Abstract
BackgroundA text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce.ObjectiveThe main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs.MethodsBetween September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis).ResultsThere was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI –8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI –2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, P<.001).ConclusionsHigh-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. 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. 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.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz).
Highlights
Mobile technology has the potential to promote patient self-management, leading to better health behaviors, which, in turn, improve clinical outcomes among people with chronic illnesses
Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the Short message service (SMS) group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations, time spent in a psychiatric hospital during the year, or other service outcomes
People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages
Summary
Mobile technology has the potential to promote patient self-management, leading to better health behaviors, which, in turn, improve clinical outcomes among people with chronic illnesses. Short message service (SMS) text messaging on mobile telephones could address some of the chronic disease management needs. The majority of mHealth studies have tested basic mobile phone features, such as text messaging [2], but the effectiveness of using text messaging for supporting treatment adherence among people with serious mental disorders, such as schizophrenia, is still not clear [3]. The number of mHealth apps promoting medication adherence has increased, including apps targeted at improving mental health [9]. A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce
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