Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program

Abstract

Background Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. Methods A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. Conclusions To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. Trial registration clinicaltrials.gov, NCT05133726. Registered 24 November 2021

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

“…Aside from those interventions addressed in this review, there are other innovations such as mobile text technology which provides evidence-based, cost-effective, geography-independent, and easily scalable methods for delivering psychological interventions to the public with mental health issues. For instance, Text4Mood [ 83 ], Text4Hope [ 84 ], and Text4Support [ 22 , 85 ] programs, which were implemented in Alberta and Nova Scotia, Canada have proven to provide psychological support services to the general public and successfully reduced psychiatric readmissions and ED visits in various populations. In the end, it is worth emphasizing that government and policymakers must work closely with researchers to develop and implement measures that will reduce the number of repeat visits to the emergency department in the mental health department as well as improve patient quality of life.…”

“…Chronic substance abuse, being single, being homeless, and not having social health insurance were reported predictors of recurrent ED visits due to acute mental health problems [ 16 , 20 , 21 ]. Repetitive ED visits are associated with overcrowding, unnecessary delays in care, dissatisfaction, and avoidable patient harm [ 22 ]. Because the ED is also an expensive place for medical care, repeat visits can contribute to high healthcare expenditures.…”

“…ED care costs are estimated to be between two and five times higher than that of primary care. In these situations, patients and their families suffer not only significant physical and psychological consequences but also financial consequences [ 22 ]. The health system is also negatively impacted by a lack of infrastructure, human resources, and financial resources caused by repetitive ED visits [ 23 ].…”

Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates

“…Supportive text messaging programs are evidence-based, cost-effective, easily scalable, devoid of geographical barriers to access, do not require expensive data plans, and comes at no cost to subscribers. There is currently a large trial in Edmonton to investigate the impact of supportive text messages, with or without peer support, on readmission rates for patients discharged from acute psychiatric hospitals in Alberta [ 93 ]. The outcome of this study will provide insights into the potential for using these low cost and easily scalable interventions to reduce readmission rates for patients discharged from inpatient psychiatric units.…”

Mobile Apps to Support Mental Health Response in Natural Disasters: Scoping Review

“…In addition, mHealth interventions were deployed to support first responders and essential workers during the pandemic [ 23 , 24 ]. Further, the technology has been deployed for therapeutic purposes in patients diagnosed with mental health conditions while simultaneously providing support against complications such as suicidal ideation (tertiary prevention) [ 25 ].…”