Schizophrenia Treatment, Medication Adherence and Collaborative Care

(Part 2 of 3)

In Part 2 of this video, Meagan Thistle, assistant digital editor, Psych Congress Network interviews Amber Hoberg, NP, Centric Physicians Group, San Antonio, Texas, on-site at Psych Congress​​​​​​, to discuss medication adherence and collaborative care for treating patients with schizophrenia.

In the upcoming Part 3 of this video series, Hoberg talks about family involvement and crisis response plans. In Part 1, Hoberg discussed meeting her patients where they are to increase treatment compliance.

Read the transcript:

Meagan Thistle:  Do you have any tips for clinicians on how they can work with their patients that you have better medication adherence?

Amber Hoberg:  Absolutely. One of the things is partnering with your patients. If they have family, get the family involved, but if they're patients like what I see every single day where they may be their own entity, they establish that rapport with my caseworkers. They trust them.

The caseworkers bring me into the picture. They trust them, so they start to trust me, and then we work together in that partnership role, so that we can get our patients to trust us, really understand we're out there for their best interest, and like I said, ask the patients questions.

"What is it that you like about your medications? What is not working for you?" That's a question I ask my patients every time. If they tell me, "I didn't take it," "Why didn't you take it? Is there a reason? Is it an access problem? Was it 'I didn't like the way it made me feel?' Was there, 'It made me sleepy. I'm worried it's making me gain weight?"

What is it that's causing you not to take that medication? Then, I can come up with different options to provide to the patient, so that we, together, in a collaborative approach, can make that decision on how we help patients. I am not one to dictate things to my patients. If I dictate to them what they're going to take, more than likely they're not going to be compliant.

If I work together with my patients in a good partnership, we have this good dialogue and rapport, we talk about the options, "What are the risks and benefits of this?" and they help me choose an option, I'm way more successful in treating these patients, and again, then maintaining adherence with their follow-ups.

Meagan:  This also sounds like a very collaborative effort with patients and your entire team. How did you go about setting up this system that you have in place with all of these caseworkers, and setting up your whole practice?

Amber:  This was set up for me. I contract with this company that, and they have these caseworkers that they bring in. There's a case manager lead that is over the caseworker. You have this lead person that they each have a team, so patients get set on these teams.

The case manager is in charge of all the patients, making sure they're taking their meds, they're making their appointments, they reach out to them for all their big, major events. They take them to doctor's appointments. If they can't get their medicines, they can't get to something, they take them there. They partner also with the patients.

Then, we have the caseworkers, there's usually about 20 of them on a team, and then they have divided amongst them 6 to 7 patients that they are responsible for every week to go visit and to check in with, and to make sure that they're doing well and that they're adherent. Then, if there's any issues, they all contact me, "Hey, there's an issue with this."

If something going on, I set their follow-up appointment for 2 weeks, but I do need to see them that current week. We can put them in during one of my clinic days to make sure we address the needs or the issues. We all work very collaboratively together to make sure we're addressing the patient's needs.

Meagan:  Great. I hope that a lot of clinicians can take that structure back and put it into their practice because it sounds...

Amber:  Absolutely. It doesn't have to be on the large scale of how we do it. It could be on a much smaller scale.

The more touches you have with the patient, the more successful you're going to be at, again, maintaining their adherence and that follow-up. It's important because we want our patients to trust us. We want our patients to see us in the light of working with them and in their best interests. That's one of the best ways that we can do that.