Project "SMS Bridge": Post-discharge care of bulimic patients via Short Message Service (SMS)
Contact: PD Dr. Stephanie Bauer (stephanie.bauer(at)med.uni-heidelberg.de)
Project management S. Bauer, H. Kordy in cooperation with E. Okon, R. Meermann (Psychosomatische Fachklinik Bad Pyrmont)
In 2001, the FOST developed a SMS-based minimal intervention to support bulimia nervosa patients during the transition from inpatient treatment to everyday life. After successful testing in a pilot study, the effectiveness and efficacy of this intervention is now being investigated in a randomized study funded by the German Federal Ministry of Education and Research (BMBF) in cooperation with the Psychosomatic Clinic Bad Pyrmont (project title: " Efficacy and economic efficiency of an integrative, inpatient-ambulatory treatment of patients with bulimia nervosa using Short Message Service").
Since a large proportion of patients do not complete inpatient treatment free of eating disorder symptoms, and since even successfully treated patients are at considerable risk of relapse, particularly in the first few months after discharge, the majority of patients require post-inpatient care from a therapeutic perspective, although it is still completely unclear how intensive such care needs to be in order to maintain what has been achieved in the clinic.
The program is centered on a weekly text message interaction of the participants with the FOST: On the one hand, the patients are asked to send a weekly brief description of their eating disorder symptomatology in a standardized form, and on the other hand, they are invited to send free text messages. Taking into account all messages received, each patient receives a weekly feedback via SMS, which focuses in particular on the changes compared to the previous week. The messages were formulated based on two principles: On one hand, they signal positive support; on the other hand, they are intended to have a behavior-modifying effect and suggest behavioral alternatives in case of negative developments. The results of the pilot study prove the practicability of the intervention and indicate a good acceptance by the participants: The quality of the program was rated as "good" or "very good" by 83% of the participants. 88% of the participants would recommend the program to others and 79% would participate again.
The subject of the currently ongoing controlled study is the question to what extent the intervention leads to an increase in the rate of partial remission. Further hypotheses relate to questions of cost-effectiveness and cost utility of the intervention and possible factors for differential efficacy. Furthermore, effects on participants' post-discharge psycho-bio-social recovery trajectories will be investigated. If the efficacy and cost-effectiveness of the intervention program are confirmed, implementation of the program in routine care could be relatively short-term due to its design (computer-based and semi-automated) and minimal time and financial supervision requirements. The project thus promises to contribute to the optimization of psychotherapeutic care services by integrating inpatient and outpatient services for patients with bulimia nervosa.
Literature
Bauer, S., Okon, E., Meermann, R. & Kordy, H. (2013). SMS-Nachsorge: Sektorenübergreifende Versorgung für Patientinnen mit Bulimia nervosa. Verhaltenstherapie, 23, 204-209.
Bauer, S., Okon, E., Meermann, R. & Kordy, H. (2012). Technology-enhanced maintenance of treatment outcome in eating disorders: Efficacy of an intervention delivered via text messaging. Journal of Consulting and Clinical Psychology, 80, 700-706.