A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients

BACKGROUND: Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. OBJECTIVE: The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. METHODS: Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. RESULTS: A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). CONCLUSIONS: Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects.Gareth Furber, Gabrielle Margaret Jones, David Healey, Niranjan Bidargadd

Changes in monthly unemployment rates may predict changes in the number of psychiatric presentations to emergency services in South Australia

BACKGROUND To determine the extent to which variations in monthly Mental Health Emergency Department (MHED) presentations in South Australian Public Hospitals are associated with the Australian Bureau of Statistics (ABS) monthly unemployment rates. METHODS Times series modelling of relationships between monthly MHED presentations to South Australian Public Hospitals derived from the Integrated South Australian Activity Collection (ISAAC) data base and the ABS monthly unemployment rates in South Australia between January 2004–June 2011. RESULTS Time series modelling using monthly unemployment rates from ABS as a predictor variable explains 69 % of the variation in monthly MHED presentations across public hospitals in South Australia. Thirty-two percent of the variation in current month’s male MHED presentations can be predicted by using the 2 months’ prior male unemployment rate. Over 63 % of the variation in monthly female MHED presentations can be predicted by either male or female prior monthly unemployment rates. CONCLUSIONS The findings of this study highlight that even with the relatively favourable economic conditions, small shifts in monthly unemployment rates can predict variations in monthly MHED presentations, particularly for women. Monthly ABS unemployment rates may be a useful metric for predicting demand for emergency mental health services.Niranjan Bidargaddi, Tarun Bastiampillai, Geoffrey Schrader, Robert Adams, Cynthia Piantadosi, Jörg Strobel, Graeme Tucker, and Stephen Alliso

Ambulatory monitor derived clinical measures for continuous assessment of cardiac rehabilitation patients in a community care model

Ambulatory monitoring tools provide a means for continuous assessment of patients compared to hospital based tools. Continuous physiological information such as ECG, heart rate, activity profile and energy expenditure can be derived from a single waist mounted activity monitor. This information when translated into clinically relevant measures, not only reflects patients condition in a similar way as convention tools but also shows the continuous status of functional capacity. In this paper, various such clinically relevant measures which can be derived from acceleration and ECG signals are described.Niranjan Bidargaddi and Antti Sarel

Predicting which type of push notification content motivates users to engage in a self-monitoring app

Despite the unprecedented access to self-monitoring health apps, lack of optimal user engagement remains a significant challenge. Push notification prompts with contextually tailored messages offers a promising strategy to improve engagement. To increase the efficacy of push-notifications on engaging individuals with health apps, greater attention to the modifiable components of push notifications that influence responsiveness is needed. This study examines the effect of message content and frequency of push notifications, along with past app usage on responding to notifications within 24 h, and engaging with self-monitoring in JOOL Health smartphone app. Mixed models were applied on a de-identified data set of 18,000 contextually tailored push notifications sent by JOOL Health App to 1414 participants. The content in sent messages on behavioural topics were mapped into either tailored suggestions or tailored insights. Our findings suggest that push notifications with tailored suggestions were more effective overall in encouraging self-monitoring, but amongst frequent app users, push-notifications containing insights was associated with greater self-monitoring. People who were not using the app as frequently were less likely to respond to a prompt. This study suggests that push-notification content does have an impact on subsequent use of key app features, and app developers should consider what content is likely to work best for who, and under what circumstances. Secondary data-analysis of commercial apps presents a unique opportunity to elucidate and optimize health behaviors. Keywords: Mobile health, Contextual tailoring, Tailored messages, Outcome

Impact of a psychiatric unit's daily discharge rates on emergency department flow

Objective: To investigate relationships between time spent in the emergency department (ED) in patients requiring admission to the psychiatric ward, the day of the week of presentation and the daily number of discharges from the psychiatric ward. Method: Retrospective analysis of patient flow as a function of day of week, time of day (a.m., p.m.), number of patients requiring admission and number of ward discharges over a one-year period, for all mental health related presentations to the ED of the Queen Elizabeth Hospital in Adelaide, South Australia, before their admission to the psychiatric inpatient facility. Results: The time spent by patients in the ED waiting for admission to the psychiatric ward was significantly greater on weekends. There were significantly fewer discharges from the psychiatric ward during weekends compared with weekdays. The average time spent by patients in the ED requiring admission to the psychiatric ward for those days when there were vacant beds was 17.9 hours (SD=14.5). More people presented to the ED with a psychiatric diagnosis in the afternoons. There was a significant inverse correlation between the time spent by patients in the ED requiring admission to the psychiatric ward per day and the number of discharges from the psychiatric ward per day. Conclusion: These findings demonstrate that patient flow is significantly slower on weekends because of fewer discharges from the ward, leading to longer times spent in the ED before ward transfer. Waiting times in the ED were very substantially greater than the proposed 4-hour target even when vacant beds were available, raising considerable doubt about that target being realistic for psychiatric patients.Tarun Bastiampillai, Geoffrey Schrader, Rohan Dhillon, Jörg Strobel, Niranjan Bidargadd

Implications of bed reduction in an acute psychiatric service

Objective: To evaluate the impact of psychiatric inpatient bed closures, accompanied by a training program aimed at enhancing team effectiveness and incorporating datadriven practices, in a mental health service. Design and setting: Retrospective comparison of the changes in services within three consecutive financial years: baseline period — before bed reduction (2006–07); observation period — after bed reduction (2007–08); and intervention period — second year after bed reduction (2008–09). The study was conducted at Cramond Clinic, Queen Elizabeth Hospital, Adelaide. Main outcome measures: Length of stay, 28-day readmission rates, discharges, bed occupancy rates, emergency department (ED) presentations, ED waiting time, seclusions, locality of treatment, and follow-up in the community within 7 days. Results: Reduced bed numbers were associated with reduced length of stay, fewer referrals from the community and subsequently shorter waiting times in the ED, without significant change in readmission rates. A higher proportion of patients was treated in the local catchment area, with improved community follow-up and a significant reduction in inpatient seclusions. Conclusion: Our findings should reassure clinicians concerned about psychiatric bed numbers that service redesign with planned bed reductions will not necessarily affect clinical care, provided data literacy and team training programs are in place to ensure smooth transition of patients across ED, inpatient and community services.Tarun J Bastiampillai, Niranjan P Bidargaddi, Rohan S Dhillon, Geoffrey D Schrader, Jörg E Strobel and Philip J Galle

An evaluation of behaviour change techniques in health and lifestyle mobile applications

Despite the current popularity and potential use of mobile applications (apps) in the area of behaviour change, health promotion, and well-being for young people, it is unclear whether their design is underpinned by theory-based behaviour change techniques. Understanding the design of these apps may improve the way they can be used to support young people’s well-being.The objectives of this study were to investigate what behaviour change techniques are included in the content of health and lifestyle apps, and determine which of these are prominent in app design. Thirty of the top-listed health and lifestyle apps across three categories (physical activity, diet, and sleep) were freely downloaded from the two most popular app stores (GooglePlay™ and AppStore™). Selected apps were used by trained researchers and the features identified coded against the Behaviour Change Techniques Taxonomy 1, a systematic classification of techniques used in behaviour change interventions. It was found that 9 of the 93 behaviour change techniques listed in the Behaviour Change Techniques Taxonomy 1 were common across the chosen health and lifestyle apps. The app found to include the most behaviour change techniques had 20 (21%), while the app found to include the least had 1 behaviour change technique (1%). The most frequently used behaviour change techniques were related to goal setting and feedback. Entire categories in the Behaviour Change Techniques Taxonomy 1 were absent in the design of the selected apps

Early effects of upgrading to a high bandwidth digital network for telepsychiatry assessments in rural South Australia

Niranjan Bidargaddi, Geoff Schrader, Leigh Roeger, Abdel Bassal, Lynley Jones and Jorg Strobe

Embedding research into clinical practice: The services, pathways access - research and knowledge (SPARK) study

Niranjan Bidargaddi, Geoffrey Schrader, Cynthia Piantadosi, Robert Adams, Bronwyn Ryan, Jennifer Williams, and Jörg Strobe