Telemedical care and quality of life in patients with schizophrenia and bipolar disorder: results of a randomized controlled trial.

BACKGROUND: Schizophrenia and bipolar disorder are serious psychiatric disorders with a high disease burden, a high number of years of life lived with disability and a high risk for relapses and re-hospitalizations. Besides, both diseases are often accompanied with a reduced quality of life (QoL). A low level of quality of life is one predictor for relapses. This study examines whether a telemedical care program can improve QoL. METHODS: Post stationary telemedical care of patients with severe psychiatric disorders" (Tecla) is a prospective controlled randomized intervention trial to implement and evaluate a telemedical care concept for patients with schizophrenia and bipolar disorder. Participants were randomized to an intervention or a control group. The intervention group received telemedical care including regular, individualized telephone calls and SMS-messages. QoL was measured with the German version of the WHOQOL-BREF. Effects of telemedicine on QoL after 6 months and treatment*time interactions were calculated using linear regressions (GLM and linear mixed models). RESULTS: One hundred eighteen participants were recruited, thereof 57.6% men (n = 68). Participants were on average 43 years old (SD 13). The treatment*time interaction was not significant. Hence, treatment had no significant effect either. Instead, gender is an influencing factor. Further analysis showed that social support, the GAF-level and QoL-values at baselines were significant determinants for the improvement of QoL. CONCLUSION: The telemedicine care concept Tecla was not significant for QoL in patients with severe psychiatric disorders. More important for the QoL is the general social support and the level of global functioning of the patients. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00008548, registered 21 May 2015 - retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do.

Improving Medication Adherence With Telemedicine for Adults With Severe Mental Illness.

OBJECTIVE: The study evaluated a telephone call and text message intervention to improve adherence to medication among patients with severe mental illness. METHODS: A randomized clinical trial was conducted, and outpatients with schizophrenia or bipolar disorder were assigned to the intervention group or to a usual care control group. The intervention was provided by trained nurses. Medication adherence was measured with the Medication Adherence Report Scale. RESULTS: The study sample comprised 120 participants. Logistic regression analysis showed that intervention group participants were significantly more likely than control group participants to be medication adherent at 6 months (odds ratio=4.11, p=.007). The superiority of the intervention emerged during months 4 to 6. Social desirability, diagnosis, and medication did not affect the results. CONCLUSIONS: Telemedicine via telephone can deliver low-threshold support to patients who are otherwise at high risk of progressive nonadherence to their psychotropic medication after 6 months.