Kumar Divya, Tully Laura M, Iosif Ana-Maria, Zakskorn Lauren N, Nye Kathleen E, Zia Aqsa, Niendam Tara Ann
Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States.
Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Sacramento, CA, United States.
JMIR Ment Health. 2018 Feb 27;5(1):e15. doi: 10.2196/mental.8551.
A growing body of literature indicates that smartphone technology is a feasible add-on tool in the treatment of individuals with early psychosis (EP) . However, most studies to date have been conducted independent of outpatient care or in a research clinic setting, often with financial incentives to maintain user adherence to the technology. Feasibility of dissemination and implementation of smartphone technology into community mental health centers (CMHCs) has yet to be tested, and whether young adults with EP will use this technology for long periods of time without incentive is unknown. Furthermore, although EP individuals willingly adopt smartphone technology as part of their treatment, it remains unclear whether providers are amenable to integrating smartphone technology into treatment protocols.
This study aimed to establish the feasibility of implementing a smartphone app and affiliated Web-based dashboard in 4 community outpatient EP clinics in Northern California.
EP individuals in 4 clinics downloaded an app on their smartphone and responded to daily surveys regarding mood and symptoms for up to 5 months. Treatment providers at the affiliated clinics viewed survey responses on a secure Web-based dashboard in sessions with their clients and between appointments. EP clients and treatment providers filled out satisfaction surveys at study end regarding usability of the app.
Sixty-one EP clients and 20 treatment providers enrolled in the study for up to 5 months. Forty-one EP clients completed the study, and all treatment providers remained in the study for their duration in the clinic. Survey completion for all 61 EP clients was moderate: 40% and 39% for daily and weekly surveys, respectively. Completion rates were slightly higher in the participants who completed the study: 44% and 41% for daily and weekly surveys, respectively. Twenty-seven of 41 (66%) EP clients who completed the study and 11 of 13 (85%) treatment providers who responded to satisfaction surveys reported they would continue to use the app as part of treatment services. Six (15%; 6/41) clients and 3 providers (23%; 3/13) stated that technological glitches impeded their engagement with the platform.
EP clients and treatment providers in community-based outpatient clinics are responsive to integrating smartphone technology into treatment services. There were logistical and technical challenges associated with enrolling individuals in CMHCs. To be most effective, implementing smartphone technology in CMHC EP care necessitates adequate technical staff and support for utilization of the platform.
越来越多的文献表明，智能手机技术是治疗早期精神病（EP）患者的一种可行的辅助工具。然而，迄今为止，大多数研究都是在独立于门诊护理的情况下进行的，或者是在研究诊所环境中进行的，通常还会提供经济激励措施以维持用户对该技术的使用依从性。将智能手机技术推广并应用于社区心理健康中心（CMHC）的可行性尚未得到检验，而且患有早期精神病的年轻人在没有激励措施的情况下是否会长期使用该技术也尚不清楚。此外，尽管患有早期精神病的患者愿意将智能手机技术作为其治疗的一部分来采用，但目前尚不清楚医疗服务提供者是否愿意将智能手机技术纳入治疗方案。
本研究旨在确定在北加利福尼亚州的4家社区门诊早期精神病诊所实施一款智能手机应用程序及附属的基于网络的仪表板的可行性。
4家诊所的早期精神病患者在其智能手机上下载了一款应用程序，并对情绪和症状进行了长达5个月的每日调查。附属诊所的治疗提供者在与患者的会诊期间以及预约之间，通过一个安全的基于网络的仪表板查看调查回复。早期精神病患者和治疗提供者在研究结束时填写了关于该应用程序可用性的满意度调查问卷。
61名早期精神病患者和20名治疗提供者参与了该研究，为期长达5个月。41名早期精神病患者完成了研究，所有治疗提供者在其诊所工作期间都留在了研究中。所有61名早期精神病患者的调查完成情况一般：每日调查和每周调查的完成率分别为40%和39%。完成研究的参与者的完成率略高：每日调查和每周调查的完成率分别为44%和41%。完成研究的41名患者中有27名（66%）以及回复满意度调查的13名治疗提供者中有11名（85%）报告称他们会继续将该应用程序作为治疗服务的一部分来使用。6名（15%；6/41）患者和3名提供者（23%；3/13）表示技术故障妨碍了他们与该平台的互动。
社区门诊诊所的早期精神病患者和治疗提供者对将智能手机技术纳入治疗服务持积极态度。在社区心理健康中心招募患者存在后勤和技术方面的挑战。为了达到最佳效果，在社区心理健康中心的早期精神病护理中实施智能手机技术需要有足够的技术人员以及对平台使用的支持。
