The Use of Text Messaging to Improve Adherence and Functioning in Psychiatric Patients

Abstract

Background: Failure to attend psychiatric appointments can lead to poor medication adherence, relapse into crisis and/or re-hospitalization, or dropping out of treatment altogether. Changes are called for in the way clinicians and their practices can use technology to level the playing field in terms of health disparities, remove barriers to communication, decrease stigma, and assist in building self-efficacy and confidence in the treatment system. Purpose: To explore whether text messaging can improve adherence and function in the adult psychiatric outpatient population. Methods and Results: A literature review demonstrated that psychiatry, as a discipline, has not fully embraced all that technology has to offer despite a limited number of studies showing phone interventions improved health outcomes. A pilot randomized texting intervention of 89 adult psychiatric patients was conducted at a non-profit outpatient mental health clinic in a large urban Mid-Atlantic metropolitan area. The intent to treat group (n=47) received text message appointment reminders in addition to regular reminder calls from the clinic's Front Desk, while the treatment as usual group (n=42) received the reminder phone calls only. Implications: Though the main outcomes of appointment and medication adherence in response to the text reminder intervention of this study did not achieve significance, the results were still generally in line with the literature, which demonstrates support for the use of text messaging technology in this way. This would suggest there is value in using text appointment reminders in practice for psychiatry/mental health. Because appointment adherence is a problem that plagues every type of healthcare practice, those that avail themselves of technology that provides text reminder capability will likely benefit in terms of improved appointment adherence. Regular attendance at appointments improves the patient-provider relationship which plays an important role in patients' medication adherence and overall stability and good health. This cannot help but cascade into improved well-being.