BACKGROUND Digital and mobile technologies have potential to improve the delivery and scale of integrated care models. OBJECTIVE We aimed to assess acceptability and feasibility, preliminary clinical outcomes, and implementation barriers of a mobile health platform used to augment an existing integrated behavioral health program. METHODS The mobile platform was used by three behavioral health care managers responsible for coordinating disease management in six primary care practices. 89 of 245 individuals (36%) who were referred by their PCP for behavioral health services consented to app-augmented behavioral health care. The mobile health platform functions included chat communication, monthly depression self-report assessments, and psychoeducational content. RESULTS The clinical improvement rate in our sample was 72% although follow-up assessments were only available for 49% of participants. At least one action in the mobile app was completed by 87% of participants (n=78; median=7; IQR=12, 0-130). Behavioral health care managers cited increased documentation burden and language as barriers to use. CONCLUSIONS Our pilot of mobile technology in collaborative care highlights important implementation barriers. Future research should systematically evaluate the implementation of digital and mobile health technology in collaborative care.
Background The collaborative care model is a well-established system of behavioral health care within primary care settings. There is potential for mobile health (mHealth) technology to augment collaborative behavioral health care in primary care settings, thereby improving scalability, efficiency, and clinical outcomes. Objective We aimed to assess the feasibility of engaging with and the preliminary clinical outcomes of an mHealth platform that was used to augment an existing collaborative care program in primary care settings. Methods We performed a longitudinal, single-arm feasibility study of an mHealth platform that was used to augment collaborative care. A total of 3 behavioral health care managers, who were responsible for coordinating disease management in 6 primary care practices, encouraged participants to use a mobile app to augment the collaborative model of behavioral health care. The mHealth platform’s functions included asynchronous chats with the behavioral health care managers, depression self-report assessments, and psychoeducational content. The primary outcome was the feasibility of engagement, which was based on the number and type of participant-generated actions that were completed in the app. The primary clinical end point was a comparison of the baseline and final assessments of the Patient Health Questionnaire-9. Results Of the 245 individuals who were referred by their primary care provider for behavioral health services, 89 (36.3%) consented to app-augmented behavioral health care. Only 12% (11/89) never engaged with the app during the study period. Across all participants, we observed a median engagement of 7 (IQR 12; mean 10.4; range 0-130) actions in the app (participants: n=78). The chat function was the most popular, followed by psychoeducational content and assessments. The subgroup analysis revealed no significant differences in app usage by age (P=.42) or sex (P=.84). The clinical improvement rate in our sample was 73% (32/44), although follow-up assessments were only available for 49% (44/89) of participants. Conclusions Our preliminary findings indicate the moderate feasibility of using mHealth technology to augment behavioral health care in primary care settings. The results of this study are applicable to improving the design and implementation of mobile apps in collaborative care.
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