Use of eHealth for Health Management in People with Schizophrenia
In this section
The Journal of Nervous and Mental Disease
Perspectives on the Use of eHealth in the management of health in people with schizophrenia
Use of eHealth for Health Management in People with Schizophrenia
Currently pharmacological and psychological therapies are the primary treatment options for people with schizophrenia.1 However, mobile devices, web-based applications and other digital technologies, known as eHealth (electronic health) also have the potential to improve health care delivery and disease management.1 This is a significant opportunity as both patients and healthcare professionals are increasingly adopting use of digital technologies into their daily routines. In a study carried out in 2016, Treisman et al. recruited a panel of experts, composed of psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker and a third-party payor, to discuss the use of eHealth in the management of schizophrenia.1 Among the topics discussed were the uses, benefits and limitations of emerging eHealth, its capability to integrate care and extend service accessibility, monitor symptoms in real time, enhance medication adherence and empower people with schizophrenia to take a more active role in managing their condition. The key insights from this panel discussion are presented below.
How could eHealth transform healthcare delivery in schizophrenia?
eHealth use could potentially transform healthcare delivery in schizophrenia by:1
Enabling early symptom recognition and intervention
A common issue in schizophrenia is that young adults showing symptoms do not receive assessment due to unfamiliarity with symptoms, stigma-related concerns or limited access to services.2 eHealth can help to raise awareness around the disease and enable people recognise the prodromal symptoms. Examples of these technologies are: disease awareness mobile applications (apps), such as โMy Journeyโ3,4 and the non-profit mental health resource โPsyberguideโ5; online and web-based tools, such as โHeadspaceโ, a mental health service available in Australia6 and tele-mental health.
Disseminating information after diagnosis
Access to eHealth support would be valuable for individuals suffering from schizophrenia at the post-diagnosis stage. People with schizophrenia often do not qualify for support systems, and they live in suboptimal conditions, which means they may not receive adequate treatment, thus relapsing and requiring hospitalization.7,8 In these instances, tailored web-based guides could provide information to them and their carers regarding treatment options and connect them to mental health experts and treatment facilities.1
Integrating care and extending service accessibility
Ensuring continuity of care in schizophrenia is another major challenge, where eHealth can support. Health Information Technology (HIT), such as electronic health records (EHRs), can contribute to improving the quality and cost-effectiveness of health care services.9 Moreover, tele-mental health and telepsychiatry, such as real-time video-conferencing can help to extend therapy beyond the clinical practice setting and increase access to care.10
Supporting medication adherence, engagement, self-management and rehabilitation
Studies have shown that 50% of people with schizophrenia do not take their medications as prescribed.11 Electronic prescribing systems and drug monitoring databases can enable the clinicians monitor adherence to medication.12 For the very reluctant individuals โsmart pillsโ with integrated detection technology can record treatment activity.1 Self-management can be challenging in people with cognitive impairment. However, mobile technology can help to detect the subjectโs feelings, thoughts, or symptom changes.13 These data can be subsequently used by doctors to shape key treatment decisions. Regarding rehabilitation, computer-assisted cognitive remediation (CACR) is an emerging game-based technology that is used to improve neurocognition and negative symptoms.14
What are the challenges in implementing eHealth in schizophrenia management?
The adoption of eHealth appears to have the potential to move schizophrenia management forward. However, further research is required in order to manage the implementation challenges:1
| Type of challenge | Challenge description | Supporting studies | Potential solutions/future considerations |
| Challenges to people living with Schizophrenia | Suspicion of technology | Freeman, 200815; Sendt et al., 201516 | Transparent policies required |
| Cognitive difficulties | Young and Geyer, 201517 | Self-management software for smartphone devices (Ben-Zeev et al., 2013b)18 | |
| Negative symptoms | Depp et al., 201019; Foussias et al., 201520 | High interest in using such technology to monitor symptoms and connect people with schizophrenia to services (Ben-Zeev et al., 2013a) 21 | |
| Digital divide and costs of technology | Smith, 201222 | Price drops in cell phones and data plans (Kurti and Dallery, 2014)23 | |
| Clinician/research challenges | Low evidence base for eHealth technologies | Donker et al., 201324; Giota and Kleftaras, 20144 | Further studies required |
| Lack of regulatory oversight for apps (unless designated medical devices) | Center for Devices and Radiological Health, 2015 | Provision of regulatory oversight for apps (FDA guidance) | |
| Attitudes and inertia | Clarke and Yarborough, 20149 | Design of formative research on optimal methods for distilling data (Ben-Zeev et al., 2013b)18 Innovative research designs for evaluating the applicability of technology-based tools at the point of care (Lillie et al., 2011)25 | |
| System challenges | HIT infrastructure remains poor in mental health | Horvitz-Lennon et al., 200926 | Use of secure e-mail and a system for allowing people with schizophrenia to view and download electronic clinical information (Paget et al., 2014)27 |
| Potential for infringing security and privacy | Daker-White and Rogers, 201328; Kumar and Lee, 201229 | Oversight of wireless security measures, such as cryptography and user authentication (Giota and Kleftaras, 20144; Kumar and Lee, 2012)29 |
Reference: Adapted from Treisman et al. J Nerv Ment Dis. 204, 620โ629 (2016) 1
References
- Treisman et al. J Nerv Ment Dis. 2016;204: 620โ629
- Gulliver et al. BMC Psychiatry. 2010; 10:113
- Amani 2011: www.ehi.co.uk/img/Document_Library0365/My_Journey_Youth_Mental_Health_App_-_Sarah_Armani.pdf
- Giota and Kleftaras. E-Health Telecommunication Systems and Networks. 2014; 3:19โ23
- http://psyberguide.org/
- https://headspace.org.au/
- Feldman et al. Popul Health Manag. 2014; 17:190โ196
- Kasckow et al. Clin Schizophr Relat Psychoses. 2014; 8:21โ27A
- Clarke and Yarborough. Gen Hosp Psychiatry. 2014; 35:339โ344
- Hilty et al. Telemed J E Health. 2013; 19:444โ454
- Velligan and Kamil. Ther Deliv. 2014; 5:611โ613
- Morris et al., 2012: www.healthit.gov/sites/default/files/pdmp_support_final.pdf
- Palmier-Claus et al. BMC Psychiatry. 2012; 12:172
- Reddy et al. Curr Treat Options Psych. 2014; 121โ133
- Freeman et al. Schizophr Bull. 2008; 34:605โ610
- Sendt et al. Psychiatry Res. 2015; 225:14โ30
- Young and Geyer. J Psychopharmacol. 2015; 29:178โ196
- Ben-Zeeb et al. Psychiatr Rehabil J. 2013; 36:289โ296
- Depp et al. NervMentDis. 2010; 198:715โ721
- Foussias et al. J Psychopharmacol. 2015; 29:116โ126
- Ben-Zeev et al. Adm Policy Ment Health. 2013; 40:340โ343
- Smith, 2012: http://www.pewinternet.org/2012/03/01/nearly-half-ofamerican-adults-are-smartphone-owners
- Kurty and Dallery. Rev Mex Anal Conducta. 2014; 40:106โ126
- Donker et al. J Med Internet Res. 2013; 15:e247
- Lillie et al. Per Med. 2011; 8:161โ173
- Horvitz-Lennon, et al. Health Aff (Milwood). 2009; 28:701โ712
- Paget et al. National Committee for Quality Assurance. 2014: www.ncqa.org/HEDISQualityMeasurement/Research/BuildingaStrategytoLeverageHealthInformationTechnology.aspx
- Daker-White and Rogers. BMC Psychiatry. 2013; 13:279
- Kumar and Lee. Sensors (Basel). 2012; 12:55โ91
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