the Psychiatrists in the practice, including 6 of the 7 original MD’s. We now provide after hours and Mon-Fri coverage for triage, prescription refills and clinical call backs for a growing number of Psychiatrists throughout the state of California.

Bringing a unique psychiatric nursing-based approach to managing after-hours urgent and emergent calls that we refer to as “Brief Care Management”, the RNs of PsychCoverage provide support, crisis management, education and follow up to private practice patients in distress during times when their Psychiatrist is unavailable.

PsychCoverage has evolved into a full time operation that has recently completed the development of Searchlight, the first of its kind web-based platform designed to provide continuity of care through documentation of after-hours psychiatric emergencies and electronic, HIPPA compliant  notification to providers. Using 18 years of experience as a guide, PsychCoverage has developed  policies and procedures which are designed to improve access and to establish standards of care for six distinct call categories that encompass the majority of after hours calls. They include Urgent Prescription Refill requests,  assessment of symptoms and side effects, patient/family education, referral to Medical ER, Emergency Psych hospitalizations and activation of first responders for life threatening emergencies.  The dual mission of PsychCoverage is to substantially improve the quality of after hours patient care and to provide a trusted, reliable and affordable service to Psychiatrists wanting a break from providing 24/7 on call access to their patients.