A Quality Improvement Project: Implementing Weekly Phone Calls to Improve Treatment Adherence in Adults with Schizophrenia

Abstract

A clinical problem identified in adults with schizophrenia is treatment non-adherence. Treatment adherence, including compliance with both medications and attending regularly scheduled appointments, is essential in the management of schizophrenia. An individual diagnosed with schizophrenia is often non-adherent to medications and appointments. Failure to take medications as prescribed and missed scheduled appointments can lead to poor outcomes. This frequently results in symptom relapses, readmissions to the hospital, homelessness, incarceration in jail or prison, victimization, suicide, violent outbursts, and lowered quality of life. Patients with schizophrenia have a medication non-adherence rate of approximately 40%, and nearly one-third do not attend their scheduled appointments. This quality improvement project aimed to explore whether weekly phone calls will increase treatment adherence in adults with schizophrenia. The methodology design was a convenience sample of 15 patients who were diagnosed with schizophrenia, and a preintervention and a postintervention scoring after 8 weekly phone calls. The Adherence to Refills and Medication Scale (ARMS), a 12-item self-report measure of medication adherence, was utilized before and after weeks of weekly phone calls. One item on the ARMS scale was scored separately (How often do you miss scheduled appointments) to reflect that original ARMS scale and its scoring to maintain the reliability and validity of the scale. The first 11 items were scored using the paired t-test. The paired t-test showed statistical significance in mean ARMS scores, before 6.13, Std. Deviation 4.518, and after .47, Std. Deviation .915, p <.001) weekly phone calls. The single item was also scored with the paired t-test. The paired t-test for the single item did not show statistical significance in means, before .60, Std Deviation .737, and after .20, Std Deviation .561, p .069. The project’s overall findings provide evidence of the effectiveness of weekly phone calls in increasing treatment adherence among adults with schizophrenia.