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A Home Health Care Intervention for Severe Mental Illness & HIV/AIDS

In Session With Michael Blank, PhD:

A Home Health Care Intervention for Severe Mental Illness & HIV/AIDS

 

February 20, 2012

Michael Blank, PhD

 

Associate Professor of Psychology in Psychiatry, University of Pennsylvania Perelman School of Medicine

 

First published in Psychiatry Weekly, Volume 7, Issue 4, on February 20, 2012




 

Q: What prompted your group to look at how home health care nurses can affect the health status of patients with HIV/AIDS?

A: Our 2011 study1 was the outgrowth of two lines of research: my longtime research on integrated models of care using home health care nurses, and the 1999 finding2 by Bruce Dembling showing that there was 14 years of excess mortality associated with having a severe mental illness. The leading cause of years of life lost (YLL) was suicide, and the third YLL was from HIV/AIDS. At the time we had no idea that HIV/AIDS were so prevalent among people with severe mental illnesses, so it was clear that an intervention needed to be developed to provide quality care to those people.

Q: How did a home health care nurse intervention affect patients’ medication adherence rates in your study?

A: In this randomized clinical trial, the experimental group received PATH (Preventing AIDS Through Health), an intervention where we devised an individually tailored treatment approach using an intervention cascade. We established an 80% medication adherence rate threshold for the PATH group, whether for psychotropics or highly active antiretroviral drugs (HAART) or both. If individual participants did not maintain at least 80% adherence, they would go to the next level of the cascade. Home health care nurses conducted an adherence self-report each week. The PATH group also received psychoeducation about the importance of medication adherence, a pillbox and instructions on how to organize it, and a beeping or vibrating watch to remind them when to take medication.

If the standard resources given to all participants did not produce an adherence rate of ≥80%, the psychoeducation provided to the PATH group was extended to their social network and family, asking those individuals to encourage the patient to meet compliance goals. If that did not work, the nurse would provide an alphanumeric pager (this was back in 2003) with which patients were reminded in real-time to take their medication. If they still were not able to maintain an 80% adherence we would give them a cell phone, and the nurse, along with mental health case managers and social network members, would arrange to call the patients and try to talk them through taking their medications in real time. If that still did not work, we then tried to do directly observed therapy. Reaching the end of the cascade is clearly an extensive, expensive intervention, albeit one for those who are the hardest to treat; less than 5% of our participants required that level of intervention.

We found statistically significant reductions in viral load for people who received the intervention, and improvements in mood and health-related quality of life. We think that PATH shows that we can provide good quality care to even very difficult-to-treat people with complex co-occurring conditions.



 

Disclosure: Dr. Blank has received research support from the National Institute of Nursing Research (R01NR00851).


References:

1. Blank MB, Hanrahan NP, Fishbein M, et al. A randomized trial of a nursing intervention for HIV disease management among persons with serious mental illness. Psychiatr Serv. 2011;62:1318-1324.

2. Dembling BP, Chen DT, Vachon L. Life expectancy and causes of death in a population treated for serious mental illness. Psychiatr Serv. 1999;50:1036-1042.