Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-13T03:47:40.946Z Has data issue: false hasContentIssue false
  • English
  • Français

Relapse prevention through health technology program reduces hospitalization in schizophrenia

Published online by Cambridge University Press:  30 May 2022

Philipp Homan Open the ORCID record for Philipp Homan [Opens in a new window] ,
Nina R. Schooler ,
Mary F. Brunette ,
Armando Rotondi ,
Dror Ben-Zeev ,
Jennifer D. Gottlieb ,
Kim T. Mueser ,
Eric D. Achtyes ,
Susan Gingerich  and
Patricia Marcy
...Show all authors
Philipp Homan
Affiliation:
Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
Nina R. Schooler
Affiliation:
Department of Psychiatry, SUNY Downstate Medical School, Brooklyn, NY, USA
Mary F. Brunette
Affiliation:
Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
Armando Rotondi
Affiliation:
Department of Critical Care Medicine, Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA, USA Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
Dror Ben-Zeev
Affiliation:
Department of Psychiatry and Behavioral Sciences, Behavioral Research in Technology and Engineering (BRiTE) Center, University of Washington School of Medicine, Seattle, WA, USA
Jennifer D. Gottlieb
Affiliation:
Cambridge Health Alliance, Division of Population Behavioral Health Innovation and Harvard Medical School Department of Psychiatry, Cambridge, MA, USA
Kim T. Mueser
Affiliation:
Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
Eric D. Achtyes
Affiliation:
Cherry Health and Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
Susan Gingerich
Affiliation:
Independent Consultant and Trainer in Narberth, Narberth, Pennsylvania, USA
Patricia Marcy
Affiliation:
Vanguard Research Group, Glen Oaks, NY, USA
Piper Meyer-Kalos
Affiliation:
University of Minnesota Medical School, Department of Psychiatry & Behavioral Sciences, Minneapolis, MN, USA
Marta Hauser
Affiliation:
Vanguard Research Group, Glen Oaks, NY, USA
Majnu John
Affiliation:
Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA Department of Mathematics, Hofstra University, Hempstead, NY, USA
Delbert G. Robinson*
Affiliation:
Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
John M. Kane
Affiliation:
Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
*
Author for correspondence: Delbert G. Robinson, E-mail: drobinso@northwell.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Psychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. Here, we asked whether a technology-enhanced approach to relapse prevention could reduce days spent in a hospital after discharge.

Methods

The Improving Care and Reducing Cost (ICRC) study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between 26 February 2013 and 17 April 2015 at 10 different sites in the USA in an outpatient setting. Patients were between 18 and 60 years old with a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified. Patients received usual care or a technology-enhanced relapse prevention program during a 6-month period after discharge. The health technology program included in-person, individualized relapse prevention planning with treatments delivered via smartphones and computers, as well as a web-based prescriber decision support program. The main outcome measure was days spent in a psychiatric hospital during 6 months after discharge.

Results

The study included 462 patients, of which 438 had complete baseline data and were thus used for propensity matching and analysis. Control participants (N = 89; 37 females) were enrolled first and received usual care for relapse prevention followed by 349 participants (128 females) who received technology-enhanced relapse prevention. During 6-month follow-up, 43% of control and 24% of intervention participants were hospitalized (χ2 = 11.76, p<0.001). Days of hospitalization were reduced by 5 days (mean days: b = −4.58, 95% CI −9.03 to −0.13, p = 0.044) in the intervention condition compared to control.

Conclusions

These results suggest that technology-enhanced relapse prevention is an effective and feasible way to reduce rehospitalization days among patients with schizophrenia.

Keywords

Schizophreniainpatient hospitalization daysrelapse preventiontechnology provided caresmartphonesweb-provided treatmentsdecision support systems
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 9 , July 2023 , pp. 4114 - 4120
Check for updates
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Equal contribution.

References

Abdel-Baki, A., Lal, S., D-Charron, O., Stip, E., & Kara, N. (2015, May). Understanding access and use of technology among youth with first-episode psychosis to inform the development of technology-enabled therapeutic interventions. Early Intervention in Psychiatry, 11(1), 72–76. http://doi.org/10.1111/eip.12250.CrossRefGoogle ScholarPubMed
Achtyes, E. D., Ben-Zeev, D., Luo, Z., Mayle, H., Burke, B., Rotondi, A. J., … Kane, J. M. (2019). Off-hours use of a smartphone intervention to extend support for individuals with schizophrenia spectrum disorders recently discharged from a psychiatric hospital. Schizophrenia Research, 206, 200–208. http://doi.org/10.1016/j.schres.2018.11.026.CrossRefGoogle ScholarPubMed
Almond, S., Knapp, M., Francois, C., Toumi, M., & Brugha, T. (2004). Relapse in schizophrenia: Costs, clinical outcomes and quality of life. The British Journal of Psychiatry, 184(4), 346–351.CrossRefGoogle ScholarPubMed
Alvarez-Jimenez, M., Alcazar-Corcoles, M., Gonzlez-Blanch, C., Bendall, S., McGorry, P., & Gleeson, J. (2014). Online, social media and mobile technologies for psychosis treatment: A systematic review on novel user-led interventions. Schizophrenia Research, 156(1), 96–106. http://doi.org/10.1016/j.schres.2014.03.021.CrossRefGoogle ScholarPubMed
Ascher-Svanum, H., Zhu, B., Faries, D. E., Salkever, D., Slade, E. P., Peng, X., & Conley, R. R. (2010). The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC Psychiatry, 10(1). http://doi.org/10.1186/1471-244x-10-2.CrossRefGoogle ScholarPubMed
Austin, P. C., & Stuart, E. A. (2015). Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statistics in Medicine, 34(28), 3661–3679. https://doi.org/10.1002/sim.6607.CrossRefGoogle ScholarPubMed
Baumel, A., Correll, C. U., Hauser, M., Brunette, M., Rotondi, A., Ben-Zeev, D., … Kane, J. M. (2016). Health technology intervention after hospitalization for schizophrenia: Service utilization and user satisfaction. Psychiatric Services, 67(9), 1035–1038. https://doi.org/10.1176/appi.ps.201500317.CrossRefGoogle ScholarPubMed
Ben-Zeev, D., Brenner, C. J., Begale, M., Duffecy, J., Mohr, D. C., & Mueser, K. T. (2014). Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophrenia Bulletin, 40(6), 1244–1253. https://doi.org/10.1093/schbul/sbu033.CrossRefGoogle ScholarPubMed
Ben-Zeev, D., Buck, B., Kopelovich, S., & Meller, S. (2019). A technology-assisted life of recovery from psychosis. NPJ Schizophrenia, 5(1). https://doi.org/10.1038/s41537-019-0083-y.CrossRefGoogle ScholarPubMed
Ben-Zeev, D., Drake, R., & Marsch, L. (2015). Clinical technology specialists. BMJ, 350(feb19 15), h945–h945. https://doi.org/10.1136/bmj.h945.CrossRefGoogle ScholarPubMed
Ben-Zeev, D., Razzano, L. A., Pashka, N. J., & Levin, C. E. (2021). Cost of mhealth versus clinic-based care for serious mental illness: Same effects, half the price tag. Psychiatric Services. https://doi.org/10.1176/appi.ps.202000349.CrossRefGoogle ScholarPubMed
Ben-Zeev, D., Scherer, E. A., Gottlieb, J. D., Rotondi, A. J., Brunette, M. F., Achtyes, E. D., … Kane, J. M. (2016). Mhealth for schizophrenia: Patient engagement with a mobile phone intervention following hospital discharge. JMIR Mental Health, 3(3), e34. http://dx.doi.org/10.2196/mental.6348.CrossRefGoogle ScholarPubMed
Brunette, M. F., Rotondi, A. J., Ben-Zeev, D., Gottlieb, J. D., Mueser, K. T., Robinson, D. G., … Kane, J. M. (2016). Coordinated technology-delivered treatment to prevent rehospitalization in schizophrenia: A novel model of care. Psychiatric Services, 67(4), 444–447. https://doi.org/10.1176/appi.ps.201500257.CrossRefGoogle ScholarPubMed
Cavelti, M., Homan, P., & Vauth, R. (2016). The impact of thought disorder on therapeutic alliance and personal recovery in schizophrenia and schizoaffective disorder: An exploratory study. Psychiatry Research, 239, 92–98. https://doi.org/10.1016/j.psychres.2016.02.070.CrossRefGoogle ScholarPubMed
Cavelti, M., Winkelbeiner, S., Federspiel, A., Walther, S., Stegmayer, K., Giezendanner, S., … Homan, P. (2018). Formal thought disorder is related to aberrations in language-related white matter tracts in patients with schizophrenia. Psychiatry Research: Neuroimaging, 279(279), 40–50. https://doi.org/10.1016/j.pscychresns.2018.05.011.CrossRefGoogle ScholarPubMed
Emsley, R., Nuamah, I., Hough, D., & Gopal, S. (2012). Treatment response after relapse in a placebo- controlled maintenance trial in schizophrenia. Schizophrenia Research, 138(1), 29–34. https://doi.org/10.1016/j.schres.2012.02.030.CrossRefGoogle Scholar
Higashi, K., Medic, G., Littlewood, K. J., Diez, T., Granström, O., & De Hert, M. (2013). Medication adherence in schizophrenia: Factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic Advances in Psychopharmacology, 3(4), 200–218. https://doi.org/10.1177/2045125312474019.CrossRefGoogle ScholarPubMed
Jones, N., Gius, B., Daley, T., George, P., Rosenblatt, A., & Shern, D. (2020). Coordinated specialty care discharge, transition, and step-down policies, practices, and concerns: Staff and client perspectives. Psychiatric Services, 71(5), 487–497. https://doi.org/10.1176/appi.ps.201900514.CrossRefGoogle ScholarPubMed
Lal, S., Dell'Elce, J., & Malla, A. K. (2015). Technology access and use among young adults with a first episode of psychosis. Psychiatric Services, 66(7), 764–765. https://doi.org/10.1176/appi.ps.201400580.CrossRefGoogle ScholarPubMed
Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., … Hsiao, J. K. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353(12), 1209–1223. https://doi.org/10.1056/nejmoa051688.CrossRefGoogle ScholarPubMed
Mohr, D. C., Cuijpers, P., & Lehman, K. (2011). Supportive accountability: A model for providing human support to enhance adherence to ehealth interventions. Journal of Medical Internet Research, 13(1), e30. http://doi.org/10.2196/jmir.1602.CrossRefGoogle Scholar
Mueser, K., Corrigan, P., & Hilton, D. (2002). Illness management and recovery: A review of the research. Psychiatric Services, 53, 1272–1284. http://doi.org/10.1176/appi.ps.53.10.1272.CrossRefGoogle ScholarPubMed
Nasi, G., Cucciniello, M., & Guerrazzi, C. (2015). The role of mobile technologies in health care processes: The case of cancer supportive care. Journal of Medical Internet Research, 17(2), e26. https://doi.org/10.2196/jmir.3757.CrossRefGoogle ScholarPubMed
O'Shea, C. J., McGavigan, A. D., Clark, R. A., Chew, D. P. B., & Ganesan, A. (2017). Mobile health: An emerging technology with implications for global internal medicine. Internal Medicine Journal, 47(6), 616–619. https://doi.org/10.1111/imj.13440.CrossRefGoogle ScholarPubMed
Prensky, M. (2001). Digital natives, digital immigrants part 1. On the Horizon, 9(5), 1–6. https://doi.org/10.1108/10748120110424816.Google Scholar
Rosenheck, R., Leslie, D., Sint, K., Lin, H., Robinson, D. G., Schooler, N. R., … Kane, J. M. (2016). Cost-effectiveness of comprehensive, integrated care for first episode psychosis in the NIMH RAISE early treatment program. Schizophrenia Bulletin, 42(4), 896–906. https://doi.org/10.1093/schbul/sbv224.CrossRefGoogle ScholarPubMed
Rotondi, A. J., Anderson, C. M., Haas, G. L., Eack, S. M., Spring, M. B., Ganguli, R., … Rosenstock, J. (2010). Web-based psychoeducational intervention for persons with schizophrenia and their supporters: One-year outcomes. Psychiatric Services, 61(11), 1099–1105. https://doi.org/10.1176/ps.2010.61.11.1099.CrossRefGoogle ScholarPubMed
Takeuchi, H., Siu, C., Remington, G., Fervaha, G., Zipursky, R. B., Foussias, G., & Agid, O. (2018). Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia. Neuropsychopharmacology, 44(6), 1036–1042. https://doi.org/10.1038/s41386-018-0278-3.CrossRefGoogle ScholarPubMed
Wiersma, D., Nienhuis, F. J., Slooff, C. J., & Giel, R. (1998). Natural course of schizophrenic disorders: A 15-year followup of a Dutch incidence cohort. Schizophrenia Bulletin, 24(1), 75–85. https://doi.org/10.1093/oxfordjournals.schbul.a033315.CrossRefGoogle ScholarPubMed
Winkelbeiner, S., Cavelti, M., Federspiel, A., Kunzelmann, K., Dierks, T., Strik, W., … Homan, P. (2018). Decreased blood flow in the right insula and middle temporal gyrus predicts negative formal thought disorder in schizophrenia. Schizophrenia Research, 201, 432–434. https://doi.org/10.1016/j.schres.2018.06.009.CrossRefGoogle ScholarPubMed
Supplementary material: File

Homan et al. supplementary material

Homan et al. supplementary material

Download Homan et al. supplementary material(File)
File 212.7 KB