The aim of this project is to develop ConnectCare, a depression intervention that combines depression specific patient portal features with provider communication strategies to increase patient activation, promote collaborative evidence-based decision making, promote treatment adherence, and reduce depressive symptoms. The proposed study will accomplish this in four primary aims. First, we will identify desired portal features through interviews with patients suffering depression and providers who specialize in treating depression. The National Network of Depression Centers will facilitate recruitment of 25 providers and 25 patients nationwide for these interviews. Family medicine providers will be included in the provider sample. These stakeholder interviews will address comfort with portals in the context of treatment for depression, perceived usefulness of proposed portal features, and optimal workflow for using portals in the context of visits for depression treatment. Interview results will inform final development of portal features and a clinical protocol for addressing the portal within medical visits. The identified portal features will be developed within the University of Iowa's Epic electronic health record platform and MyChart patient portal. Though the final features will be determined in the study, we expect they will include shared decision making materials related to depression treatment, assessment and visualization of patient reported outcomes of most importance to patients (e.g. social functioning, side effect burden), and training and guidance on the appropriate use of secure messaging and health information exchange features within the context of mental health care. A formal usability study of the user interface will be conducted with 20-25 depressed patients. The clinical protocol and initial workflow issues will also be specified. Training materials for both patients and providers will be developed once the user interface and clinical protocol is finalized. The effectiveness of ConnectCare will be examined in a pilot study of 50 depressed patients seeking treatment at the University of Iowa Hospitals and Clinics. Patients will be enrolled prior to their visit and randomized to receive either ConnectCare or an attention control intervention. In the attention control intervention, patients will receive training about Epic's MyChart and support at each medical visit should they have questions or issues related to MyChart. We hypothesize that at 6-months post-baseline, patients receiving ConnectCare will have improved scores on the 9-Item Patient Health Questionnaire, the Patient Activation Measure for Mental Health, the Medication Adherence Rating Scale, the Frequency, Intensity, and Burden of Side Effects Ratings, and the Work and Social Adjustment Scale when compared to the attention control group.
The aim of this project is to develop a clinical intervention, ConnectCare, to help patients and providers use patient portal features to improve the treatment of depression. Interviews with key stakeholders will identify the most desired portal and clinical intervention features for ConnectCare. A pilot randomized controlled trial will test the effectiveness of ConnectCare in improving patient engagement, improving medical adherence, and reducing depressive symptoms.
