SDM-BD: A patient app and EPR-integrated care team interface to digitally-enable support for shared decision making to improve maintenance management of patients with Bipolar Disorder (BD)
A smartphone app and a clinical dashboard will give people with bipolar disorder a direct say in their long-term medication decisions, rather than leaving them as passive recipients of a fixed prescription. Bipolar disorder is a highly recurrent condition, and the effectiveness of maintenance treatment depends heavily on whether patients understand their options, adhere to medication, and manage side effects. Yet routine NHS care offers almost no structured support for patient involvement or ongoing monitoring. This project addresses that gap by adapting an existing digital platform—the Fora health app—to let patients record preferences, track side effects, and share decision-making with their clinical team through an electronic patient record interface. If the feasibility trial shows the service works, it could reduce relapse rates and the need for inpatient and outpatient care. That would directly improve quality of life for people with bipolar disorder while cutting healthcare costs. The project also includes a commercial strategy to ensure the service can be deployed at scale within the NHS.
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Research question: Does the adaptation and implementation of a new patient-focused digitally enabled service improve the experience of maintenance treatment for people with bipolar disorder? Background: As a burdensome and highly recurrent condition, effective maintenance treatment for bipolar disorder (BD) is of critical importance to improving patient outcomes and reducing health related costs. Effectiveness of maintenance treatment is strongly influenced by patient preferences and knowledge about their treatment regime via adherence and management of side effects. However, at present, resources in routine healthcare settings are extremely limited regarding patient involvement and ongoing monitoring support packages. Aims: The overarching aim of this study is to improve the quality of maintenance treatment for people with BD. This is separated into the following sequential objectives: 1. To understand how people with BD would value greater decision-making support before and during maintenance treatment; 2. To refine the Fora health smartphone app to meet the needs of people with BD (as per aim 1); 3. To obtain an objective assessment of the service s feasibility within healthcare services; 4. To identify patient and healthcare professional views after using the Fora intervention. Methods: The following methodological approaches will be taken: 1. Patient and healthcare professional consultation, both qualitative and quantitative (objectives 1 & 4); 2. Technological design and service refinements (objective 2); 3. A feasibility trial to establish the effects of the newly refined service on decision-making, quality of life, medication use, mood, and future service use (including economic evaluation) compared to usual care (objective 3). Timelines: The project will run along the following timelines: Project start – 5th April 2024 Service Development - Work Package 1 (WP1): Month 1–12: Iterative development of the service in line with patient and clinical needs. Feasibility Study - Work Package 2 (WP2): Month 1-12: Ethics approval, participant recruitment and clinical training. Month 13-27: Completion of the study. Month 28-30: Study analysis. Commercial Development - Work Package 3 (WP3): Month 1-12: Initial commercial strategy and price point analysis. Month 13-30: Iterative commercial strategy and health economic analysis. Potential impacts: Effective maintenance treatment clearly reduces episode relapses and thus decreases requirement for inpatient and outpatient care. As such, if this service demonstrates improvement in effectiveness of maintenance treatment (through e.g., adherence, side effects management), it will reduce the burden of their bipolar condition with direct beneficial impacts on their own quality of life and economic benefits to healthcare services.
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