Enhancing the scalability of the collaborative care model for depression using mobile technology

Abstract

The collaborative care model (CoCM) has substantial support for improving behavioral health care in primary care. However, large-scale CoCM adoption relies on addressing operational and financial implementation challenges across health care settings with varying resources. An academic medical center serving socioeconomically and racially diverse patients implemented the CoCM in seven practices. A smartphone application was introduced to facilitate CoCM care management during depression treatment (app-augmented CoCM). App features included secure texting, goal/appointment reminders, symptom monitoring, and health education material. A nonrandomized convenience patient sample (N = 807) was enrolled in app-augmented CoCM and compared with patients in standard CoCM (N = 3,975). Data were collected on clinical contact frequency, engagement, and clinical outcomes. App-augmented CoCM patients received more health care team contacts (7.9 vs. 4.9, p < .001) and shorter time to follow up compared with the standard CoCM sample (mean = 11 vs. 19 days, p < .001). App-augmented CoCM patients had clinical outcomes similar to the standard CoCM group (47% vs. 46% with ≥50% depression improvement or score <10), despite app-augmented patients having more prior depression treatment episodes. Further, the app-augmented group with greater app engagement demonstrated increased behavioral health appointment compliance, including more completed appointments and fewer no shows, and greater depression symptom improvement than those with less app engagement. App-augmented CoCM may improve patient engagement in treatment and provide opportunities to implement key CoCM elements without overburdening practice resources. CoCM sustainability and scalability in primary care may be enhanced by using this technology.

Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review

“…A total of 20 studies were included in this review. The characteristics of the studies are summarized in Table 1, and more details on individual studies are provided in Multimedia Appendix 2 [15,35,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. The 20 studies included a comparative effectiveness trial of an interactive voice recording (IVR) intervention in a safety net population and a series of post hoc analyses on the same study population [41][42][43][44], a randomized trial of an internet support group with an associated subgroup analysis [45,46], 30% (6/20) other randomized trials [35,[47][48][49][50][51][52], a nonrandomized trial [53], 25% (5/20) implementation trials without a comparator [15,[54][55][56][57], and a qualitative exploratory study [58].…”

“…Most studies identified by this review implemented or assessed multiple technologies at once rather than a single intervention. Of the 20 studies, 5 (25%) [15,50,53,54,57,58] assessed mobile apps, and 5 (25%) used a web-based platform [46,[49][50][51][52]. Adewuya et al [47] and Jin and Wu [48] used SMS text messaging as a core feature of the intervention, although other investigators used SMS text messaging as an adjunctive tool [51,53,59].…”

“…Of the 20 studies, 5 (25%) [15,50,53,54,57,58] assessed mobile apps, and 5 (25%) used a web-based platform [46,[49][50][51][52]. Adewuya et al [47] and Jin and Wu [48] used SMS text messaging as a core feature of the intervention, although other investigators used SMS text messaging as an adjunctive tool [51,53,59]. Of the 20 research groups, 2 (10%) used IVR [49,60].…”

“…Digital and mobile health technology can facilitate and scale treatment as part of the CoCM. For example, providing psychoeducational material is a basic intervention that was implemented in most of the studies in this review [15,35,46,[49][50][51]53,54,57]. Mobile apps can allow the BHCM to monitor and nudge patients to engage with psychoeducational materials or provide automatic reminders.…”

Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review (Preprint)

“…Of the 20 studies, 1 (5%) described a decision support tool to triage patients into different levels of care [52]. Studies also used technology to facilitate measurement-based care by collecting clinical assessments [48,51,53,54]. Most studies provided participants with self-management modules and psychoeducational materials [15,35,46,[49][50][51]53,54,57].…”