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Kalman JL, Burkhardt G, Samochowiec J, Gebhard C, Dom G, John M, Kilic O, Kurimay T, Lien L, Schouler-Ocak M, Vidal DP, Wiser J, Gaebel W, Volpe U, Falkai P. Digitalising mental health care: Practical recommendations from the European Psychiatric Association. Eur Psychiatry 2023; 67:e4. [PMID: 38086744 PMCID: PMC10790232 DOI: 10.1192/j.eurpsy.2023.2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 01/06/2024] Open
Abstract
The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical-legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process.
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Affiliation(s)
- Janos L. Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Miriam John
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Ozge Kilic
- Department of Psychiatry, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Tamas Kurimay
- North-Buda Saint John Central Hospital, Buda Family Centred Mental Health Centre, Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary
| | - Lars Lien
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Diego Palao Vidal
- Mental Health Service, Parc Taulí University Hospital, Unitat Mixta de Neurociència Traslacional I3PT-INc-UAB, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jan Wiser
- CNWL NHS Foundation Trust, London, UK
| | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131, VR-Klinikum Düsseldorf, Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
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Wu T, Xiao X, Yan S, Fang Y, Wang M, Zu F, Zhang Y, Qian R. Digital health interventions to improve adherence to oral antipsychotics among patients with schizophrenia: a scoping review. BMJ Open 2023; 13:e071984. [PMID: 37977861 PMCID: PMC10660841 DOI: 10.1136/bmjopen-2023-071984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES To assess the current evidence on the potential of digital health interventions (DHIs) to improve adherence to oral antipsychotics among patients with schizophrenia by assessing the methodologies, feasibility and effectiveness of DHIs as well as the perceptions of relevant stakeholders. DESIGN The scoping review was conducted based on the methodologies outlined by Levac et al and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. DATA SOURCES PubMed, Embase, Web of Science, Scopus, CINAHL, PsycINFO and the Cochrane Library were searched in August 2023 to identify relevant publications from the previous decade. ELIGIBILITY CRITERIA Studies published in English focused on improving medication adherence among adult patients with schizophrenia or schizoaffective disorder via DHIs were selected. Protocols, editorials, comments, perspectives, reviews, correspondence and conference abstracts were excluded. DATA EXTRACTION AND SYNTHESIS The extracted data included general information about the study, framework, participants, features and strategies of DHIs, measurement tools for adherence used, and main findings. RESULTS In total, 64 studies were included in the qualitative synthesis. Features used in DHIs to improve medication adherence included phone calls, text messages, mobile apps, sensors, web-based platforms and electronic devices. Strategies included medication reminders and monitoring, providing medication-related information and suggestions, other illness management suggestions and individual support. Texting and mobile apps were commonly used as medication reminders and monitoring methods. Additionally, the use of sensors combined with other digital technologies has garnered significant attention. All the interventions were considered acceptable and feasible, and several were assessed in pilot trials. Preliminary findings suggest that DHIs could enhance medication adherence in patients with schizophrenia. However, further validation of their effectiveness is required. CONCLUSION DHIs are a promising approach to enhancing medication adherence among patients with schizophrenia. Future interventions should be interactive, focusing on user preference, experience and privacy.
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Affiliation(s)
- Tao Wu
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Xiao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shirui Yan
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Fang
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Fengying Zu
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanhong Zhang
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ruilian Qian
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Bruhns A, Baumeister A, Demeroutis G, Jahn H, Willenborg B, Shaffy A, Moritz S, Bücker L. A mobile-based aftercare intervention to increase self-esteem in inpatients diagnosed with depression: A randomized controlled trial. Psychother Res 2023:1-20. [PMID: 36628469 DOI: 10.1080/10503307.2022.2157226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE In this randomized controlled trial, we investigated the effectiveness, side effects and user satisfaction of the self-help smartphone app "MCT & More" among inpatients with a diagnosis of depression after their discharge from a psychiatric hospital over a period of 4 weeks. METHODS A total of 159 inpatients were recruited in four German psychiatric hospitals three days before hospital discharge (intervention group: n = 79; treatment as usual: n = 80). Based on the vulnerability model (low self-esteem contributes to depression), self-esteem represented the primary outcome, quality of life and depressive symptoms the secondary outcomes. RESULTS Intention-to-treat analyzes showed no statistical significance for the primary and secondary outcome parameters, except for the subscale self-competence in favor of the intervention group (with a small effect size of d = 0.35), in the context of an exploratory approach (post hoc). The more positive the attitude toward mobile-based interventions and the more positive the treatment expectations, the more frequently the app was used (r = .35, p = .008; r = .34, p = .009). CONCLUSION Further symptom reduction could not be obtained. However, the results suggest that an effect on improvement in self-competence could be achieved by low-threshold aftercare programs. Future studies should include long-term assessments to examine the impact of mobile-based aftercare on relapse.Trial registration: DRKS00022559.
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Affiliation(s)
- Alina Bruhns
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Baumeister
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Holger Jahn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,AMEOS Klinikum Heiligenhafen, Heiligenhafen, Germany
| | | | - Athif Shaffy
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Karabulut E, Yazıcı HG, Özkan S. Maximizing Pharmacological Treatment Adherence of Children and Adolescents: A Randomized Controlled Study. J Psychosoc Nurs Ment Health Serv 2023; 61:16-24. [PMID: 35858190 DOI: 10.3928/02793695-20220705-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of the current randomized controlled study was to evaluate treatment adherence of children and adolescents who visited an outpatient psychiatry clinic and started medication for the first time, with telehealth application. This study was performed with parents of patients who visited the clinic from October 1, 2020, to March 31, 2021. Data were collected using a personal information form, Medication Control Form, and Morisky Medication Adherence Scale via telephone after verbal and written consent were obtained. It was found that 96.7% of participants in the experimental group had high medication adherence, whereas 93.3% of participants in the control group had low medication adherence. Results show that telehealth application is effective in maximizing adherence to treatment among children and adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 16-24.].
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Gallinat C, Moessner M, Apondo S, Thomann PA, Herpertz SC, Bauer S. Feasibility of an Intervention Delivered via Mobile Phone and Internet to Improve the Continuity of Care in Schizophrenia: A Randomized Controlled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12391. [PMID: 34886117 PMCID: PMC8656751 DOI: 10.3390/ijerph182312391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022]
Abstract
Schizophrenia is a severe mental illness associated with a heavy symptom burden and high relapse rates. Digital interventions are increasingly suggested as means to facilitate continuity of care, relapse prevention, and long-term disease management for schizophrenia spectrum disorders. In order to investigate the feasibility of a mobile and internet-based aftercare program, a 2-arm randomized controlled pilot study was conducted. The program could be used by patients for six months after inpatient treatment and included psychoeducation, an individual crisis plan, optional counseling via internet chat or phone and a supportive monitoring module. Due to the slow pace of enrollment, recruitment was stopped before the planned sample size was achieved. Reasons for the high exclusion rate during recruitment were analyzed as well as attitudes, satisfaction, and utilization of the program by study participants. The data of 25 randomized patients suggest overall positive attitudes towards the program, high user satisfaction and good adherence to the monitoring module. Overall, the results indicate that the digital program might be suitable to provide support following discharge from intensive care. In addition, the study provides insights into specific barriers to recruitment which may inform future research in the field of digital interventions for severe mental illness.
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Affiliation(s)
- Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, 69115 Heidelberg, Germany; (M.M.); (S.B.)
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, 69115 Heidelberg, Germany; (M.M.); (S.B.)
| | - Sandra Apondo
- Department of General Psychiatry, University Hospital Heidelberg, 69115 Heidelberg, Germany; (S.A.); (S.C.H.)
| | - Philipp A. Thomann
- Zentrum für Seelische Gesundheit, Gesundheitszentrum Odenwaldkreis GmbH, 64711 Erbach im Odenwald, Germany;
| | - Sabine C. Herpertz
- Department of General Psychiatry, University Hospital Heidelberg, 69115 Heidelberg, Germany; (S.A.); (S.C.H.)
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, 69115 Heidelberg, Germany; (M.M.); (S.B.)
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Kim B, Weatherly C, Wolk CB, Proctor EK. Measurement of unnecessary psychiatric readmissions in the context of care transition interventions: a scoping review. BMJ Open 2021; 11:e045364. [PMID: 33558362 PMCID: PMC7871679 DOI: 10.1136/bmjopen-2020-045364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine how published studies of inpatient to outpatient mental healthcare transition processes have approached measuring unnecessary psychiatric readmissions. DESIGN Scoping review using Levac et al's enhancement to Arksey and O'Malley's framework for conducting scoping reviews. DATA SOURCES Medline (Ovid), Embase (Ovid), PsycINFO, CINAHL, Cochrane and ISI Web of Science article databases were searched from 1 January 2009 through 28 February 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that (1) are about care transition processes associated with unnecessary psychiatric readmissions and (2) specify use of at least one readmission time interval (ie, the time period since previous discharge from inpatient care, within which a hospitalisation can be considered a readmission). DATA EXTRACTION AND SYNTHESIS We assessed review findings through tabular and content analyses of the data extracted from included articles. RESULTS Our database search yielded 3478 unique articles, 67 of which were included in our scoping review. The included articles varied widely in their reported readmission time intervals used. They provided limited details regarding which readmissions they considered unnecessary and which risks they accounted for in their measurement. There were no perceptible trends in associations between the variation in these findings and the included studies' characteristics (eg, target population, type of care transition intervention). CONCLUSIONS The limited specification with which studies report their approach to unnecessary psychiatric readmissions measurement is a noteworthy gap identified by this scoping review, and one that can hinder both the replicability of conducted studies and adaptations of study methods by future investigations. Recommendations stemming from this review include (1) establishing a framework for reporting the measurement approach, (2) devising enhanced guidelines regarding which approaches to use in which circumstances and (3) examining how sensitive research findings are to the choice of the approach.
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Affiliation(s)
- Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Weatherly
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Courtney Benjamin Wolk
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Enola K Proctor
- George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
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Cai Y, Gong W, He H, Hughes JP, Simoni J, Xiao S, Gloyd S, Lin M, Deng X, Liang Z, He W, Dai B, Liao J, Hao Y, Xu DR. Mobile Texting and Lay Health Supporters to Improve Schizophrenia Care in a Resource-Poor Community in Rural China (LEAN Trial): Randomized Controlled Trial Extended Implementation. J Med Internet Res 2020; 22:e22631. [PMID: 33258788 PMCID: PMC7738261 DOI: 10.2196/22631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Schizophrenia is a severe and disabling condition that presents a dire health equity challenge. Our initial 6-month trial (previously reported) using mobile texting and lay health supporters, called LEAN, significantly improved medication adherence from 0.48 to 0.61 (adjusted mean 0.11, 95% CI 0.03 to 0.20, P=.007) for adults with schizophrenia living in a resource-poor village in rural China. OBJECTIVE We explored the effectiveness of our texting program in improving participants' medication adherence, functioning, and symptoms in an extended implementation of the intervention after its initial phase. METHODS In an approximated stepped-wedge wait-list design randomized controlled trial, 277 community-dwelling villagers with schizophrenia were assigned 1:1 in phase 1 into intervention and wait-list control groups. The intervention group received (1) lay health supporters (medication or care supervisors), (2) e-platform (mobile-texting reminders and education message) access, (3) a token gift for positive behavioral changes, and (4) integration with the existing government community-mental health program (the 686 Program) while the wait-listed control group initially only received the 686 Program. Subsequently (in the extended period), both groups received the LEAN intervention plus the 686 Program. The primary outcome was antipsychotic medication adherence (percentage of dosages taken over the past month assessed by unannounced home-based pill counts). The secondary outcomes were symptoms measured during visits to 686 Program psychiatrists using the Clinical Global Impression scale for schizophrenia and functioning measured by trained student assessors using the World Health Organization Disability Assessment Schedule 2.0. Other outcomes included data routinely collected in the 686 Program system (refill records, rehospitalization due to schizophrenia, death for any reason, suicide, wandering, and violent behaviors). We used intention-to-treat analysis and missing data were imputed. A generalized estimating equation model was used to assess program effects on antipsychotics medication adherence, symptoms, and functioning. RESULTS Antipsychotics medication adherence improved from 0.48 in the control period to 0.58 in the extended intervention period (adjusted mean difference 0.11, 95% CI 0.04 to 0.19; P=.004). We also noted an improvement in symptoms (adjusted mean difference -0.26, 95% CI -0.50 to -0.02; P=.04; Cohen d effect size 0.20) and a reduction in rehospitalization (0.37, 95% CI 0.18 to 0.76; P=.007; number-needed-to-treat 8.05, 95% CI 4.61 to 21.41). There was no improvement in functioning (adjusted mean difference 0.02, 95% CI -0.01 to 0.06; P=.18; Cohen d effect size 0.04). CONCLUSIONS In an extended implementation, our intervention featuring mobile texting messages and lay health workers in a resource-poor community setting was more effective than the 686 Program alone in improving medication adherence, improving symptoms, and reducing rehospitalization. TRIAL REGISTRATION Chinese Clinical Trial Registry; ChiCTR-ICR-15006053 https://tinyurl.com/y5hk8vng.
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Affiliation(s)
- Yiyuan Cai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Hua He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Meijuan Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinlei Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjun He
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bofeng Dai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Liao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
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Góngora Alonso S, Sainz-De-Abajo B, De la Torre-Díez I, Franco-Martin M. Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study. JMIR Ment Health 2020; 7:e15776. [PMID: 33252351 PMCID: PMC7735900 DOI: 10.2196/15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. OBJECTIVE The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model. METHODS For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015. RESULTS After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex. CONCLUSIONS With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced.
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Affiliation(s)
- Susel Góngora Alonso
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain
| | - Beatriz Sainz-De-Abajo
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain
| | - Isabel De la Torre-Díez
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain
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Esteki-Ghashghaei F, Saadatnia M, Khorvash F, Shahnazi H. The Effect of Home Base Physical Activity Program based on the BASNEF Model on Motor Recovery in Patients with Stroke. Home Health Care Serv Q 2020; 39:154-167. [PMID: 32401625 DOI: 10.1080/01621424.2020.1765938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study aimed to determine the effect of education based on the BASNEF model on the physical activity and improvement of motor activity in patients with stroke. This randomized control trial study was conducted on 40 patients with acute ischemic stroke admitted to a teaching hospital in Isfahan, Iran from August 2017 to September 2018. The patients were randomly divided into intervention and control groups. The intervention included personal education and a manual CD of physical activity for the intervention group. After education, the mean scores of the BASNEF model's constructs in the intervention group were significantly higher than those of the control group (P < .001). Furthermore, the motor ability of the intervention group in upper and lower extremities was significantly higher than that of the control group (p < .001). Interventions based on educational models can increase the motivation of patients with stroke in performing recommended physical activity.
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Affiliation(s)
- Fatemeh Esteki-Ghashghaei
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences , Isfahan, Iran
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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11
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D'Arcey J, Collaton J, Kozloff N, Voineskos AN, Kidd SA, Foussias G. The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. JMIR Ment Health 2020; 7:e16993. [PMID: 32238334 PMCID: PMC7163420 DOI: 10.2196/16993] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis. OBJECTIVE This review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis. METHODS Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources. RESULTS Of the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received. CONCLUSIONS Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation.
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Affiliation(s)
- Jessica D'Arcey
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - Joanna Collaton
- Department of Clinical Psychology, University of Guelph, Guelph, ON, Canada
| | - Nicole Kozloff
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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12
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Kidd SA, Feldcamp L, Adler A, Kaleis L, Wang W, Vichnevetski K, McKenzie K, Voineskos A. Feasibility and outcomes of a multi-function mobile health approach for the schizophrenia spectrum: App4Independence (A4i). PLoS One 2019; 14:e0219491. [PMID: 31306439 PMCID: PMC6629069 DOI: 10.1371/journal.pone.0219491] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 06/15/2019] [Indexed: 12/19/2022] Open
Abstract
Relative to the large investments in mobile health (mHealth) strategies for mental illnesses such as anxiety and depression, the development of technology to facilitate illness self-management for people with schizophrenia spectrum illnesses is limited. This situation falls out of step with the opportunity mHealth represents for providing inexpensive and accessible self-care resources and the routine use of mobile technologies by people with schizophrenia. Accordingly, the focus of this study was upon the feasibility of a schizophrenia-focused mobile application: App4Independence (A4i). A4i is a multi-feature app that uses feed, scheduling, and text-based functions co-designed with service users to enhance illness self-management. This study was completed in a large urban Canadian centre and employed pre-post assessments over a 1-month period that examined medication adherence, personal recovery, and psychiatric symptomatology. App use metrics were assessed as was qualitative feedback through semi-structured interview. Findings are reported in line with the World Health Organization mHealth Evidence and Assessment (mERA) checklist. Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements. This research suggested that A4i is feasible in terms of outcome and process indicators and is a technology that is ready to move on to clinical trial and validation testing. This study contributes to the small but emergent body of work investigating digital health approaches in severe mental illness populations.
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Affiliation(s)
- Sean A. Kidd
- University of Toronto, Department of Psychiatry, Toronto, Canada
- * E-mail:
| | | | | | | | - Wei Wang
- University of Toronto, Department of Psychiatry, Toronto, Canada
| | | | - Kwame McKenzie
- University of Toronto, Department of Psychiatry, Toronto, Canada
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13
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Xu D(R, Xiao S, He H, Caine ED, Gloyd S, Simoni J, Hughes JP, Nie J, Lin M, He W, Yuan Y, Gong W. Lay health supporters aided by mobile text messaging to improve adherence, symptoms, and functioning among people with schizophrenia in a resource-poor community in rural China (LEAN): A randomized controlled trial. PLoS Med 2019; 16:e1002785. [PMID: 31013275 PMCID: PMC6478272 DOI: 10.1371/journal.pmed.1002785] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Schizophrenia is a leading cause of disability, and a shift from facility- to community-based care has been proposed to meet the resource challenges of mental healthcare in low- and middle-income countries. We hypothesized that the addition of mobile texting would improve schizophrenia care in a resource-poor community setting compared with a community-based free-medicine program alone. METHODS AND FINDINGS In this 2-arm randomized controlled trial, 278 community-dwelling villagers (patient participants) were randomly selected from people with schizophrenia from 9 townships of Hunan, China, and were randomized 1:1 into 2 groups. The program participants were recruited between May 1, 2015, and August 31, 2015, and the intervention and follow-up took place between December 15, 2015, and July 1, 2016. Baseline characteristics of the 2 groups were similar. The patients were on average 46 years of age, had 7 years of education, had a duration of schizophrenia of 18 years with minimal to mild symptoms and nearly one-fifth loss of functioning, and were mostly living with family (95%) and had low incomes. Both the intervention and the control groups received a nationwide community-based mental health program that provided free antipsychotic medications. The patient participants in the intervention group also received LEAN (Lay health supporters, E-platform, Award, and iNtegration), a program that featured recruitment of a lay health supporter and text messages for medication reminders, health education, monitoring of early signs of relapses, and facilitated linkage to primary healthcare. The primary outcome was medication adherence (proportion of dosages taken) assessed by 2 unannounced home-based pill counts 30 days apart at the 6-month endpoint. The secondary and other outcomes included patient symptoms, functioning, relapses, re-hospitalizations, death for any reason, wandering away without notifying anyone, violence against others, damaging goods, and suicide. Intent-to-treat analysis was used. Missing data were handled with multiple imputations. In total, 271 out of 278 patient participants were successfully followed up for outcome assessment. Medication adherence was 0.48 in the control group and 0.61 in the intervention group (adjusted mean difference [AMD] 0.12 [95% CI 0.03 to 0.22]; p = 0.013; effect size 0.38). Among secondary and other outcomes we noted substantial reduction in the risk of relapse (26 [21.7%] of 120 interventional participants versus 40 [34.2%] of 117 controls; relative risk 0.63 [95% CI 0.42 to 0.97]; number needed to treat [NNT] 8.0) and re-hospitalization (9 [7.3%] of 123 interventional participants versus 25 [20.5%] of 122 controls; relative risk 0.36 [95% CI 0.17 to 0.73]; NNT 7.6). The program showed no statistical difference in all other outcomes. During the course of the program, 2 participants in the intervention group and 1 in the control group died. The limitations of the study include its lack of a full economic analysis, lack of individual tailoring of the text messages, the relatively short 6-month follow-up, and the generalizability constraint of the Chinese context. CONCLUSIONS The addition of texting to patients and their lay health supporters in a resource-poor community setting was more effective than a free-medicine program alone in improving medication adherence and reducing relapses and re-hospitalizations. Future studies may test the effectiveness of customization of the texting to individual patients. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-ICR-15006053.
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Affiliation(s)
- Dong (Roman) Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of National Governance, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, Washington, United States of America
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Juan Nie
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of National Governance, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meijuan Lin
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Wenjun He
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of National Governance, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yeqing Yuan
- Silver School of Social Work, New York University, New York, New York, United States of America
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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14
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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15
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Darvish A, Khodadadi-Hassankiadeh N, Abdoosti S, Ghapandar Kashani M. Effect of Text Messaging-based Psychiatric Nursing Program on Quality of Life in Veterans with Post-Traumatic Stress Disorder: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2019. [PMID: 30643833 PMCID: PMC6311209 DOI: 10.30476/ijcbnm.2019.40846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recurrent post-traumatic stress disorder (PTSD) can devastate the life of a veteran. Despite the widespread use of mobile learning technology in health care and nursing, few studies have examined its potential in PTSD patients and the effect on quality of life (QoL). The present study aimed to investigate the effect of a text messaging-based psychiatric nursing program on QoL in veterans with PTSD symptoms. METHODS A single-blinded, randomized, controlled trial was conducted at the outpatient clinic of Sadr Hospital in Tehran (Iran) from January 2014 to October 2015. A total of 98 veterans with PTSD who referred to the outpatient clinic of the hospital were initially assessed for eligibility to participate in the study. Based on the inclusion criteria, 66 veterans were recruited in the study and randomly allocated to a control group (n=33) and an intervention group (n=33). Due to the lost to follow-up, 9 participants (control=4, intervention=5) were excluded from the analysis phase. The intervention group received psychiatric support via short text messages for 6 months, whereas the control group received the routine hospital care. The self-rating scale for PTSD (SRS-PTSD) and the short form 36 (SF-36) were used to evaluate the severity of symptoms and the QoL, respectively. The results were analyzed using the SPSS software (version 18.0) with the Chi-square test, Fisher's exact test, independent sample t test, and paired sample t test. P<0.05 was considered statistically significant. RESULTS A significant improvement in PTSD (P=0.001) and QoL (P=0.001) was observed in the intervention group compared to the control group. Moreover, the recurrence frequency in the intervention group was significantly lower (P=0.03). CONCLUSION The text messaging-based psychiatric nursing program reduced the severity of symptoms in veterans with PTSD and improved their QoL. Trial Registration Number: IRCT2013101214983N1.
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Affiliation(s)
- Asieh Darvish
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Naema Khodadadi-Hassankiadeh
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
,Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Mojgan Ghapandar Kashani
- Department of Psychiatry, Sadr Hospital, Foundation of Martys and Veterans Affairs, Tehran, Iran
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16
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Hennemann S, Farnsteiner S, Sander L. Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research. Internet Interv 2018; 14:1-17. [PMID: 30510909 PMCID: PMC6205252 DOI: 10.1016/j.invent.2018.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/17/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mental disorders are characterized by a high likelihood of recurrence. Thus, aftercare and follow-up interventions aim to maintain treatment gains and to prevent relapse. Internet- and mobile-based interventions (IMIs) may represent promising instruments in tertiary prevention. This systematic review summarizes and evaluates the research on the efficacy of IMIs as aftercare or follow-up interventions for adults with mental health issues. METHODS A systematic database search (PsycInfo, MEDLINE, CENTRAL) was conducted and studies selected according to predefined eligibility criteria (RCTs, adult population, clinical symptoms/disorder, assessed with validated instruments, clinical-psychological intervention rationale, aftercare/follow-up intervention, web-/mobile-based, minimum follow-up measurement of three months, inclusion of a control group). Inspected outcomes were symptom severity, recurrence- and rehospitalization rates, functioning, quality of life and adherence to primary treatment.Systematic review registration: PROSPERO CRD42017055289. RESULTS Sixteen RCTs met the inclusion criteria, covering trials on depression (n = 5), eating disorders (n = 4) and transdiagnostic interventions (n = 7). The majority of the interventions were based on Cognitive Behavioral Therapy (CBT) principles and were web-based (n = 11). Methodological quality of included studies was suboptimal. Limitations included attrition bias and non-specification of routine care co-interventions. IMIs yielded small to medium post-treatment effects for symptom severity (d = -0.08 - d = -0.45) in comparison to control groups. Best evidence base was found for symptom severity of depression and anxiety. Study results regarding recurrence and rehospitalization were inconsistent. DISCUSSION There is some evidence, that IMIs are feasible instruments for maintaining treatment gains for some mental disorders. However, further high quality, large-scale trials are needed to expand research fields, improve adherence to and uptake of IMIs and facilitate implementation of effective interventions into routine care.
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Affiliation(s)
- Severin Hennemann
- University of Mainz, Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany
| | - Sylvia Farnsteiner
- University of Mainz, Institute of Psychology, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany
| | - Lasse Sander
- University of Freiburg, Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, Engelbergerstraße 41, 79085 Freiburg, Germany
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17
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Rüegg N, Moritz S, Berger T, Lüdtke T, Westermann S. An internet-based intervention for people with psychosis (EviBaS): study protocol for a randomized controlled trial. BMC Psychiatry 2018; 18:102. [PMID: 29653532 PMCID: PMC5899332 DOI: 10.1186/s12888-018-1644-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence shows that internet-based self-help interventions are effective in reducing symptoms for a wide range of mental disorders. To date, online interventions treating psychotic disorders have been scarce, even though psychosis is among the most burdensome disorders worldwide. Furthermore, the implementation of cognitive-behavioral therapy (CBT) for psychosis in routine health care is challenging. Internet-based interventions could narrow this treatment gap. Thus, a comprehensive CBT-based online self-help intervention for people with psychosis has been developed. The aim of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting list control group. METHODS The intervention includes modules on delusion, voice hearing, social competence, mindfulness, and seven other domains. Participants are guided through the program by a personal moderator. Usage can be amended by an optional smartphone app. In this randomized controlled trial, participants are allocated to a waiting list or an intervention of eight weeks. Change in positive psychotic symptoms of both groups will be compared (primary outcome) and predictors of treatment effects will be assessed. DISCUSSION To our knowledge, this project is one of the first large-scale investigations of an internet-based intervention for people with psychosis. It may thus be a further step to broaden treatment options for people suffering from this disorder. TRIAL REGISTRATION NCT02974400 (clinicaltrials.gov), date of registration: November 28th 2016.
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Affiliation(s)
- Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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