How Telehealth Can Improve Patient Care and Outcomes: Mobile Health (mHealth) vs Clinic-Based Intervention for People with Serious Mental Illness Discussant: Mark Ishaug, MA Speaker: Dror Ben-Zeev, PhD CEO, Thresholds Professor of Psychiatry and Behavioral Sciences, University of Washington Director, mHealth for Mental Health Program #PCORI2018 November 1, 2018
Dror Ben-Zeev, PhD • Disclosure: Intervention content licensing agreement with Pear Therapeutics Mark Ishaug, MA Disclosure: Nothing to disclose 2 • November 1, 2018
Serious Mental Illness (SMI) • Schizophrenia, Bipolar Disorder, Major Depressive Disorder • 4% of world population • Significant functional impairment • May be chronic but certainly not static • Illness management strategies increase and lengthen recovery periods 3 • November 1, 2018
Barriers of Clinic-Based Mental Health Care • Distance/transportation • Hours of operation • Other patients/people • Stigma • Quality of care 4 • November 1, 2018
Mobile Health (mHealth) for Mental Health • Mobile phones are ubiquitous (Ben-Zeev et al., 2012; Carras et al., 2014; Torous, 2018) • People with SMI are interested in mHealth (Firth et al., 2015) • Smartphones can bring mHealth to life • mHealth for SMI shows promise How does mHealth compare to clinic-based care? 5 • November 1, 2018
FOCUS: mHealth Intervention for people with SMI • 3 Daily prompts • “On-demand” resources Hello, Drori! • 5 treatment targets: voices, social, MEDICATION VOICES meds, sleep, mood MOOD SOCIAL • Dashboard • mHealth Support Specialist SLEEP TOOLBOX 6 • November 1, 2018
FOCUS interactions • System prompt: 3 times daily • Patient initiated: On demand 24/7 • mHealth specialist: 1 phone call weekly 7 • November 1, 2018
FOCUS Clinical Status Assessment Hello, Rachel! Have you been bothered by voices today? 8 • November 1, 2018
FOCUS Cognitive Assessment How would you describe the voices: 9 • November 1, 2018
FOCUS Intervention: Written If the voices got it wrong once, they probably don’t know Voices may sound like they How about when the voices Can you think of any time when everything, right? Think about know everything, but they were sure something was the voices made a mistake? it. don’t. going to happen, but it didn’t? 10 • November 1, 2018
FOCUS Intervention: Videos 11 • November 1, 2018
FOCUS Online Dashboard 12 • November 1, 2018
PCORI-funded comparative effectiveness trial: 2015- 2017 • Study site: Thresholds Chicago • Randomized Controlled Trial (RCT) • N=163 (49% schizophrenia, 28% bipolar disorder, 23% MDD) • 18 years or older (Average age: 49) • Ethnicity: 65% African-American, 27.5% White • Fifth grade reading level or higher • Assessments: Baseline (0 months) Post treatment (3 months) Follow Up (6 months) Ben-Zeev et al. (2018) Psychiatric Services. 13 • November 1, 2018
Comparative Effectiveness Trial (12 Week RCT) FOCUS (N=82) WRAP (N=81) Hello, Peter! MEDICATION VOICES vs MOOD SOCIAL SLEEP TOOLBOX No Significant Difference in Clinical Outcomes or Satisfaction Ratings Between Conditions Ben-Zeev et al. (2018) Psychiatric Services. 14 • November 1, 2018
Study Results: Treatment Commencement and Patient Engagement Ben-Zeev et al. (2018) Psychiatric Services. 15 • November 1, 2018
Study Results: Depression Ben-Zeev et al. (2018) Psychiatric Services. 16 • November 1, 2018
Study Results: General Psychopathology Ben-Zeev et al. (2018) Psychiatric Services. 17 • November 1, 2018
Study Results: Recovery Ben-Zeev et al. (2018) Psychiatric Services. 18 • November 1, 2018
Study Results: Patient Satisfaction Ben-Zeev et al. (2018) Psychiatric Services. 19 • November 1, 2018
Conclusion and Next Steps • mHealth demonstrated superior treatment commencement and engagement • FOCUS and WRAP produced similar patient satisfaction and clinical outcomes • How do we disseminate and implement mHealth in real-world mental health treatment settings? • FCC’s Lifeline program? • Billing Codes for mHealth related activities? Ben-Zeev et al. (2018) Psychiatric Services. 20 • November 1, 2018
Learn More • www.pcori.org/research-results/2014/comparing-smartphone- program-peer-led-program-help-people-serious- mentalinfo@pcori.org • #PCORI2018 • www.mhh4mh.org • Ben-Zeev, D., Brian, R.M., Jonathan, G.K., et al. (2018). Mobile Health (mHealth) vs Clinic-Based Group Intervention for People with Serious Mental Illness: A Randomized Controlled Trial. Psychiatric Services 69 (9), 978-985. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800063 21 • November 1, 2018
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