Digital health in clozapine care : empowering patients and supporting healthcare professionals

Abstract

Digital health technologies are increasingly integrated into clinical practice, transforming how healthcare is delivered and managed. However, individuals with serious mental illness are often excluded from their design and evaluation. Schizophrenia is among the most severe and disabling mental disorders and often requires long-term, intensive care. For those with treatment-resistant schizophrenia, Clozapine is the gold-standard treatment, but its strict monitoring requirements create significant burdens for patients and professionals. Digital technologies offer opportunities to address these challenges by supporting patients and improving monitoring and workflows for healthcare professionals. This thesis explores how digital health technologies can support both patients and healthcare professionals in a specialized Clozapine outpatient clinic. Using a mixed-methods action research design, the study was conducted in two phases. Phase 1 investigated patients’ experiences with the Landspítali mobile patient portal, focusing on empowerment, self-care self-efficacy, health literacy, and quality of life. Eleven participants receiving Clozapine treatment were enrolled in the study and completed repeated-measure questionnaires and semi-structured interviews. Quantitative results showed a significant increase in empowerment scores and a positive trend in health literacy. Qualitative findings revealed that participants valued access to appointments and laboratory results. They described the application as simple and practical but underdeveloped. They expressed a desire for expanded features such as educational content, medication support, and interactive tools. Phase 2 examined healthcare professionals’ digital workflows through a time-in-motion study and co-design sessions. Observations revealed that nearly half of the time was spent on documentation and administrative tasks, with frequent duplication across systems. In collaboration with clinic staff, the Patient Group module in the electronic health record was redesigned to automate blood test monitoring, appointment tracking, and documentation of side effects. Follow-up interviews indicated that these changes reduced workload and improved oversight. Together, these findings demonstrate that digital technologies can enhance recovery-oriented care in schizophrenia by promoting patient empowerment and facilitating more efficient clinical workflows. The study highlights the importance of co-designing digital health technologies with both patients and professionals to ensure that they are not only technically functional but also meaningful and sustainable in practice.