Depression currently ranks fourth for disability-adjusted life-years worldwide and is projected to jump to the second leading cause of disability by 2020. In contrast to other chronic medical conditions clinicians do not routinely use MBC to treat depression. This project evaluates the feasibility of using an electronic measurement based care (e-MBC) treatment program for major depressive disorder. The e-MBC system will allow patients to reduce the burden associated with clinic visits and at the same time increase the quality of care by providing their physician necessary feedback on their treatment. e-MBC can easily be incorporated into the clinics existing secure electronic Personal Health Care records communication system, the same system that allows patients to request refills, make an appointment, or leave a message for their treating physician. The e-MBC system has the ability to provided patient-centered care and can be seamlessly integrated into the standard clinical care workflow, with no need for additional knowledge or IT training. The study will be conducted at the UTSouthwestern Family Medicine clinic using the MyChart PHR system. Eligible patients starting an antidepressant or having their antidepressant treatment changed will be randomly assigned to 2 groups: e-MBC (n=25) or office-based MBC (n=25). After brief instruction in the use of the MyChart e-MBC system patients in the e-MBC group will receive a MyChart message from the study physician requesting they use the MyChart system to fill-out the MBC assessments online. Patients in the e-MBC group will be scheduled for follow-up based on the clinician's interpretation of the MBC assessments. In parallel, patients in the office-based MBC group will be scheduled for follow-up on a monthly basis. MBC assessments of depressive severity, tolerability, and compliance take less than 5 minutes for the patient to fill-out during an office visit or using the e-MBC system. The physician's review of the MBC assessment takes less than 1 minute. Additionally, a patient satisfaction with treatment questionnaire will be administered (pre-post), as well as physician surveys of ease use and usefulness of the e-MBC system (post).
The Specific Aims of the study are: 1) to determine if patients with MDD will utilize the e-MBC system to a greater extent than the office- based system;2) to determine if physicians experience greater satisfaction with the e-MBC system than the office-based system;3) to compare patient satisfaction between the e-MBC and office-based MBC care groups;with a Secondary Aim to compare patient treatment outcomes between the e-MBC group and a group receiving office-based MBC care. The results of the study will allow us to evaluate both physician and patient barriers to the adoption of e- MBC systems and develop techniques to overcome these barriers. If results are promising, the next critical steps for us would be to conduct a multicenter three-arm randomized controlled trial to compare the effectiveness of e-MBC, office-based MBC, and telephone nurse follow-up.
This project evaluates the feasibility of using an electronic measurement based care (e-MBC) treatment program to aid in the treatment of major depressive disorder. The system would allow patients to reduce clinic visits and at the same time increase the quality of care by providing their physician necessary feedback on their treatment using the clinic's exiting electronic Personal Health Record system. The e-MBC system can be seamlessly integrated into the standard clinical care workflow, with no need for additional knowledge or IT training, and requiring only a few minutes each month from patients and physicians.