Patient engagement tools helpful in depressed primary care patients

By Reuters Staff

Patients with depressive symptoms seen in primary care were more engaged in their care when they watched a tailored computer program right before seeing their doctor, a new study found. But this didn't translate into better depression outcomes at 12 weeks.

"Despite progress, depression in primary care remains underrecognized and undertreated," Dr. Richard Kravitz from University of California Davis in Sacramento and colleagues note in JAMA November 6.

They set out to see if "patient engagement" strategies might boost appropriate depression care in primary care. They developed and tested in a randomized controlled trial two interventions.

One was a targeted depression engagement video (DEV) designed to enhance depression recognition and care-seeking by educating the patients about depression. The video emphasized the importance of disclosing relevant symptoms to their primary care provider and suggested ways to do this.

The other was a tailored interactive multimedia computer program (IMCP) that provided patients with feedback tailored to their level of depressive symptoms. Those with PHQ-9 scores less than 5 were told they were probably not depressed, whereas those with higher scores were told they might be depressed and were advised to talk with their doctor about it and gave help in doing so.

Participants completed the DEV or IMCP, or a sleep hygiene control video, one hour before their scheduled visit with their primary care physician and the researchers collected data before and after the visit. A total of 925 adults (603 with depression and 322 without depression) treated by 135 PCPs in California participated in the trial.

Among depressed patients, more patients in the IMCP group than the DEV group reported right after the visit that their PCP recommended an antidepressant medication or gave them a mental health referral, or both (the primary outcome). Rates were 26% for IMCP, 17.5% for DEV, and 16.3% for control. The IMCP was associated with a "statistically significant 10-percentage point increase" in the likelihood of the primary outcome, the researchers say.

Both the IMCP and DEV were associated with a two-fold increased likelihood that the depressed patient would ask their PCP for information about depression.

Among depressed patients who participated in the 12-week follow-up telephone interview, depression symptoms and mental and physical health scores on standard measures improved from baseline in all three treatment groups. But neither the IMCP nor the DEV was associated with improved mental or physical health outcomes compared with control. "Thus, our interventions did not demonstrate benefit at the 12-week follow-up," the researchers say.

In the nondepressed group, the researchers say they "could not exclude" the possibility that the IMCP and DEV increased patient-reported clinician recommendations for an antidepressant drug. They call for further research to determine effects on clinical outcomes and "whether the benefits outweigh possible harms."

In considering the mechanism by which the IMCP improved the doctor-patient encounter, the researchers "speculate that individualized information about depression and its manifestations may have helped some depressed individuals to identify their personal symptoms and distress as depression and to communicate these insights to providers verbally or nonverbally."

"In turn," they add, "clinicians may have been less deterred by perceptions of depression-related stigma on the part of patients and consequently more disposed to offer treatment. In addition, individualized information about depression treatment may have increased some patients' receptiveness to antidepressant medication or psychotherapy. These tentative explanations should be tested in future studies."

The authors did not respond to request for comment by press time.

SOURCE: http://bit.ly/Hyouvs

JAMA 2013;310:1818-1828.