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Moitra E, Amaral TM, Benz MB, Cambow S, Elwy AR, Kunicki ZJ, Lu Z, Rafferty NS, Rabasco A, Rossi R, Schatten HT, Gaudiano BA. A Hybrid Type 1 trial of a multi-component mHealth intervention to improve post-hospital transitions of care for patients with serious mental illness: Study protocol. Contemp Clin Trials 2024; 139:107481. [PMID: 38431134 PMCID: PMC10960682 DOI: 10.1016/j.cct.2024.107481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The transition from acute (e.g., psychiatric hospitalization) to outpatient care is associated with increased risk for rehospitalization, treatment disengagement, and suicide among people with serious mental illness (SMI). Mobile interventions (i.e., mHealth) have the potential to increase monitoring and improve coping post-acute care for this population. This protocol paper describes a Hybrid Type 1 effectiveness-implementation study, in which a randomized controlled trial will be conducted to determine the effectiveness of a multi-component mHealth intervention (tFOCUS) for improving outcomes for adults with SMI transitioning from acute to outpatient care. METHODS Adults meeting criteria for schizophrenia-spectrum or major mood disorders (n = 180) will be recruited from a psychiatric hospital and randomized to treatment-as-usual (TAU) plus standard discharge planning and aftercare (CHECK-IN) or TAU plus tFOCUS. tFOCUS is a 12-week intervention, consisting of: (a) a patient-facing mHealth smartphone app with daily self-assessment prompts and targeted coping strategies; (b) a clinician-facing web dashboard; and, (c) mHealth aftercare advisors, who will conduct brief post-hospital clinical calls with patients (e.g., safety concerns, treatment engagement) and encourage app use. Follow-ups will be conducted at 6-, 12-, and 24-weeks post-discharge to assess primary and secondary outcomes, as well as target mechanisms. We also will assess barriers and facilitators to future implementation of tFOCUS via qualitative interviews of stakeholders and input from a Community Advisory Board throughout the project. CONCLUSIONS Information gathered during this project, in combination with successful study outcomes, will inform a potential tFOCUS intervention scale-up across a range of psychiatric hospitals and healthcare systems. CLINICALTRIALS govregistration: NCT05703412.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Toni M Amaral
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Madeline B Benz
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Simranjeet Cambow
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Zhengduo Lu
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Neil S Rafferty
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Ana Rabasco
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Rita Rossi
- Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA
| | - Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Psychosocial Research Program, Butler Hospital, Providence, RI 02906, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Choi YA, Kweon YR. Drug Attitude and Medication Adherence of Patients with Early Psychosis in South Korea: Mediating Effect of Medication Adherence Self-Efficacy. Patient Prefer Adherence 2023; 17:1247-1255. [PMID: 37201154 PMCID: PMC10187643 DOI: 10.2147/ppa.s408781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
Purpose This study examined the mediating effect of medication adherence self-efficacy (MASE) on the relationship between drug attitude (DA) and medication adherence (MA) in patients with early psychosis. Patients and Methods A total of 166 patients, aged 20 years or older, and who had received treatment within 5 years of their initial psychotic episode at a University Hospital outpatient center, participated in the study. Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson's correlation coefficients, and multiple linear regression. Additionally, a bootstrapping test was conducted to determine the statistical significance of the mediating effect. All study procedures adhered to Strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. Results This study found a significant correlation between MA and DA (r=0.393, p<0.001), and between MA and MASE (r=0.697, p<0.001). MASE had a partial mediating effect on the association between DA and MA. The model that integrated both DA and MASE accounted for 53.4% of the variation in MA. Bootstrapping analysis indicated that MASE was a significant partial parameter (lower limit confidence interval [CI] 0.114; upper limit CI 0.356). Further, 64.5% of the study participants were either currently enrolled in college or had higher levels of education. Conclusion These findings could potentially lead to a more personalized approach to medication education and adherence, considering the unique DA and MASE of each patient. By identifying the mediating effect of MASE on the relationship between DA and MA, healthcare providers could tailor interventions to enhance the ability of patients with early psychosis to adhere to prescribed medication regimens.
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Affiliation(s)
- Yoon-A Choi
- Department of Nursing, Chonnam National University Hospital, Gwangju, South Korea
| | - Young-Ran Kweon
- Department of Nursing, Chonnam National University, Gwangju, South Korea
- Correspondence: Young-Ran Kweon, Department of Nursing, Chonnam National University, P.O. Box 61469, 60 Baekseo-ro, Dong-gu, Gwangju, South Korea, Tel +82 62 530 4966, Fax +82 62 220 4544, Email
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Kirchner SK, Lauseker M, Adorjan K, Anderson-Schmidt H, Anghelescu IG, Baune BT, Budde M, Dannlowski U, Dietrich DE, Fallgatter AJ, Falkai P, Figge C, Gade K, Heilbronner U, Hiendl L, Juckel G, Kalman JL, Klöhn-Saghatolislam F, Konrad C, Lang FU, Oraki Kohshour M, Papiol S, Reich-Erkelenz D, Reimer J, Reininghaus EZ, Schaupp SK, Schmauß M, Schmitt A, Schulte EC, Senner S, Spitzer C, Vogl T, Zimmermann J, Hasan A, Schulze TG, Senner F. Medication Adherence in a Cross-Diagnostic Sample of Patients From the Affective-to-Psychotic Spectrum: Results From the PsyCourse Study. Front Psychiatry 2021; 12:713060. [PMID: 35126191 PMCID: PMC8811370 DOI: 10.3389/fpsyt.2021.713060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/07/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION According to the World Health Organization, medication adherence is defined as the extent to which a person's behavior corresponds with an agreed recommendation from a healthcare provider. Approximately 50% of patients do not take their medication as prescribed, and non-adherence can contribute to the progress of a disease. For patients suffering from mental diseases non-adherence plays an important role. Various factors have been proposed as contributing to non-adherence, however the literature remains heterogeneous dependent on the analyzed patient subgroups. This study comprehensively evaluates the association of sociodemographic, clinical, personality and quality of life related factors with medication adherence by analyzing data from the PsyCourse study. The PsyCourse study is a large and cross-diagnostic cohort of psychiatric patients from the affective-to-psychotic spectrum. METHODS The study sample comprised 1,062 patients from the PsyCourse study with various psychiatric diagnoses (mean [SD] age, 42.82 [12.98] years; 47.4% female). Data were analyzed to identify specific factors associated with medication adherence, and adherence was measured by a self-rating questionnaire. Odds ratios (OR) were estimated by a logistic regression for binary outcomes. Missing data were imputed using multiple imputation. RESULTS The following factors showed the strongest association with medication adherence: never having used illicit drugs (OR, 0.71), number of prescribed antipsychotics (OR, 1.40), the personality trait conscientiousness (OR, 1.26), and the environmental domain of quality of life (OR, 1.09). CONCLUSION In a large and cross-diagnostic sample, we could show that a higher level of conscientiousness, a higher number of antipsychotic medication, a better quality of life within the environmental domain, and the absence of substance abuse contribute to a better medication adherence independent of the underlying disorder.
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Affiliation(s)
- Sophie-Kathrin Kirchner
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Bezirkskrankenhaus (BKH) Augsburg, University of Augsburg, Augsburg, Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Heike Anderson-Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Ion-George Anghelescu
- Department of Psychiatry and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Bernhardt T Baune
- Department of Psychiatry, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Detlef E Dietrich
- AMEOS Clinical Center Hildesheim, Hildesheim, Germany.,Center for Systems Neuroscience (ZSN), Hannover, Germany.,Department of Psychiatry, Medical School of Hannover, Hannover, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Katrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Lena Hiendl
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, Landschaftsverbund Westfalen-Lippe (LWL) University Hospital, Bochum, Germany
| | - Janos L Kalman
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Farahnaz Klöhn-Saghatolislam
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Mojtaba Oraki Kohshour
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sergi Papiol
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Health North Hospital Group, Bremen, Germany
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Max Schmauß
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Bezirkskrankenhaus (BKH) Augsburg, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, Butanta, Brazil
| | - Eva Christina Schulte
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Simon Senner
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Thomas Vogl
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Bezirkskrankenhaus (BKH) Augsburg, University of Augsburg, Augsburg, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Department of Psychiatry and Behavorial Sciences, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Fanny Senner
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
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