Bauer Amy M, Hodsdon Sarah, Bechtel Jared M, Fortney John C
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
John Snow, Inc, Boston, MA, United States.
J Med Internet Res. 2018 Jun 6;20(6):e10048. doi: 10.2196/10048.
Despite a proliferation of patient-facing mobile apps for mental disorders, there is little literature guiding efforts to incorporate mobile tools into clinical care delivery and integrate patient-generated data into care processes for patients with complex psychiatric disorders.
The aim of this study was to seek to gain an understanding of how to incorporate a patient-provider mobile health (mHealth) platform to support the delivery of integrated primary care-based mental health services (Collaborative Care) to rural patients with posttraumatic stress disorder and/or bipolar disorder.
Using the Principles for Digital Development as a framework, we describe our experience designing, developing, and deploying a mobile system to support Collaborative Care. The system consists of a patient-facing smartphone app that integrates with a Web-based clinical patient registry used by behavioral health care managers and consulting psychiatrists. Throughout development, we engaged representatives from the system's two user types: (1) providers, who use the Web-based registry and (2) patients, who directly use the mobile app. We extracted mobile metadata to describe the early adoption and use of the system by care managers and patients and report preliminary results from an in-app patient feedback survey that includes a System Usability Scale (SUS).
Each of the nine Principles for Digital Development is illustrated with examples. The first 10 patients to use the smartphone app have completed symptom measures on average every 14 days over an average period of 20 weeks. The mean SUS score at week 8 among four patients who completed this measure was 91.9 (range 72.5-100). We present lessons learned about the technical and training requirements for integration into practice that can inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions.
Adhering to the Principles for Digital Development, we created and deployed an mHealth system to support Collaborative Care for patients with complex psychiatric conditions in rural health centers. Preliminary data among the initial users support high system usability and show promise for sustained use. On the basis of our experience, we propose five additional principles to extend this framework and inform future efforts to incorporate health technologies to improve care for patients with psychiatric conditions: design for public health impact, add value for all users, test the product and the process, acknowledge disruption, and anticipate variability.
尽管面向患者的精神障碍移动应用程序大量涌现，但关于如何将移动工具纳入临床护理服务以及如何将患者生成的数据整合到复杂精神疾病患者的护理流程中的文献却很少。
本研究旨在了解如何整合患者与医疗服务提供者的移动健康（mHealth）平台，以支持为患有创伤后应激障碍和/或双相情感障碍的农村患者提供基于初级保健的综合精神卫生服务（协作式护理）。
以数字发展原则为框架，我们描述了设计、开发和部署一个支持协作式护理的移动系统的经验。该系统包括一个面向患者的智能手机应用程序，它与行为健康护理经理和咨询精神科医生使用的基于网络的临床患者登记系统集成。在整个开发过程中，我们邀请了该系统两类用户的代表参与：（1）使用基于网络登记系统的医疗服务提供者，以及（2）直接使用移动应用程序的患者。我们提取了移动元数据来描述护理经理和患者对该系统的早期采用和使用情况，并报告了一项应用内患者反馈调查的初步结果，该调查包括系统可用性量表（SUS）。
通过实例阐述了九条数字发展原则中的每一条。最初使用智能手机应用程序的10名患者在平均20周的时间里平均每14天完成一次症状测量。在完成该测量的4名患者中，第8周的SUS平均得分为91.9（范围为72.5 - 100）。我们介绍了在整合到实践中的技术和培训要求方面吸取的经验教训，这些经验教训可为未来将健康技术纳入以改善精神疾病患者护理的努力提供参考。
遵循数字发展原则，我们创建并部署了一个移动健康系统，以支持农村健康中心为患有复杂精神疾病的患者提供协作式护理。初始用户的初步数据支持该系统具有较高的可用性，并显示出持续使用前景。基于我们的经验，我们提出另外五条原则以扩展这个框架，并为未来将健康技术纳入以改善精神疾病患者护理的努力提供参考：设计具有公共卫生影响的方案、为所有用户增加价值、测试产品和流程、认识到干扰因素、预测变异性。
