Mobile Technology to Engage and Link Patients and Providers in Antidepressant Treatment
| Status: | Completed |
|---|---|
| Conditions: | Depression, Major Depression Disorder (MDD) |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/7/2015 |
| Start Date: | June 2014 |
| End Date: | April 2015 |
| Contact: | Susan M Kaiser, MPH |
| Email: | susan.kaiser@northwestern.edu |
| Phone: | 312-503-1249 |
Major depressive disorder (MDD) is common and imposes a very high societal burden in terms
of cost, morbidity, suffering, and mortality. While primary care is the de facto site for
treatment of MDD, outcomes in primary care are poor. Two principal reasons for the poor
outcomes in primary care are poor patient adherence to antidepressant medications (ADMs) and
the failure of physicians to provide guideline-congruent care. This problem is aggravated by
a lack of communication between patients and the care team.
A growing body of research indicates that primary care-centered strategies aimed at
enhancing guideline-congruent care have not been effective. Interventions aimed at improving
adherence in the patient have been successful in changing patient adherence behavior;
however these frequently fail to improve depression outcomes, particularly when there is no
intervention on the physician side to encourage optimization of ADMs. The most effective
strategies address both provider and patient behaviors, usually through the use of a
case-manager who monitors and supports patient adherence and response to treatment, and
provides actionable feedback to the PCP. However, case-managers have not been widely
implemented in primary care settings.
Recent technology developments have opened new opportunities to improve health care, and to
link patients and their providers. The investigators proposal harnesses these advances to
develop and pilot the medLink system. ADM adherence will be passively measured using an
electronic pill dispenser, which is connected to a mobile smartphone via GSM, so that
targeted, timely reminders can be provided when the patient fails to take the ADM. When the
patient is adherent, the patient will not be bothered with reminders. Depressive symptoms
and side-effects will be periodically monitored weekly via the phone. Every 4 weeks, or if
indicated (e.g intolerable side effects or urgent situations), primary care teams will
receive notifications via the electronic medical record that include a summary of patient
data on treatment response and side effects, guideline-congruent treatment recommendations
based on patient data and a recommendation to contact the patient, if indicated.
Simultaneously, a similar message will be provided to the patient via short message service
(or text), including feedback, possible treatment options, and a recommendation to contact
the physician's office. Thus, both the patient and care team will be activated to provide,
request and adhere to guideline-congruent care.
The aim of this proposal is to develop and pilot the medLink system. Development will employ
an iterative user-centered approach. The pilot trial will compare 12 weeks of the medLink
system to a treatment as usual control among primary care patients with MDD initiating ADM
treatment. Outcomes will include patient adherence to ADM, physician adherence to treatment
guidelines, and depression.
of cost, morbidity, suffering, and mortality. While primary care is the de facto site for
treatment of MDD, outcomes in primary care are poor. Two principal reasons for the poor
outcomes in primary care are poor patient adherence to antidepressant medications (ADMs) and
the failure of physicians to provide guideline-congruent care. This problem is aggravated by
a lack of communication between patients and the care team.
A growing body of research indicates that primary care-centered strategies aimed at
enhancing guideline-congruent care have not been effective. Interventions aimed at improving
adherence in the patient have been successful in changing patient adherence behavior;
however these frequently fail to improve depression outcomes, particularly when there is no
intervention on the physician side to encourage optimization of ADMs. The most effective
strategies address both provider and patient behaviors, usually through the use of a
case-manager who monitors and supports patient adherence and response to treatment, and
provides actionable feedback to the PCP. However, case-managers have not been widely
implemented in primary care settings.
Recent technology developments have opened new opportunities to improve health care, and to
link patients and their providers. The investigators proposal harnesses these advances to
develop and pilot the medLink system. ADM adherence will be passively measured using an
electronic pill dispenser, which is connected to a mobile smartphone via GSM, so that
targeted, timely reminders can be provided when the patient fails to take the ADM. When the
patient is adherent, the patient will not be bothered with reminders. Depressive symptoms
and side-effects will be periodically monitored weekly via the phone. Every 4 weeks, or if
indicated (e.g intolerable side effects or urgent situations), primary care teams will
receive notifications via the electronic medical record that include a summary of patient
data on treatment response and side effects, guideline-congruent treatment recommendations
based on patient data and a recommendation to contact the patient, if indicated.
Simultaneously, a similar message will be provided to the patient via short message service
(or text), including feedback, possible treatment options, and a recommendation to contact
the physician's office. Thus, both the patient and care team will be activated to provide,
request and adhere to guideline-congruent care.
The aim of this proposal is to develop and pilot the medLink system. Development will employ
an iterative user-centered approach. The pilot trial will compare 12 weeks of the medLink
system to a treatment as usual control among primary care patients with MDD initiating ADM
treatment. Outcomes will include patient adherence to ADM, physician adherence to treatment
guidelines, and depression.
Inclusion Criteria:
- Has been prescribed an anti depressant medicaition by an Northwestern University PCP,
but has not yet initiated treatment
- Has a DSM-IV diagnosis of non-psychotic MDD as assessed using the Mini International
Neuropsychiatric Interview (MINI)plus a score of 12 or greater on the Quick Inventory
of Depressive Symptomatology - Clinician Rated (QIDS-C).
- Is familiar with the use of mobile phones
- Is able and willing to carry the mobile phone
- Is able to speak and read English
- Is at least 18 years of age.
Exclusion Criteria:
- Is currently taking an anti depressant medication or has taken one in the previous 3
months
- Has visual, hearing, voice, or motor impairment that would prevent completion of
study procedures or use of mobile phone
- Is diagnosed with a psychotic disorder, bipolar disorder, dissociative disorder, or
other diagnosis for which participation in this trial is either inappropriate or
dangerous
- Hazardous substance or alcohol use for which another treatment would be indicated
- Is severely suicidal (has ideation, plan, and intent)
We found this trial at
1
site
Northwestern University Northwestern is recognized both nationally and internationally for the quality of its educational...
Click here to add this to my saved trials
