Off-hours use of a smartphone intervention to extend support for individuals with schizophrenia spectrum disorders recently discharged from a psychiatric hospital

Eric D. Achtyes, Dror Ben-Zeev, Zhehui Luo, Heather Mayle, Brandi Burke, Armando J. Rotondi, Jennifer D. Gottlieb, Mary F. Brunette, Kim T. Mueser, Susan Gingerich, Piper S. Meyer-Kalos, Patricia Marcy, Nina R. Schooler, Delbert G. Robinson, John M. Kane

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Introduction: Technology-delivered healthcare interventions may enhance dissemination of evidence-based treatments in low-resource areas. These interventions may be accessed ‘on-demand,’ including after hours. Patients with schizophrenia do engage with technological aids but when/how they would utilize these tools is not known. Methods: We conducted a large, prospective, ten-site, longitudinal study of four technology-assisted interventions for patients with schizophrenia spectrum disorders within 60 days of psychiatric hospital discharge, a high risk period. One tool employed was a smartphone intervention called ‘FOCUS,’ which could be used by patients as needed, providing help in five content areas: medications, mood, social, sleep and voices. Each login was date- and time-stamped as occurring during normal clinic hours, or ‘off-hours,’ and the pattern of use described. Results: 347 of 368 patients utilized FOCUS during the 6-month study. There were a total of 75,447 FOCUS logins; 35,739 (47.4%) were self-initiated and 38,139 (50.6%) were off-hours. 18,450 of the logins during off-hours were self-initiated (24.5%). No differences in average usage per month were found based on race/ethnicity. A subset of ‘high utilizers’ (n = 152, 43.8%) self-initiated use of all five FOCUS modules both on- and off-hours. They tended to be women, >35 years old, and had a high school diploma or greater. Conclusion: Most patients with schizophrenia spectrum disorders recently discharged from the hospital utilized a smartphone intervention targeted to address troublesome residual symptoms. One quarter of the total smartphone utilization was self-initiated off-hours, indicating the potential utility of this tool to extend support for patients during periods of elevated risk.

Original languageEnglish (US)
Pages (from-to)200-208
Number of pages9
JournalSchizophrenia Research
Volume206
DOIs
StatePublished - Apr 2019

Bibliographical note

Funding Information:
Centers for Medicare & Medicaid Services Innovations Grant 1C1CMS331052-01-00 (Kane) and a Network180 project grant (Achtyes). The contents of this report are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

Funding Information:
Centers for Medicare & Medicaid Services Innovations Grant 1C1CMS331052-01-00 (Kane) and a Network180 project grant (Achtyes). The contents of this report are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services. We wish to thank Ms. Roshanah Dayton, who assisted with data collection and Ms. Shirley Verwys for proofreading this manuscript. We also wish to thank all of the patients and staff at the treatment centers involved in this study: Burrell Behavioral Health - Springfield, MO; Care Free Clinic - Lansing, MI; Center for Rural Behavioral Health - Albuquerque, NM; Cherry Health - Grand Rapids, MI; Community Mental Health Center, Inc. - Lawrenceburg, IN; Henderson Behavioral Health - Lauderdale Lakes, FL; Manchester Mental Health Center - Manchester, NH; PeaceHealth - Eugene, OR; University of Missouri Kansas City - Kansas City, MO; Zucker Hillside Hospital - Glen Oaks, NY.

Funding Information:
Dr. Achtyes has received research support from Alkermes, AssurEx, Astellas, Avanir, Boehringer Ingelheim, Janssen, Neurocrine Biosciences, Novartis, Otsuka, Pfizer, Pine Rest Foundation, Priority Health, Network180 and Vanguard Research Group and has served on advisory panels for Alkermes, Roche, Janssen, Neurocrine Biosciences and the Vanguard Research Group. Dr. Ben-Zeev has an intervention content licensing agreement with Pear Therapeutics. Dr. Brunette receives research support from Alkermes. Dr. Robinson has been a consultant or received grants from Asubio, Bristol-Myers Squibb, Janssen, Otsuka, and Shire. Ms. Marcy is a stockholder in Pfizer. Dr. Schooler has served on advisory boards for Alkermes, Forum (formerly EnVivo), and Sunovion. Dr. Kane has been a consultant for or has received honoraria from Alkermes, Eli Lilly, EnVivo Pharmaceuticals (Forum), Forest, Genentech, H. Lundbeck, Intracellular Therapeutics, Janssen Pharmaceuticals, Johnson and Johnson, Otsuka, Reviva, Roche, Sunovion, and Teva and is a shareholder in Med-Avante, Inc., LB Pharmaceuticals and Vanguard Research Group. The other authors report no financial relationships with commercial interests.

Publisher Copyright:
© 2018 Elsevier B.V.

Keywords

  • Off-hours
  • Relapse
  • Schizophrenia
  • Smartphone
  • Technology
  • Underserved

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