Depression is common, imposing a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people with depression are treated in primary care, however outcomes remain poor. There have been two broad attempts to address this problem. One is collaborative care, which uses care managers to coordinate patient care. Collaborative care can be highly effective when implemented correctly, however, it requires more resources than many settings have available. The other potential solution is digital mental health, using web-base and app-based tools to support patient behavior change. While a large number of randomized controlled trials have demonstrated the efficacy of these interventions, attempts to implement digital mental health interventions in real-world care settings have failed, primarily because patients do not use them and there has been little attention paid to implementation and care manager tools. IntelliCare has shown great promise in overcoming these limitations. The IntelliCare platform is highly modular and flexible, and currently includes a suite of 13 apps, with CM and administrative dashboards. IntelliCare has been shown to reduce symptoms of depression and to maintain high levels of patient engagement over 8 or more weeks. The proposed study will work with a collaborative care program within primary care clinics. The first phase will focus on adaptation of the existing IntelliCare platform to support the care management by facilitating patient and CM communication, acquisition of data critical to measurement-based care, and providing a low intensity digital mental health intervention that can extend the capacity of care mangers to deliver care. The adapted IntelliCare platform will then be tested in a rollout hybrid trial that evaluates effectiveness, implementation, and allows for ongoing optimization and refinement during the trial. This project has the potential to significantly improve our ability to deliver effective treatment for depression in a primary care setting.
Collaborative care has proven effective for improving depression outcomes in primary care, but frequently requires more resources than are available. This project will adapt a promising digital mental health intervention, IntelliCare, to support collaborative care by providing better communication channels between patients and care managers, better acquisition of data necessary for measurement-based care, and a digital intervention that can expand care manager capacity.
