Development and evaluation of SMS-based monitoring and management service for people with bipolar disorder

BACKGROUND:Bipolar disorder is a recurrent and severe mental disorder that is a major cause of disability worldwide. People with bipolar disorder also suffer from a high level of physical illness, particularly cardiovascular disease. Patients can, nevertheless, aspire to live fully independent and economically productive lives if chronic symptoms and risk of relapse can be minimized. Long-term, responsive and flexible care systems are required to maximize health and social outcomes. Monitoring of both physical and psychological status receives a central place in current guidelines that try to raise the standard of care management. We have developed an innovative, efficient and highly acceptable method of monitoring patient reported outcomes in people with bipolar disorder. We also see potential in its further development for patients with schizophrenia.OVERALL AIMWe propose a research programme to augment the existing pilot system with physical monitoring and responsive interventions. We will evaluate this system in patients with bipolar disorder. OBJECTIVES1. To refine our existing innovative methods of monitoring patient reported mental health outcomes to facilitate self-monitoring and self-management2. To develop and evaluate effective strategies for rapid response to patient-identified exacerbations of illness3. To improve the access of people with bipolar disorder (and potentially other chronic mental disorders) to expert advice and care 4. To investigate simple, effective psychological interventions that can readily be integrated into existing systems of care and whose impact can be evaluated using our monitoring approach.5. To review systematically and synthesize the best evidence that can inform the monitoring of adherence to and adverse effects of medicines6. To integrate the monitoring of adherence to treatment and physical health so underpinning systems of shared care across the primary/secondary interface.RESEARCH PROGRAMMEThe research programme will have two overarching themes to address specific uncertainties identified in the NICE guidelines on the treatment of bipolar disorder:THEME 1. MONITORING PATIENT REPORTED OUTCOME MEASURES, MEDICINES AND PHYSICAL HEALTH Monitoring can be defined as the periodic measurement that guides the management of a chronic or recurrent condition. Such monitoring should drive both self-management by patients and interventions by clinicians. We have already developed and piloted a cost-effective and efficient monitoring system based on text messaging. For people with bipolar disorder, we will determine whether, as our experience suggests, it has the potential to allow full implementation of key aspirations of the NICE clinical practice guideline which relate to empowering the patient and facilitating access to appropriate specialist and expert care at the point of need. It is very likely also to be modifiable for patients with schizophrenia and other severe mental disorders and an extension to these other groups will be investigated. The system will not be suitable for all patients, but our experience suggests that it is acceptable to a majority of patients.THEME 2. INTEGRATION OF CARE.Monitoring is too often regarded as an end in itself. Unfortunately, the care of people with bipolar disorder often fails to integrate the monitoring of psychological and physical health indices with active management of these aspects of health and functioning. Improved methods of monitoring alone (Theme 1) will help, but we need also to build on advances in understanding of psychological interventions that improve outcomes under research conditions. It is widely acknowledged that translating research advances into the enhancement of usual care is a major challenge, to which we believe our work can bring solutions. Of particular importance will be the use of our sensitive patient rated measures of symptoms as outcomes in both routine practice and in the development and evaluation of novel interventio