Kauppi Kaisa, Välimäki Maritta, Hätönen Heli M, Kuosmanen Lauri M, Warwick-Smith Katja, Adams Clive E
Department of Nursing Science, University of Turku, Lemminkäisenkatu 1, Turku, Finland, 20014.
Cochrane Database Syst Rev. 2014 Jun 17;2014(6):CD009960. doi: 10.1002/14651858.CD009960.pub2.
Non-compliance is a significant problem among people with serious mental disorders, presenting a challenge for mental health professionals. Prompts such as telephone calls, visits, and a posted referral letter to patients are currently used to encourage patient attendance at clinics and/or compliance with medication. More recently, the use of information and communication technology (ICT)-based prompting methods have increased. Methods include mobile text message (SMS - short message service), e-mail or use of any other electronic device with the stated purpose of encouraging compliance.
To investigate the effects of ICT-based prompting to support treatment compliance in people with serious mental illness compared with standard care.
We searched the Cochrane Schizophrenia Group's Trials Register (31(st) May 2011 and 9(th) July 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. Also, we inspected references of all identified studies for further trials and contacted authors of trials for additional information.
Relevant randomised controlled trials involving adults with serious mental illness, comparing any ICT-based prompt or combination of prompts by automatic or semi-automatic system compared with standard care.
Review authors reliably assessed trial quality and extracted data. We calculated risk ratio (RR) with 95% confidence intervals (CI) using a fixed-effect model. For continuous outcomes, we estimated the mean difference (MD) between groups, again with 95% confidence intervals. A 'Summary of findings' table using GRADE was created, and we assessed included studies for risk of bias.
The search identified 35 references, with 25 studies, but we could only include two studies with a total of 358 participants. The studies had a moderate risk of bias, and therefore risk overestimating any positive effects of ICT-based prompting. Both included studies compared semi-automatised ICT-based prompting intervention with standard care groups in mental health outpatient care. The interventions were SMS-message and an electronic assistant device. One included study reported our primary outcome, compliance.There was not any clear evidence that ICT-based prompts increase improvement in compliance (stop taking medication within six months n = 320, RR 1.11 CI 0.96 to 1.29, moderate quality evidence). There was some low quality evidence that ICT-based prompts have small effects for: mental state (average change in specific symptom scores within three months n = 251, MD -0.30 CI -0.53 to -0.07; severity of illness within three months n = 251, MD -0.10 CI -0.13 to -0.07 and six months n = 251, MD -0.10 CI -0.13 to -0.07; average change in depressive scores within six months n = 251, RR 0.00 CI -0.28 to 0.28; global symptoms within three months n = 251, MD -0.10 CI -0.38 to -0.07; negative symptoms within three months n = 251, MD -0.10 CI -0.38 to 0.18 and six months n = 251, MD -0.30 CI -0.58 to 0.02, low quality evidence). Level of insight improved more among people receiving ICT-based prompt compared with those in the control group at six months (n = 251, MD -0.10 CI -0.13 to -0.07). ICT-based prompts also increased quality of life (average change in quality of life within six months n = 251, RR 0.50 CI 0.19 to 0.81, moderate quality evidence).Based on the existing data, there is no evidence that either intervention is less acceptable than the other (n = 347, 2 RCTs, RR 1.46 CI 0.70 to 3.05, low quality evidence). Included studies did not report outcomes of service utilisation, behaviour, costs or adverse events.
AUTHORS' CONCLUSIONS: The evidence base on the effects of ICT-based prompts is still inconclusive. Data to clarify ICT-based prompting effects are awaited from an ongoing trial, but further well-conducted trials considering the different ICT-based prompts are warranted.
不依从是严重精神障碍患者中的一个重大问题，给心理健康专业人员带来了挑战。目前使用诸如电话、家访以及给患者张贴转诊信等提示方式来鼓励患者前往诊所就诊和/或遵医嘱服药。最近，基于信息通信技术（ICT）的提示方法的使用有所增加。方法包括移动短信（SMS - 短消息服务）、电子邮件或使用任何其他电子设备，其目的是鼓励患者遵医嘱。
与标准护理相比，调查基于ICT的提示对支持严重精神疾病患者治疗依从性的效果。
我们检索了Cochrane精神分裂症研究组试验注册库（2011年5月31日和2012年7月9日），该注册库基于对CINAHL、BIOSIS、AMED、EMBASE、PubMed、MEDLINE、PsycINFO以及临床试验注册库的定期检索。此外，我们检查了所有已识别研究的参考文献以查找更多试验，并联系试验作者获取更多信息。
相关随机对照试验，涉及患有严重精神疾病的成年人，比较基于ICT的任何提示或通过自动或半自动系统进行的提示组合与标准护理。
综述作者可靠地评估了试验质量并提取了数据。我们使用固定效应模型计算了风险比（RR）及95%置信区间（CI）。对于连续性结果，我们估计了组间平均差（MD），同样带有95%置信区间。创建了一个使用GRADE的“结果总结”表，并且我们评估了纳入研究的偏倚风险。
检索到35篇参考文献，涉及25项研究，但我们只能纳入两项研究，共358名参与者。这些研究存在中度偏倚风险，因此可能高估了基于ICT的提示的任何积极效果。两项纳入研究均在心理健康门诊护理中将基于ICT的半自动提示干预与标准护理组进行了比较。干预措施为短信和电子辅助设备。一项纳入研究报告了我们的主要结果，即依从性。没有明确证据表明基于ICT的提示能提高依从性（六个月内停止服药的人数n = 320，RR 1.11，CI 0.96至1.29，中等质量证据）。有一些低质量证据表明基于ICT的提示对以下方面有微小影响：精神状态（三个月内特定症状评分的平均变化n = 251，MD -0.30，CI -0.53至 -0.07；三个月内疾病严重程度n = 251，MD -0.10，CI -0.13至 -0.07以及六个月内n = 251，MD -0.10，CI -0.13至 -0.07；六个月内抑郁评分的平均变化n = 251，RR 0.00，CI -0.28至0.28；三个月内总体症状n = 251，MD -0.10，CI -0.38至 -0.07；三个月内阴性症状n = 251，MD -0.10，CI -0.38至0.18以及六个月内n = 251，MD -0.30，CI -0.58至0.02，低质量证据）。与对照组相比，接受基于ICT提示的患者在六个月时洞察力水平改善更多（n = 251，MD -0.10，CI -0.13至 -0.07）。基于ICT的提示还提高了生活质量（六个月内生活质量的平均变化n = 251，RR 0.50，CI 0.19至0.81，中等质量证据）。基于现有数据，没有证据表明任何一种干预比另一种更难以接受（n = 347，2项随机对照试验，RR 1.46 CI 0.70至3.05，低质量证据）。纳入研究未报告服务利用、行为、成本或不良事件结果。
关于基于ICT的提示效果的证据仍然不明确。正在进行的一项试验有望提供数据以阐明基于ICT的提示效果，但仍需要进一步开展设计良好的试验，考虑不同的基于ICT的提示方式。
