Most adult patients are treated for depression in primary care settings. Unfortunately, few receive treatment that meets the recommended guidelines. The current project, Technology Enhanced Depression Intervention for primary care (TEDI), proposes the use of technology as a substitute for time-intensive provider contact so that this scarce treatment resource can be applied more effectively. We propose to develop a system to monitor patient medication compliance via wireless two-way communication devices (pagers). Pagers enable us to send medication reminders and educational messages, and monitor compliance and side effects. In the event of noncompliance or serious side effects, the system is able to automatically contact providers. In addition, supplementary behavioral treatment will be delivered via the World Wide Web. This interactive multimedia tutorial will teach behavioral skills derived from cognitive-behavioral therapy using assessment and feedback, psychoeducation, structured exercises, homework, and homework monitoring. TEDI is not meant to take the place of human intervention and treatment. Rather, it is a supplemental tool, designed to augment providers' treatment and notify them when further human intervention or judgment is required. Recognizing both the benefits and limitations of technology, we envision this technology being integrated into a step-care approach to the treatment of depression.
A low-cost tool that enhances the treatment of depression in the primary care setting would have many potential customers. Phase 3 commercialization will likely involve partnership with a company already active in our target markets such as disease management companies, large insurance carriers, or pharmaceutical companies that make anti-depressant medication.
