Improving patient compliance? - the potential impact of Telepsychology

by Bill Campos and Dr Gary Banks
Sydney Counselling Centre

Background:

Poor treatment compliance can have an impact on client outcomes. This is especially salient for clients with mental health problems, and/or those on long-term prophylactic medications with potentially high levels of adverse effects. Telepsychology has emerged from the observations of mental health professionals and psychiatrists of the need for increased compliance.

The difference between telepsychology and helplines lies in the case management practices of the services in regard to the callers. In general terms helplines are a community link where people can call, talk to someone with no strings attached and be anonymous. The caller is in the driver seat in terms of ending the call and there is no cost (or minimal cost) to the caller. Helplines are usually staffed by volunteers and the service is available at extended hours, often 24 hours.

Telepsychology on the other hand, is a detailed sharing of information between a psychologist and the client with the object of developing rapport, creating a basic therapeutic alliance with a goal of improved compliance with a previously determined medical treatment program. Client details are maintained as per recognised health service guidelines and sessions are structured. This means that a Psychologist can make telephone appointments and e-mail details to and from the caller in the context of building this therapeutic relationship. Information relating to the caller can effectively be stored, followed up and continuity of care maintained.

Telepsychology and pharmaceutical treatment compliance

Historically, pharmaceutical companies had focused very much on medical practitioners as their primary consumer, having little or no opportunity for direct contact with the end user of their product i.e. the patient. However the impact of trends such as disease ‘management’ and preventative treatments have meant that there has been a change of focus from treatment instigation to treatment compliance.

Drawing on these observations potential telepsychology services in the pharmaceutical industry should be developed with the following goals in mind:

• Improve treatment adherence (compliance)
• Improve data collection about end users of products
• Develop a "closer" relationship with patient/ carer/ families
• Tailor information appropriately to the needs of the individual.

More recently telepsychology services for mental health patients and also hypertensive patients have incorporated techniques from the motivational Interviewing to facilitate compliance. In most cases, adherence levels will improve with the provision of information about a patient condition and medication but there is still a reasonable percentage who have barriers to adherence which typically relate to their belief system about their illness or medication impact. For example, if someone believes that "they will never get better" the likelihood of taking treatment is quite low. Therefore, the Psychologist on the telephone attempts to address barriers to adherence utilising Motivational Interviewing and brief therapy techniques as a means of "exposing" and addressing the individual’s belief systems and irrational cognitions which may impinge on their desire to take treatment reliably.

Written materials to back up the telephone interactions are very important. These needed to cover a wide range of topics from the medication, to stress management to collaborating with the doctor.

Finally, the key process is the utilisation of both reactive and proactive telephone contacts. Typically within the healthcare system the responsibilities and onus of seeking help rests with the patient. This is a perfectly appropriate approach in which one does not seek to change or encourage alternative forms of behaviour. Conversely, with the provision of a telepsychology service there is the potential to encourage people to do what is perhaps not usual, i.e. adhere to treatment. Therefore some programs are designed to make proactive calls at least three-four times during the first three months of treatment instigation, thus allowing opportunity to address concerns about the treatment, tackle areas where there may be a lack of understanding and develop interventions based on motivational interviewing and Brief Therapy to improve medium to long-term treatment adherence.

Finally, by way of illustration, a recent evaluation of a telepsychology program with patients diagnosed with Schizophrenia, showed that at 12 weeks 95% of patients reported adherence to their medication as prescribed by their doctor. The other 5% were patients who experienced some form adverse reaction and required to stop treatment. For further information about telepsychology, contact Dr Gary Banks, Sydney Counselling Centre (02) 9415 2223 or email gkbanks@sydneycounselling.com.au