Nursing Staff Need Education on Motivational Intervention to Teach Patients

Readmission of Bipolar Patients and Lack of Education among Healthcare Providers: Nursing Staff Need Education on Motivational Intervention to Teach Patients How to Prevent Readmission

Background and Purpose

The readmission rate for bipolar patients ranges from 40% to 50% within a year of being discharged from the hospital. Various factors influence the readmission rate of schizophrenia and depression patients. Therefore, multiple interventions (models and methods for quality improvement) have been developed to reduce patient readmission rates. However, multiple factors responsible for the readmission of bipolar patients, clinical and demographic attributes alone are not enough to determine bipolar patients likely to be readmitted to hospitals post-treatment. Medication adherence and improved treatment, according to recent research, are critical to determining the link between readmission of bipolar patients and their non-adherence to medication (Brown, 2014).

Although continuity of care and medication adherence measurements were previously difficult to assess, ongoing methodological work makes them easy to evaluate. Despite major progress over the years, the assessment and creation of management programs of structured disease for bipolar patients continue to be a challenge for future research (Brown, 2014). Therefore, there is a need for empirical work to assess the effectiveness of various interventions to reduce readmission rates of bipolar patients post-hospital discharge. This research paper aims to explore motivational interventions to improve medication adherence in bipolar patients and reduce readmissions. Is motivational intervention an evidence-based strategy that healthcare providers (nurses) can deploy to enhance antipsychotics adherence among bipolar patients to reduce readmissions?

Nature of the Project – Description of the Issue or Larger Problem

Comorbid substance use disorders (SUDs) are more common in bipolar disorder patients than other psychiatric patients. More than 60% of bipolar patients, according to the Epidemiologic Catchment Area study, have a long-term history of SUDs co-occurring. SUDs in bipolar patients, according to Brown (2014), ranges from 14% to 65% in hospital settings. An earlier age of bipolar onset, greater symptoms resistance between mood episodes, reduced relapse time, higher mood episodes frequency, greater disability, longer recovery times, more mixed and fast cycling episodes, greater severity of mania and depression, and higher mortality rates are linked to comorbid substance abuse. Moreover, bipolar patients who abuse substances experience heightened increases in readmissions, violence, and poorer psychosocial outcomes than their bipolar counterparts without SUDs (Brown, 2014).

Additionally, bipolar disorder patients with comorbid SUDs are at a higher risk of attempting suicide than their counterparts without SUDs. Even a history of a SUD and lack of a current diagnosis is linked to poorer acute response to treatment, more time with mood symptoms critical clinically, prolonged remission time of an acute episode, and increased rate of bipolar patient readmission. Bipolar patients with medication non-adherence issues range from 20% to 60%. Non-adherence to medication is linked to various negative health outcomes in bipolar patients, including readmissions. Adherence includes behavioral adherence, such as maintaining appointments for treatments and following lifestyle changes prescribed post-treatment. Many bipolar patients fail to attend referral appointments and increasingly drop out of treatment post-hospitalization.

Factors that influence non-adherence in bipolar patients include longer treatment durations, history of non-adherence, fear of the side effects of medication, poor illness insight and patient-doctor collaboration, negative beliefs about treatment, specific cultural beliefs, and the existence of psychotic attributes such as cluster B and mania personality traits. Lower functioning and poorer adherence result from substance abuse. Drug abuse and comorbid alcohol abuse is the most significant non-adherence predictor in bipolar patients. The link among treatment non-adherence, drug use, and bipolar outcomes is reciprocal, sophisticated, and variable. Substance use, however, predicts poor medication adherence in patients with bipolar disorder, leading to various negative outcomes such as relapse and readmissions.

How Readmission of Bipolar Patients Affects Nursing Practice and the Overall Healthcare System

The rate of medication non-adherence and readmission of bipolar patients in the United States of America continues to increase (Torres-Robles et al., 2018). Mental health disorders impact more than 46 million American adults annually (National Institute of Mental Health (NIMH), 2019). Psychotropic medications are used to prevent relapse and readmissions in bipolar patients. However, medication non-adherence continues to be prevalent among psychiatric bipolar patients (Torres-Robles et al., 2018). The increasing number of medication non-adherence and readmissions of bipolar patients heightens the financial burden on families, healthcare providers, and society (Joe & Lee, 2016; Rao et al., 2017).

Psychotropic medications help bipolar patients to reduce the risk of suicidal tendencies, relapse, longer remission times, and readmissions and to manage related symptoms (Borba et al., 2018). Interventions that foster medication adherence in bipolar patients can impact health outcomes and society positively. Major contributors to non-adherence include a lack of insight and knowledge about interventions for enhancing psychotropic medication adherence (Phan, 2016). Various psycho-educational and behavioral interventions can reduce medication non-adherence among bipolar patients (Borba et al., 2018; Steinkamp et al., 2019). There is a demand to educate nurses and other healthcare providers about evidence-based interventions such as motivational strategies that enhance medication adherence among bipolar patients to reduce readmissions. With increased understanding and knowledge of viable interventions, there is a higher chance of improving patient outcomes.

Possible Strategies for Addressing the Problem

Multiple psychosocial treatments, such as psycho-education, family therapy, and cognitive-behavioral therapy (CBT), have been created and tested to effectively treat bipolar patients’ pharmacotherapy. Adjunctive therapies are beneficial to enhancing psycho-educational medication adherence and functioning in some bipolar patients. Many strategies can address the issue of bipolar patient non-adherence to medication and relapse. Although various interventions can prevent bipolar patient readmissions, the focus of this paper is motivational intervention. There is a demand to educate healthcare providers about this strategy to improve adherence and reduce readmissions after hospitalization.

Research Design and Setting

This study proposes to assess the impact of a motivational intervention on medication adherence and relapse in bipolar patients. The motivational interviewing (MI) strategy was administered in an outpatient setting. The design of pretest-posttest was deployed. The MI intervention took three weeks and included a one-on-one session and a couple of follow-up interventions through telephone calls. Self-efficacy, adherence, and motivation to change were the major outcome measures. Study participants showed great improvement in the three outcome measures after administering MI intervention. The strategy indicated promising results in enhancing adherence to medication in adult patients with bipolar. Deploying an MI strategy can help psychiatric-mental health nurse practitioners to enhance patient health outcomes.

Models, concepts, and theories were adopted in the study. Medication non-adherence is a major behavioral risk factor among bipolar patients (Cutler et al., 2018). Psychotropic medication non-adherence is prevalent among bipolar patients with low socioeconomic statuses and those from minority groups, including communities with poor access to resources (Torres-Robles et al., 2018). Bipolar patients require proper and timely modification of behavior and long-term maintenance to prevent health deterioration and serious effects that may cause relapse or even death (Borba et al., 2018). Becker’s (1974) health belief model (HBM) was deployed in this study to enhance the understanding of the essence of psychotropic medication adherence among bipolar patients.

Developed in the 1950s by psychologists, the HBM aims to enhance preventive programs by the general public (Becker, 1974). It is founded on perceived benefits, perceived susceptibility, perceived usefulness, perceived barriers, cues to action, and self-efficacy (Jones et al., 2015). On the other hand, the Iowa Model was adopted to translate empirical evidence into practice, to enhance the quality of care (Titler et al., 2001). It covers seven major processes of data collection to get evidence on the issue of bipolar patient readmission. Practitioners such as psychiatric clinicians adopt the model to apply research findings to enhance patient health outcomes.

A Conceptual Framework based on the Iowa Model

Fig 1. The Iowa Model for Evidence-Based Practice (Titler et al., 2001).

Data Collection

Study subjects were recruited from a psychiatric hospital. They had been diagnosed with bipolar disorder and treated for the same before discharge, aged at least 18 years, and spoke and read fluent English. The Structured Clinical Interview for DSM-IV Patient Version (SCID) was used to assess bipolar diagnoses. Medication adherence or compliance among the bipolar patients and study subjects was determined using a self-report scale, the Medication Compliance Questionnaire (MCQ). The MCS created the Treatment Assessment Form (TAF) based on attended and missed treatment appointments reported every month. These data collection methods were adopted to ease use and interpretation and enhanced reliability (Vita & Barlati, 2019; WHO, 2019).

Finings and Implications

Study results showed that most bipolar patients could improve medication adherence due to motivational intervention. This can improve their quality of life—the paper advocates for innovative approaches and medication adherence among bipolar patients. Motivational interventions can motivate bipolar patients to adhere to medications for a better quality of life. The study has a major effect on patients, healthcare institutions, communities, and the healthcare system. Bipolar patients can choose motivational interventions as the most effective evidence-based strategy for psychotropic medication adherence. Psychiatric clinicians can adopt the findings to create interventions that meet particular bipolar patient needs for treatment (Vita & Barlati, 2019; WHO, 2019). Creating awareness about motivational interventions can improve adherence and benefit bipolar patients’ families and communities. They also have an impact on positive social change, atop enhancing health outcomes. This results in reduced readmissions and healthcare costs.

References

Becker, M. H. (1974). The health belief model and sick role behavior. Health Education Monographs, 2(4), 409-419. doi:10.1177/109019817400200407

Borba, L. D. O., Maftum, M. A., Vayego, S, A., Montovani, M. D. F., Felix, J. V. C., & Kalinke, L. P. (2018). Adherence of mental therapy for mental disorder patients to drug health treatment. Revista da Escola de Enfermagem da USP, 52 e03341. doi:10.1590/S1980- 220X2017006603341