While treatment adherence is particularly important for patients with severe mental disorders such as schizophrenia, there is a lack of high-quality studies looking at the effectiveness of using mobile interventions for these patients.
A previous search of the Cochrane Schizophrenia Group’s Trials Registry for randomized controlled trials (RCTs) on the effectiveness of information and communications technology (ICT) on treatment compliance of patients with serious mental disorders only recovered two relevant studies. These studies were evaluated to have overestimated the positive effects of ICT due to moderate bias levels.1
Text messaging programs have repeatedly been shown to be effective for improving medication adherence in a variety of other disease areas, thus evidence specific to patients with severe mental disorders could have significant implications for management and outcomes.
Recently, Välimäki et al looked into the matter again with the Mobile.Net study, a large, pragmatic, multicenter, parallel-group, 12-month RCT in Finland, investigating the impact of individually tailored, semi-automated, non-interactive text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes (N=1,139).2
Unfortunately, the results showed that tailored mobile telephone text messages did not reduce patients’ readmission rate to psychiatric hospitals, time spent in hospital, time between hospitalizations, or number of healthy days. Furthermore, patients’ satisfaction with care or quality of life did not differ statistically between the groups (P=0.12 and P=0.80, respectively), and response rates dropped to similar levels in the intervention (47.6%, 268/563) and control (46.8%, 262/560) groups. In fact, the overall cost of treatment was higher among those receiving text messages (P<0.001), but the cost amongst those who were readmitted was similar between groups (P=0.25).
At a glance, it seems that text-message reminders are not providing any advantages to patients with serious mental disorders. However, most of the above-mentioned parameters are related to cost and not directly measuring patients’ health condition. The study did note that those receiving text messages were less disabled when readmitted than those on usual care (OR 0.68, 95% CI 0.47–0.97; based on GAS scores), which suggests some level of health improvement as a result of the text reminders.
Although this was a carefully designed, large-scale study, it was unfortunate that the investigators did not study some key parameters in parallel, such as direct health outcomes and direct adherence measures (pill count or blood test results vs patient readmission rates). It was also disappointing that the study used one-way text messaging, rather than a bi-directional interactive program to monitor patient feedback. Future studies incorporating these additional elements and outcome measures will be helpful in truly assessing the effectiveness of mobile interventions on medication adherence among patients with severe mental disorders, and the relationship between improving adherence on health outcomes.