Systematic review of patients’ participation in and experiences of technology-based monitoring of mental health symptoms in the community

Walsh, S. et al. BMJ Open. 2016. 6:e008362


Objectives: To review systematically the literature on patients’ experiences of, and participation in, technology-based monitoring of mental health symptoms. This practice was defined as patients monitoring their mental health symptoms, emotions or behaviours outside of routine clinical appointments by submitting symptom data using technology, with feedback arising from the data (for example, supportive messages or symptom summaries, being sent to the patient, clinician or carer).

Design: Systematic review following PRISMA guidelines of studies evaluating technology-based symptom monitoring. Tools from narrative synthesis were used to analyse quantitative findings on participation rates and qualitative findings on patient views.

Data sources: PubMed, EMBASE, PsycINFO, BNI, CINAHL, Cochrane Registers and Web of Science electronic databases were searched using a combination of ‘psychiatry’, ‘symptom monitoring’ and ‘technology’ descriptors. A secondary hand search was performed in grey literature and references.

Results: 57 papers representing 42 studies met the inclusion criteria for the review. Technology-based symptom monitoring was used for a range of mental health conditions, either independently of a specific therapeutic intervention or as an integrated component of therapeutic interventions. The majority of studies reported moderate-to-strong rates of participation, though a third reported lower rates. Qualitative feedback suggests that acceptability of monitoring is related to perceived validity, ease of practice, convenient technology, appropriate frequency and helpfulness of feedback, as well as the impact of monitoring on participants’ ability to manage health and personal relationships.

Conclusions: Such symptom monitoring practices appear to be well accepted and may be a feasible complement to clinical practice. However, there is limited availability of data and heterogeneity of studies. Future research should examine robustly patients’ role in the development and evaluation of technology-based symptom monitoring in order to maximise its clinical utility.

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Tackling bullying and harassment in the NHS

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NHS Employers Health, Safety and Wellbeing Partnership Group (HSWPG) has launched a new set of resources and an infographic to support NHS organisations to develop cultures where staff are free from the fear of intimidating behaviour.

The partnership group recognises that bullying can have a detrimental effect on an individual’s overall health and wellbeing. The new resources also include a webpage containing practical tools, evidence and support for tackling bullying.

New care models and staff engagement

NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association, have  published a  guide to the work vanguards are doing to engage their staff in the design and delivery of new care models.

The new report – New Care Models and Staff Engagement: All Aboard aims to help spread the learning from the vanguard programme across the health and care sector.

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The publication contains four case studies which examine the ongoing work of NHS and local government organisations that are ensuring staff are at the heart of all decisions about new models of care in local areas.

Health and care integration

The NHS Confederation and Local Government Association have jointly published Stepping up to the place: the key to successful health and care integration.

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This document describes what a fully integrated, transformed system should look like based on the evidence. It builds on existing joint work and calls on local and national stakeholders to work together to ensure integration becomes integral to a transformed system.

“Hiding who I am”: exposing the reality of end of life care for LGBT people

Marie Curie

Marie Curie
Source: Marie Curie

This report looks at the barriers that prevent lesbian, gay, bisexual and trans (LGBT) people from accessing end of life care and highlights their real-life experiences. Its findings indicate that nearly three-quarters (74 per cent) of LGBT people are not confident that health and social care services provide sensitive end of life care for their needs.  As a result, access to care is often delayed and LGBT people are more likely to experience unmanaged symptoms and pain at the end of their lives.

Clinical effectiveness and cost-effectiveness of collaborative care for depression in UK primary care (CADET): a cluster randomised controlled trial

Richards DA, Bower P, Chew-Graham C, Gask L, Lovell K, Cape J, Pilling S, Araya R, Kessler D, Barkham M, Bland MJ, Gilbody S, Green C, Lewis G, Manning C, Kontopantelis E, Hill JJ, Hughes-Morley A, Russell A.

Health Technology Assesment Volume 20 Issue 14 , 2016

Collaborative care, that places a care manager in primary care to deliver treatment and coordinate care between GPs and specialists, improved recovery of people with moderate to severe depression. Primary responsibility for prescribing remained with the GP. This large trial found that improvements were modest, but were similar to those found in an evaluation of the Improving Access to Psychological Therapies programme.

The collaborative care model was cost-effective too. Collaborative care cost on average £272.50 per participant and had a cost per quality-adjusted life year (QALY) of £14,248, which is within NHS willingness-to-pay thresholds. Because depression is so common, the implementation of a collaborative care model is likely to require a considerable investment of resources. It would also be necessary to get GPs on board – the researchers found it was difficult for GPs to engage with the collaborative care framework.

Hospital patient discharge process: an evaluation

European Journal of Hospital Pharmacy

Qualitative study in the UK found that to improve the patient discharge process, innovative solutions are required to overcome current issues. A significant finding was a lack of patient involvement in the discharge process throughout the 13 hospitals included.

Objectives Medication discrepancies for patients after discharge from hospital are well documented. They have been shown to cause unnecessary harm to patients and can result in hospital readmission. To improve patient discharge, the current process of discharging patients from hospital (the discharge process) needs evaluating to determine where and why medication issues occur. This study aimed to identify and evaluate the discharge process used in a range of acute National Health Service hospitals across the North West of England.

Methods This qualitative study involved semi-structured telephone interviews with 13 chief pharmacists or an appropriately nominated member of the hospital pharmacy team. Thematic analysis of the transcribed interview data was performed. Data analysis revealed eight main themes which all impacted on the discharge process.

Results The study was successful in identifying the discharge process across the range of hospitals as well as key issues and examples of good practice. The hospitals involved in the study were found to have similar discharge processes with issues common to all. One significant finding was a lack of patient involvement in the discharge process.

Conclusions To improve the patient discharge process, innovative solutions are required to overcome the current issues. In future work, the study findings will be used to develop a new model of care for patient discharge from hospital.

Eur J Hosp Pharm doi:10.1136/ejhpharm-2016-000928