Web and Mobile Process Support for Management of Patients with Depression: Preliminary Results of the Improvehealth.eu Randomized Controlled Trial
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Abstract
Background: At Medicine 2.0 2008 we have presented the development of web and mobile environment for process support for management of patients with depression. The environment supports participation of all actors involved in the process of integrated care (patient, care manager, general practitioner/psychiatrist, psychologist, peer). Automated analysis of self-assessment questionnaires allows for stepped-care approach employed by care manager.
Objectives: The objectives of the study are to measure the effectiveness and efficiency of this novel approach to depression treatment. By comparing the treatment involving the above intervention to existing treatment we aim to measure any changes in adherence and treatment outcome.
Methods: To measure the changes we are performing a randomized controlled trial involving over 50 patients. Controls receive existing care whereas the experimental group receives existing care combined with participation in the improvehealth.eu environment and care management. Depression levels before and after 6 month treatment are gathered via on-line and paper questionnaires including psychosocial and clinical information and analysed to show differences in adherence and outcome of treatment in both groups. Delay of onset of improvement of clinical symptoms is being collected retrospectively. A multivariate analysis of psychosocial and intervention related factors influencing patient compliance and treatment outcome will also be conducted.
Results: Preliminary results from experimental group are as follows: of 30 patients in this group 3 were no-shows (10%) and 3 were early drop-outs (10%). 62% of the remaining 24 patients completed stage 1 of on-line follow-up protocol (10 weeks of weekly reporting and analysis). Patients successfully submitted a total of 240 self-assessment questionnaires. Average participation was 83 days (SE=38 days). The chance for a non-early drop-out patient to finish stage 1 is 61% (SE=10%) based on K-M survival curve analysis. Adherence to treatment in experimental group was 83% at 10 weeks as compared to 60-70% in published managed care studies. Improvement in Beck Depression Inventory as measure of treatment outcome was 62% (SE=23%) or 18 points (SE=10 points).
Conclusion: Preliminary results will show if there are any effects of web and process-support environments on adherence and outcome of depression treatment. Implications on disease burden and use of this approach in treatment of other long-term diseases will be discussed.
Objectives: The objectives of the study are to measure the effectiveness and efficiency of this novel approach to depression treatment. By comparing the treatment involving the above intervention to existing treatment we aim to measure any changes in adherence and treatment outcome.
Methods: To measure the changes we are performing a randomized controlled trial involving over 50 patients. Controls receive existing care whereas the experimental group receives existing care combined with participation in the improvehealth.eu environment and care management. Depression levels before and after 6 month treatment are gathered via on-line and paper questionnaires including psychosocial and clinical information and analysed to show differences in adherence and outcome of treatment in both groups. Delay of onset of improvement of clinical symptoms is being collected retrospectively. A multivariate analysis of psychosocial and intervention related factors influencing patient compliance and treatment outcome will also be conducted.
Results: Preliminary results from experimental group are as follows: of 30 patients in this group 3 were no-shows (10%) and 3 were early drop-outs (10%). 62% of the remaining 24 patients completed stage 1 of on-line follow-up protocol (10 weeks of weekly reporting and analysis). Patients successfully submitted a total of 240 self-assessment questionnaires. Average participation was 83 days (SE=38 days). The chance for a non-early drop-out patient to finish stage 1 is 61% (SE=10%) based on K-M survival curve analysis. Adherence to treatment in experimental group was 83% at 10 weeks as compared to 60-70% in published managed care studies. Improvement in Beck Depression Inventory as measure of treatment outcome was 62% (SE=23%) or 18 points (SE=10 points).
Conclusion: Preliminary results will show if there are any effects of web and process-support environments on adherence and outcome of depression treatment. Implications on disease burden and use of this approach in treatment of other long-term diseases will be discussed.
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