OBJECTIVES: Treatment compliance can be a challenging issue among patients with SMI. This claims-linked medical chart abstraction study describes the frequency of documented treatment-related compliance discussions between providers and patients with SMI.

METHODS: Administrative claims data from 01JAN2014 to 31DEC2015 identified fully-insured commercial health plan patients, ages 18-65, with ICD-9/ ICD-10 diagnosis codes for SMI (major depression disorder (MDD), bipolar disorder (BD) or schizophrenia), evidence of hospitalization or emergency treatment and 18-months of health plan continuous enrollment. The date of the hospitalization or emergency visit was defined as the index date and patients were required to have a claim for an antipsychotic medication during the 6-month period prior and 60 days after index date. An outpatient medical chart including behavioral health treatment was abstracted over a 12-month period after index date.

RESULTS: A pilot of 15 medical charts abstracted (MDD = 5, BD = 6, schizophrenia = 4) included 88 behavioral health encounters. Antipsychotic medication use was confirmed in all medical charts. During the first visit after index, 5 patients had >1 behavioral health diagnosis recorded in the medical chart and 47% experienced a change in medication.

Only 4 of the 15 charts (27%) included a compliance-related discussion during the first visit after index. Among the total 88 visits abstracted, approximately 10% of visits (n=9) included use of a specific terms for treatment compliance (8 MDD and 1 BD) and all were specific to medication treatment. When compliance-similar terms were assessed, 36% of visits (n=32) referenced a discussion using related terms (30 medication treatment compliance; 16 non-pharmacotherapy interventions).

CONCLUSIONS: Among a pilot sample of SMI patients who had recently received acute care, outpatient follow-up services often included a change in treatment but infrequently included a discussion of treatment compliance; representing an opportunity to improve the quality of care for these vulnerable patients.