ORIGINAL PAPER Use of a Computerized Medication Shared Decision Making Tool in Community Mental Health Settings: Impact on Psychotropic Medication Adherence Bradley D. Stein • Jane N. Kogan • Mark J. Mihalyo • James Schuster • Patricia E. Deegan • Mark J. Sorbero • Robert E. Drake Received: 4 August 2011 / Accepted: 2 July 2012 / Published online: 27 July 2012 Ó Springer Science+Business Media, LLC 2012 Abstract Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psycho- tropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medi- cation adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important out- comes such as engagement, patient-prescriber communi- cation, quality of care, self-management, and long-term clinical and functional outcomes. Keywords Psychotropic medication Á Medication adherence Á Shared-decision making Á Computer intervention Á Recovery Introduction Increasing people’s engagement in their own healthcare is a major goal of current attempts to reform healthcare (Say and Thomson 2003). These efforts have spurred interest in shared decision making, a collaborative process in which patients and clinicians share information and reach agree- ment regarding treatment through discussion (Adams and Drake 2006; Charles et al. 1999; Frosch and Kaplan 1999; Joosten et al. 2008; Jordan et al. 2002; Montgomery and Fahey 2001). In mental healthcare as well, clients/con- sumers, clinicians, and other stakeholders are calling for more person-centered care (Institute of Medicine 2001; Mueser et al. 2002; New Freedom Commission on Mental Health 2003; Toprac et al. 2000) and shared decision making (Adams and Drake 2006; Adams et al. 2007; De- egan and Drake 2006). In general healthcare, decision aids and shared decision making have been increasingly used to enhance patient- B. D. Stein (&) RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA e-mail: stein@rand.org J. N. Kogan UPMC Center for High Value Health Care, U.S. Steel Tower, 9th Fl., 600 Grant Street, Pittsburgh, PA 15219, USA M. J. Mihalyo Á J. Schuster Á M. J. Sorbero Community Care Behavioral Health Organization, One Chatham Center, 112 Washington Place, Suite 700, Pittsburgh, PA 15219, USA P. E. Deegan 17 Forest Street, Byfield, MA, USA R. E. Drake Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic Street Suite B4-1, Lebanon, NH 03766, USA 123 Community Ment Health J (2013) 49:185–192 DOI 10.1007/s10597-012-9528-8