# Remote Cognitive Adaptation Training to improve medication follow through in managed care (R-CAT)

> **NIH NIH R56** · UNIVERSITY OF TEXAS HLTH SCIENCE CENTER · 2020 · $767,263

## Abstract

Project Summary/Abstract
 Poor adherence to prescribed medications is a major public health problem across chronic illness such
as severe mental illness (SMI), leads to increased risk of hospitalizations, costs up to $300 billion annually and
is arguably one of the most important modifiable risk factors leading to poor outcomes. According to the World
Health Organization, increasing adherence may have a greater effect on health than any improvement in
specific medical treatments.
 We propose to test a remotely delivered version of Cognitive Adaptation Training (R-CAT) which uses
environmental supports to bypass many of the problems people have in following through with medication even
when they think it is the right thing to do for their illness. R-CAT is designed to bypass problems including,
forgetting, distraction, problem-solving, motivation, and resources such as limited access to transportation.
CAT delivered in person has been found to improve medication follow-though, reduce hospitalizations, and
improve outcomes for individuals with SMI. R-CAT was developed to serve a larger number of individuals as
well as those in rural settings, and includes individualized medication set up; text reminders; telephone staff to
check in and assist in re-filling medication containers; mail-delivered supports (signs, customized pill
containers, alarms, checklists), limited in-home visits and a series of participation prizes to improve habit
formation and sustain good medication follow-through. We propose to randomize 266 managed care members
to R-CAT or Treatment as Usual for 6 months and to follow them for 6 months after treatment ends. Medication
follow-through will be assessed using unannounced in-home pill counts and claims data for refills. We will also
measure symptoms, service use, and care costs. In addition, we will examine the mechanisms of action of R-
CAT. The path model proposes that during treatment repetitive behavior performed at the same time, in the
same way, every day in response to R-CAT cues (i.e., taking medication because of cues, alarms, text
messages) leads to habit formation, increasing habit strength/automaticity. We propose that habit strength at
the end of treatment then predicts maintenance of adherence. Improving adherence to medication may be one
of the most important MCO-wide behavioral change targets. If successful, a remote, easy to deliver
intervention such as R-CAT in managed care has the potential to improve adherence and outcomes for those
with SMI and other chronic medical conditions and to substantially reduce the costs of care.

## Key facts

- **NIH application ID:** 10209187
- **Project number:** 1R56MH123797-01
- **Recipient organization:** UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
- **Principal Investigator:** Dawn Irene Velligan
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $767,263
- **Award type:** 1
- **Project period:** 2020-09-01 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10209187

## Citation

> US National Institutes of Health, RePORTER application 10209187, Remote Cognitive Adaptation Training to improve medication follow through in managed care (R-CAT) (1R56MH123797-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10209187. Licensed CC0.

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