Mental health outcomes among depressed or anxious primary care patients with multimorbidity (2 or more chronic medical problems) have been compromised by poor communication about patient's preoccupations with finances, safety, mobility, and other everyday concerns related to chronic disease. Patients are not empowered to articulate these concerns and time constraints make it difficult for PCPs to elicit them. Capitalizing on recent developments in decision technology and conjoint analysis, we propose to test the feasibility and impact of a novel intervention that has two components: a computer-based discussion prioritization tool (DPT) and a customized question prompt list (QPL). The DPT helps patients identify their most pressing concerns. The QPL will be generated after patients use the DPT, and consists of tailored question prompts designed to help patients'express their concerns. This proposed project will be implemented in two phases. Phase 1 will establish the usability of the DPT and QPL and the feasibility of having patients and PCPs use the DPT and QPL in a primary care setting. In Phase 2, participants (e40 years of age) with a diagnosis of 2 or more chronic medical conditions (type 2 diabetes, cardiovascular disease, chronic obstructive pulmonary disease, asthma and osteoarthritis) who screen positive for either depression or anxiety will be recruited from 2 primary care clinics and randomized to customized care vs. an active control. We expect that the intervention will improve patient-PCP communication, improve the therapeutic alliance between the patient and the PCP, and improve mental health outcomes. This work will lay the groundwork for a larger randomized controlled trial to test the effects of the customized care intervention with repeated exposures over time.
Even seemingly easy decisions, such as what to talk about with a primary care provider (PCP), can be difficult when patients have depression or anxiety and multiple medical problems. The goal of this study is to develop and test a computer-based intervention that helps patients communicate about important concerns that are often overlooked by PCPs such as financial and safety concerns. The goal of this project is to test whether the intervention improves communication, connection with the PCP and mental health outcomes.