Peer and Text Message Support to Reduce Readmission Rates for Patients Discharged From Acute Psychiatric Care

NCT05133726 | Active Not Recruiting

• 1 other identifier: Pro00111459
• Study Type: interventional
• Target: 1,132
• Locations: 1 country
• Sites: 7

Brief Summary

Avoidable hospital readmissions are a pressing problem for our healthcare system. They lead to substantial human suffering and higher financial costs. Most discharged psychiatric inpatients in Alberta are offered follow-up appointments with Alberta Health Services (AHS) Addiction and Mental Health (AMH) community providers. Patients often wait 28-38 weeks for their first appointment, which leads many to miss their first appointments, and increases the likelihood of relapse. As a result, patients discharged into the community are readmitted to the Emergency Department (ED). To address this significant revolving door, the investigators will implement a low-cost, evidence-based system that delivers daily supportive texts to patients' mobile phones. The text messages developed by experts and service users, based on cognitive behavioral therapy principles. Our proposed program also includes peer support from previous mental health patients who have had similar challenges as participants, but are now in recovery. In this way, the investigators aim to reduce the psychological treatment and support gap for AMH patients who have been discharged from acute care and are scheduled to receive mental health and psychiatric treatment from A\&MH services after a long wait. Our pilot test of these interventions provide evidence that psychiatric readmissions, and emergency department visits can be reduced by 10-25% if implemented at scale in Alberta, thus resulting in cost-savings for individuals and the province.

Conditions

Psychiatric Illness

Keywords

Psychiatric Illness; Peer support; Text Message; Electronic health (eHealth); Readmission rate

Outcome Measures

Primary Outcomes (1)

• Change in 30 day readmission rate

  Readmission to acute psychiatric care within 30 days of discharge

  baseline, 24 weeks, 52 weeks

Secondary Outcomes (5)

• Change in Clinical Outcomes in Routine Evaluation 10 (CORE-10) scores

  baseline, 24 weeks, 52 weeks

• Change in EuroQol- 5 Dimension (EQ-5D)scores

  baseline, 24 weeks, 52 weeks

• Change in Patient Health Questionnaire (PHQ-9) scores

  baseline, 24 weeks, 52 weeks

• Change in Recovery Assessment Scale (RAS)scores

  baseline, 24 weeks, 52 weeks

• Change in Brief Resilience Scale scores

  baseline, 24 weeks, 52 weeks

Other Outcomes (4)

• Change in the Reach of the Text4Support

  baseline, 24 weeks, 52 weeks

• Change in the fidelity of the intervention

  baseline, 24 weeks, 52 weeks

• Sustainability of the intervention

  52 weeks

Study Arms (3)

Text Message cluster

EXPERIMENTAL

This arm will receive only daily text message support for six months plus weekly text message over 6 weeks (six information text messages all together)

Other: Text4Support

Text message with or without peer support

EXPERIMENTAL

All individuals in this cluster will receive daily text message support for six months plus weekly text message over 6 weeks (six information text messages all together) with some selected members also receiving peer support for six months

Other: Text4Support; Other: Peer support

Control group

NO INTERVENTION

This group will only receive usual care plus weekly text message over 6 weeks (six information text messages all together) with provides information about community services

Interventions

Text4Support OTHER

Daily supportive text messages

Also known as: Supportive messages

Text Message cluster; Text message with or without peer support

Peer support OTHER

Meeting with peers who have lived experiences with similar diagnoses but are in recovery

Text message with or without peer support

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients who are 18 or 65 years of age
• Able to provide informed written consent have been diagnosed with mental health condition, and are ready for discharge.
• Patients should have a mobile device capable of receiving text messages

You may not qualify if:

• If they have an addiction disorder but not a mental health diagnosis
• Are not capable of reading text messages from a mobile device or if they know they will be out of town during the 12-month follow-up period.
• Patients are also ineligible if they do not consent to take part in the study,

Sponsors & Collaborators

• University of Alberta: lead
• Alberta Innovates Health Solutions: collaborator

Study Sites (7)

Royal Alexander Hospital

Edmonton, Alberta, T5H2V1, Canada

Location

Alberta Hospital

Edmonton, Alberta, T5J2J7, Canada

Location

Misericordia Community Hospital

Edmonton, Alberta, T5R4H5, Canada

Location

University of Alberta Hospital

Edmonton, Alberta, T6G2R3, Canada

Location

Grey Nuns Hospital

Edmonton, Alberta, T6L5X8, Canada

Location

Northern Lights Regional Health Centre

Fort McMurray, Alberta, Canada

Location

Foothills Hospital

Calgary, Canada

Location

Related Publications (9)

• Adu MK, Shalaby R, Eboreime E, Sapara A, Nkire N, Chawla R, Chima C, Achor M, Osiogo F, Chue P, Greenshaw AJ, Agyapong VI. Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial. JMIR Res Protoc. 2021 Oct 13;10(10):e29495. doi: 10.2196/29495.

  PMID: 34643541 BACKGROUND

• Agyapong VIO, Juhas M, Ohinmaa A, Omeje J, Mrklas K, Suen VYM, Dursun SM, Greenshaw AJ. Randomized controlled pilot trial of supportive text messages for patients with depression. BMC Psychiatry. 2017 Aug 2;17(1):286. doi: 10.1186/s12888-017-1448-2.

  PMID: 28768493 BACKGROUND

• Shalaby RAH, Agyapong VIO. Peer Support in Mental Health: Literature Review. JMIR Ment Health. 2020 Jun 9;7(6):e15572. doi: 10.2196/15572.

  PMID: 32357127 BACKGROUND

• Agyapong VI, Mrklas K, Juhas M, Omeje J, Ohinmaa A, Dursun SM, Greenshaw AJ. Cross-sectional survey evaluating Text4Mood: mobile health program to reduce psychological treatment gap in mental healthcare in Alberta through daily supportive text messages. BMC Psychiatry. 2016 Nov 8;16(1):378. doi: 10.1186/s12888-016-1104-2.

  PMID: 27821096 BACKGROUND

• Agyapong VI, Ahern S, McLoughlin DM, Farren CK. Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. J Affect Disord. 2012 Dec 10;141(2-3):168-76. doi: 10.1016/j.jad.2012.02.040. Epub 2012 Mar 29.

  PMID: 22464008 BACKGROUND

• Mao W, Shalaby R, Owusu E, Elgendy HE, Agyapong B, Chue P, Silverstone PH, Greenshaw AJ, Li XM, Eboreime E, Vuong W, Ohinmaa A, MacMaster FP, Agyapong V. Predictors of Psychiatric Emergency Department Visits Following Inpatient Discharge: Secondary Analysis of a Stepped-Wedge Cluster Randomized Trial. JMIR Form Res. 2025 Oct 30. doi: 10.2196/79184. Online ahead of print.

  PMID: 41241947 DERIVED

• Agyapong VIO, Shalaby R, Agyapong B, Mao W, Owusu E, Elgendy HE, Eboreime E, Silverstone PH, Chue P, Li XM, Vuong W, Ohinmaa A, MacMaster F, Greenshaw AJ. Effectiveness of Text Messages and Text Messages Plus Peer Support on Psychiatric Readmission and Length of Stay: Outcomes From a Quantitative Stepped-Wedge Cluster Randomized Trial. JMIR Ment Health. 2025 Nov 18;12:e81760. doi: 10.2196/81760.

  PMID: 41108215 DERIVED

• Owusu E, Mao W, Shalaby R, Elgendy HE, Agyapong B, Eboreime E, Lawal MA, Nkire N, Wei Y, Silverstone PH, Chue P, Li XM, Vuong W, Ohinmaa A, Taylor V, Hilario CT, Greenshaw AJ, Agyapong VIO. The prevalence and correlates of low resilience in patients prior to discharge from acute psychiatric units in Alberta, Canada. BMC Psychiatry. 2025 Mar 27;25(1):295. doi: 10.1186/s12888-025-06704-8.

  PMID: 40148879 DERIVED

• Eboreime E, Shalaby R, Mao W, Owusu E, Vuong W, Surood S, Bales K, MacMaster FP, McNeil D, Rittenbach K, Ohinmaa A, Bremault-Phillips S, Hilario C, Greiner R, Knox M, Chafe J, Coulombe J, Xin-Min L, McLean C, Rathwell R, Snaterse M, Spurvey P, Taylor VH, McLean S, Urichuk L, Tzeggai B, McCabe C, Grauwiler D, Jordan S, Brown E, Fors L, Savard T, Grunau M, Kelton F, Stauffer S, Cao B, Chue P, Abba-Aji A, Silverstone P, Nwachukwu I, Greenshaw A, Agyapong VIO. Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program. BMC Health Serv Res. 2022 Mar 12;22(1):332. doi: 10.1186/s12913-022-07510-8.

  PMID: 35279142 DERIVED

Related Links

• Website documenting evidence from predecessor programs

MeSH Terms

Conditions

Mental Disorders

Study Officials

• Vincent Agyapong, MD,PhD

  University of Alberta

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Stepped edge design

Study Record Dates

• First Submitted: October 21, 2021
• First Posted: November 24, 2021
• Study Start: March 1, 2022
• Primary Completion: March 31, 2024
• Study Completion (Estimated): June 30, 2026
• Last Updated: August 21, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF
• Time Frame: Data will be available from the onset of collection till 5 years after the study
• Access Criteria: All the hard and electronic copies and other research project related documents will be stored in secure, locked locations and only staff working on this research project will have access to it. Electronic versions of the data will be securely stored in AHS offices. The data master list containing identifying data, will be stored separately from other study data, and will only be accessible to the principal investigator and/or their delegate(s)

Locations

CA (7)