Abstract
BackgroundeHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018.ObjectiveThe objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients.MethodsThe integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single.ResultsSignificant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04).ConclusionsTo our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis.International Registered Report Identifier (IRRID)RR2-10.1111/eip.12960
Highlights
High interest in eHealth services and digital and mobile health has been noted in many recent studies among patients with psychotic disorder diagnoses [1,2]
Smartphone apps have been proposed as tools to mitigate social isolation, lack of access to care, and other triggers caused by the pandemic [3,4,5]
We found that nearly every immigrant considered for inclusion agreed to use the app (ReMindCare group 19% [10/11], treatment as usual (TAU) group 3% [1/11]; χ2=4.2, P=.04)
Summary
High interest in eHealth services and digital and mobile health has been noted in many recent studies among patients with psychotic disorder diagnoses [1,2]. Many studies are using real-time ecological momentary assessment (EMA) surveys to monitor symptoms and experiences and identify early indicators of relapse [9]. Beyond relapse prediction, these EMA data can offer novel information on the longitudinal health status of patients, which could improve treatment and shared decision making between patient and physician [10]. Results: Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Conclusions: To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis.
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