Feasibility and effectiveness of an automated telehealth intervention to improve illness self-management in people with serious psychiatric and medical disorders.

Abstract

Objective Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. Methods We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. Results Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as “much better” or “somewhat better” postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. Conclusions and Implications for Practice These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals.

Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature

“…Among these were 4 modified versions of the Health Buddy automated home messaging device delivered across diverse mental health settings (Godleski et al, 2012; Kasckow et al, 2011; Pratt et al, 2013; Pratt et al, 2014), 3 separate evaluations of the Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) (Komatsu et al, 2013; Spaniel et al, 2012; Spaniel, Vohlidka, Hrdlicka, et al, 2008; Spaniel, Vohlidka, Kozeny, et al, 2008), and a trial of an online platform for self-managing bipolar disorder (Todd et al, 2014). Measures of feasibility and acceptability included frequency of intervention use over time, response rates, study retention, proportion of devices that were returned undamaged, and participant reported usability (see Table 1).…”

Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

“…[10][11][12][13][14][15] It is well established in adult medical and surgical inpatient settings that psychiatric services are effective for responding to troubling mental health symptoms, 6,9 are well received by patients and referring medical services, and contribute to staff education about psychiatric illness and management. [16][17][18][19][20] PCLS involvement has been found to reduce medical complications, length of stay, and number of hospitalizations via early referral for psychiatric consultations, 21 behavioral health interventions (cognitivebehavioral or supportive therapies), 22,23 treatment of psychiatric presentation on medical and surgical units (ie, delirium, depression), 10,21 and facilitating access to appropriate psychiatric treatment postdischarge.…”

Systematic Review of Integrated General Medical and Psychiatric Self-Management Interventions for Adults With Serious Mental Illness

“…More than 70 different outcome measures were used in these studies, ranging from self-report to biological measures. Self-management skills and behaviors significantly increased in seven studies (22–25,28,32,33). Self-management attitudes significantly increased in four studies (25,26,28,32) and one study reported qualitative evidence of increased self-management attitudes (35).…”

“…The 15 included studies reported on nine interventions (Table 1), including: Automated Telehealth (22); Health and Recovery Peer program (HARP) (23); Helping Older People Experience Success (HOPES) (24–26); Integrated Illness Management and Recovery (I-IMR) (27,28); Life Goals Collaborative Care (LGCC) (29–31); Living Well (32); Norlunga Chronic Disease Self-Management program (33); Paxton House (34); and Targeted Training in Illness Management (TTIM) (35,36) (Table 1). Interventions were studied within diverse types of settings.…”

“…Six interventions (i.e., Automated Telehealth, HARP, HOPES, I-IMR, Living Well, and Norlunga Chronic Disease Self-Management program) targeted a heterogeneous set of serious mental illnesses and medical illnesses that require ongoing treatment (i.e., congestive heart failure, hypertension, diabetes, chronic obstructive pulmonary disease, hypothyroidism, asthma, and heart disease) (22, 24–28). …”