Encouraging patients with mental illness to stick to their treatment plans by using medical apps seems like a promising idea.
While there may be some potential, the results of a recently published study of schizophrenic patients who received text reminders and other relevant information about their treatment plans suggest that their outcomes are no different from those patients who had not received the text messages.
The results surprised some observers. Other studies using text messages to encourage adherence to treatment plans demonstrated significant improvements in the number of patients who successfully completed their treatment plans.
But in a recently published study of schizophrenic patients, those who received text messages were not evaluated according to how well they adhered to their medication. It instead measured the impact of texting on the patients’ rate of hospital readmission, time between hospitalizations, and time spent in a psychiatric hospital.
The study, published last July in the Journal of Medical Internet Research, followed 1,139 patients over a period of up to 12 months. The primary focus was tracking whether or not a patient had to be readmitted to a psychiatric hospital during the study.
The researchers succeeded in following up with 98 percent of the patients who agreed to participate. Of those patients, the group that received text messages ended up being readmitted at a slightly higher rate of 43 percent, compared to 39 percent for the control group. The researchers also noted that the text messages did not appear to reduce the time between hospitalizations, time spent in psychiatric hospitals, or any other service outcomes. In addition, the cost of treatment for the text message group was higher than the group that did not receive text messages (an average of €10,103 for the text message group versus €9,210 for the non-text message group).
The one area of improvement was among patients receiving text messages who were deemed less “disabled” upon readmission to hospital.
“SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up,” the study’s authors wrote. “Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families.”
The study of schizophrenic patients contrasts significantly with earlier studies that found great potential in the use of medical apps, although not necessarily for patients with mental illness.
A meta-analysis published last year in the Journal of the American Medical Association found that mobile phone text messaging approximately doubled the odds of medication adherence.
That study examined the results of 16 clinical trials that used varying forms of text message protocols. Some used personalized messages sent to patients, some sent daily messages, and others used two-way messaging.
The researchers found that the text messaging improved medication adherence from 50 percent (the baseline rate for patients with chronic disease) to 68 percent — an increase of almost 17 percent.
While promising, these results should be interpreted with caution, given the short duration of trials and reliance on self-reported medication adherence measures,” the study’s authors wrote. “Future studies need to determine the features of text message interventions that improve success, as well as appropriate patient populations, sustained effects, and influences on clinical outcomes."
Given the technology’s ability to scale, its promising potential (the schizophrenic study notwithstanding) and its capacity to impact many patients at once, researchers will likely continue to study and look for ways to improve medical apps. Any success would have a significant effect on patients with mental illness.