Automated telehealth for managing psychiatric instability in people with serious mental illness

Abstract

Background Serious mental illness (SMI) with psychiatric instability accounts for disproportionately high use of emergency room visits and hospitalizations. Aim To evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management for improving psychiatric illness management and reducing acute service use among individuals with SMI and psychiatric instability. Methods Thirty-eight individuals with SMI received the automated telehealth intervention for 6 months. Psychiatric symptoms, illness self-management, and self-reported service use (emergency room visits and hospital admissions) were collected at baseline, 3- and 6-months. Measures of quality of life, health indicators, and subjective health status were also collected. Results Participants demonstrated improvements in self-reported psychiatric symptoms and illness self-management skills, an 82% decrease in hospital admissions (from 76 to 14 hospitalizations, p<0.001) and a 75% decrease in emergency room visits (from 63 to 16 visits, p<0.001). Improvements were also observed in quality of life, severity of depressive symptoms, and mental health status. Conclusion These highly promising findings support the use of an automated telehealth device monitored by a nurse care manager for people with SMI, and highlight the potential for cost savings through reductions in acute health care utilization.

Systematic review of patients' participation in and experiences of technology-based monitoring of mental health symptoms in the community

“…Most studies were designed to assess feasibility and were single-arm pilot studies, 9 18 27 28 43 47 49 51 52 54–62 66 67 69 70–74 or observational studies. 21 29–31 64 68 Some were randomised controlled trials (RCTs) 19 20 22 25 26 44 45 50 59 63 65 and some were non-randomised trials 46 53 that reported the efficacy of technology-based symptom monitoring in terms of reduced severity of symptoms, 19 22 25 26 remission rates 44 or increased adherence compared with paper monitoring.…”

“… 65 In other studies, monitoring was a component of an intervention, which when evaluated, reported positive impact on symptoms, 20 45 59 63 mixed findings 46 53 or non-significant findings. 50 Five papers contained <10 participants, 52 58 64 67 74 21 papers contained <50 participants, 9 18 22 43 46–49 53–57 60 65 66 69–73 16 papers contained between 50 and 99 participants, 1 20 21 25 26 29–31 44 45 50 51 59 61–63 and five papers contained 100 or more participants, 19 27 28 68 one of which was the longitudinal ongoing study of ChronoRecord. 32–42 …”

Evidence-Based Evaluation of eHealth Interventions: Systematic Literature Review

“…However, concerning case studies, all conducted evaluation at the end of the intervention. Although several aspects of evaluation have been found in conceptual articles [32][33][34][35][36][37][38][39]41], the case studies mostly evaluated clinical [20,[42][43][44][46][47][48][49][52][53]55,[59][60][61][64][65], and human/social aspects [42,[46][47][48][49][53][54][55]59,61,63,65].…”

Over promised, over-sold and underperforming? – e-health in mental health

“…This requires specific skills in the coach as well as close monitoring. One recent study reports on the effects of providing expert support through a trained telehealth nurse who viewed the output from an adapted version of Health Buddy (Pratt et al, 2015 ). The nurse examined the information collected from each participant several times each day during the working week and followed a communication protocol depending on the category of response from the participant (red, yellow and green) where red are responses that are of major concern.…”