Augmenting Mental Health in Primary Care: A 1-Year Study of Deploying Smartphone Apps in a Multi-site Primary Care/Behavioral Health Integration Program

Abstract

Background: Integrating behavioral health (BH) services into primary care is an evidence-based intervention that can increase access to care, improve patient outcomes, and decrease costs. Digital technology, including smartphone apps, has the potential to augment and extend the reach of these integrated behavioral health services through self-management support impacting lifestyle behaviors. To date, the feasibility and acceptability of using mental health mobile apps within an integrated primary care setting has not yet been explored as part of routine clinical care. Objectives: The objectives of this study were to (a) test the feasibility of using mental health applications to augment integrated primary care services; (b) solicit feedback from patients and providers to guide implementation, and (c) develop a mental health apps toolkit for system-wide dissemination. Methods: Cambridge Health Alliance (CHA) is a safety-net healthcare system that includes three community hospitals and 12 Primary Care (PC) clinics serving nearly 150,000 ethnically and socioeconomically diverse patients around Boston. To select and disseminate mental health apps, a four-phase implementation was undertaken: (1) Evaluation of mental health mobile applications (2) Development of an apps toolkit with stakeholder input, (3) Conducting initial pilot at six primary care locations, and (4) Rolling out the app toolkit across 12 primary care sites and conducting 1-year follow-up survey. Results: Among BH providers, 24 (75%) responded to the follow-up survey and 19 (83%) indicated they use apps as part of their clinical care. Anxiety was the most common condition for which app use was recommended by providers, and 10 (42%) expressed interest in further developing their knowledge of mental health apps. Among patients, 35 (65%) of participants provided feedback; 23 (66%) reported the tools to be helpful, especially for managing stress and anxiety. Conclusions: Our findings indicate mental health apps are applicable and relevant to patients within integrated primary care settings in safety-net health systems. Behavioral health providers perceive the clinical value of using these tools as part of patient care, but require training to increase their comfort-level and confidence applying these tools with patients. To increase provider and patient engagement, mobile apps must be accessible, simple, intuitive and directly relevant to patients' treatment needs.

Limitations of Existing Dialysis Diet Apps in Promoting User Engagement and Patient Self-Management: Quantitative Content Analysis Study

“…The language barrier was identified as a limiting factor that affects mHealth app accessibility and effectiveness [ 17 ]. Implications of the language barrier are believed to be more profound for users from countries where English is not the first language (ie, Asian countries).…”

“…An earlier study found that approximately half of the commercial diet apps for kidney diseases were not credible and only had fair technical quality [ 14 ]. Nevertheless, other important aspects of commercial dialysis diet apps that may be linked to greater user acceptance, engagement, and effectiveness have yet to be explored, such as health behavioral theory [ 15 ], a set of valuable features [ 16 ], and other aspects, such as language medium [ 17 ] and food databases [ 18 ].…”

Leveraging Implementation Science to Understand Factors Influencing Sustained Use of Mental Health Apps: a Narrative Review

“…There is a huge need for provider training in MH apps, with little if any instruction currently occurring within degree-granting programs or continuing education efforts (Gordon et al 2020;Gratzer and Goldbloom 2020;Hilty et al 2019;Lattie et al 2020). Indeed, providers describe needing better education regarding effective MH apps, their functionalities, and how to introduce them to patients in a timely manner (Jacob et al 2020); lack of familiarity with apps and lack of time to discuss them were noted as key barriers to recommending apps (Hoffman et al 2019). There have been recent efforts to develop frameworks of clinician competencies and app evaluation criteria to help address this problem (Hilty et al 2020;Torous et al 2018c).…”

mHealth App Prescription in Australian General Practice: Pre-Post Study

“…It sends the prescribed app to patients as text messages and can monitor and receive data on patients’ use and adherence to the system. In the United States, the Cambridge Health Alliance network of primary care clinics implemented a mental health app dissemination program, in which they evaluated mental health apps, selected 7 apps, and recommended these 7 apps in 12 primary care clinics [ 5 ]. Similar to the finding of our study, app prescriptions for anxiety and stress were the most frequently prescribed.…”