A Web-Delivered Care Management and Patient Self-Management Program for Recurrent Depression: A Randomized Trial

Abstract

OBJECTIVE This study assessed the impact of an Internet-delivered care management and patient self-management program, eCare for Moods, on patients treated for recurrent or chronic depression. METHODS Patients with recurrent or chronic depression were randomly assigned to eCare (N=51) or usual specialty mental health care (N=52). The 12-month eCare program integrates with ongoing depression care, links to patients' electronic medical records, and provides clinicians with panel management and decision support. Participants were interviewed at baseline and six, 12, 18, and 24 months after enrollment. Telephone interviewers blind to treatment used a timeline follow-back method to estimate depression severity on a 6-point scale for each of the 105 study weeks (including the baseline). Differences between groups in weekly severity over two years were examined by generalized estimating equations. RESULTS Participants in eCare experienced more reduction in depressive symptoms (estimate=-.74 on the 6-point scale over two years; 95% confidence interval [CI]=-1.38 to -.09, p=.025) and were less often depressed (-.24 over two years; CI=-.46 to -.03, p=.026). At 24 months, 43% of eCare and 30% of usual-care participants were depression free; the number needed to treat to attain one additional depression-free participant was 8. eCare participants had other favorable outcomes: improved general mental health (p=.002), greater satisfaction with specialty care (p=.003) and with learning new coping skills (p<.001), and more confidence in managing depression (p=.006). CONCLUSIONS Internet-delivered care management can help improve outcomes of patients treated for recurrent or chronic depression.

Using e-technologies in clinical trials

“…With the recent emphasis on comparative effectiveness research (CER) and precision medicine, studies are using or planning to use EHR to facilitate recruitment and consent and collect clinical data (Kaelber, Foster, Gilder, Lore, & Jain, 2012; Baer et al, 2013; Fleurence et al, 2014; Fleurence et al, 2014; Lu et al, 2014; Collins & Varmus, 2015). EHRs can provide an automated electronic approach to (1) identify or flag potential subjects at the point of clinical care (Ruffin & Nease, 2011; Brieger & Aliprandi-Costa, 2013; Amin et al, 2014; Smith et al, 2007); (2) differentiate between clinical and research procedures/costs; (3) extract clinical data for import into study databases (Waitman et al, 2014) (Hunkeler et al, 2012; Sargious & Lee, 2014); and (4) collect study clinical outcomes directly (Otsuka et al, 2013; Basch, 2014; Stillman et al, 2014). Health systems with comprehensive integrated EHRs, like the Department of Veterans Affairs (VA), are starting to use this approach to recruit, screen, randomize, obtain consent, and collect data.…”

Computer-Assisted Cognitive Behavioral Therapy for Pregnant Women with Major Depressive Disorder

“…19,20 The possibilities for computer-assisted mental health care are numerous, and a multitude of recent studies have examined the efficacy of computer-assisted or computerized treatment modalities as a treatment for depression in specific populations who are either reluctant to seek treatment, are avoidant, or experience difficulties leaving their home. [42][43][44] CCBT combines a multimedia computer program with abbreviated one-on-one therapist time while maintaining the efficacy of standard cognitive behavior therapy. CCBT delivers therapy while reducing time in the therapist's office and helping improve access to and cost effectiveness of therapy.…”

Factors Associated With Treatment Initiation for Psychiatric and Substance Use Disorders Among Persons With HIV

“…Strategies such as those used in the Improving Mood: Promoting Access to Collaborative Treatment trial have explored how to improve depression treatment within primary care settings (56). Depression treatment initiatives implemented in KPNC also have encouraged electronic communication between patients and specialty care providers (57). Given the need for HIV patients to closely track their medications and other aspects of care, these strategies seem especially appropriate in this population.…”