Affiliations 

  • 1 Hospital Sultanah Bahiyah, Department of Psychiatry and Mental Health, Alor Setar, Kedah, Malaysia
  • 2 University of Malaya, Faculty of Medicine, Department of Psychological Medicine, Kuala Lumpur, Malaysia. chong_guan@um.edu.my
  • 3 Hospital Melaka, Department of Psychiatry and Mental Health, Melaka, Malaysia
  • 4 University of Malaya, Faculty of Medicine, Department of Psychological Medicine, Kuala Lumpur, Malaysia
Med J Malaysia, 2021 09;76(5):617-623.
PMID: 34508365

Abstract

INTRODUCTION: Non-attendance and medication adherence are longstanding concerns in psychiatric outpatient settings. This study aimed to determine effectiveness of reminders using mobile messaging applications (messaging apps) in improving outpatient attendance and medication adherence among patients with depression.

METHODS: This was a parallel, open-label randomised controlled trial with participants recruited from psychiatric outpatient services of a teaching hospital in Kuala Lumpur and a secondary hospital in Melaka. Adults (≥18 years) diagnosed with major depressive disorder; capable of reading and understanding English or Bahasa Malaysia; prescribed with at least one antidepressant and owns a smart phone were subsequently randomly assigned (1:1) to receive treatment reminders (intervention) or standard treatment without reminders (control), using a computergenerated randomisation programme. The intervention group received two reminder categories: Outpatient appointment reminders (a day before appointment); and medication reminders (weekly basis). Participants were followed-up over two months. We utilised Montgomery- Asberg Depression Rating Scale (MADRS) to measure the severity of depression; and Brief Adherence Rating Scale (BARS) to assess medication adherence. Primary outcomes were outpatient attendance rates and medication adherence assessed at two months. Secondary outcomes included changes in depression severity within each group at two months; comparison of changes in depression severity between both groups; preferences of participants towards treatment reminders, and reasons for non-attendance among participants. This trial was registered with the National Medical Research Registry, NMRR-19-3466-52001.

RESULTS: Between February and April 2020, 183 participants were randomised to each group, of whom 179 reached study endpoint (91 [98.9%] of 92 in intervention group and 88 [96.7%] of 91 in control group). All recruited participants (n=183) were analysed using intention-to-treat approach. At two months, intervention group has significantly higher outpatient attendance rates (76.8%) than control group (56.4%) (p=0.002), and reported higher medical adherence percentage (mean difference 23.1, [95%CI 0.4, 35.8]; p<0.001). There was also significant difference in the MADRS score change between both groups (mean difference 3.4, [95%CI 0.4, 6.3]; p=0.025). Treatment reminders preferences among participants varied; forgetfulness was the most commonly reported reason (53%) for missing outpatient appointments.

CONCLUSION: Reminders through mobile messaging applications significantly improved outpatient attendance and medication adherence among patients with depression. Our findings support the use of messaging apps for treatment reminders in psychiatric outpatient settings. However, concerns regarding confidentiality require careful measures to be taken.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.