Randomized Trial of Depression Follow-Up Care by Online Messaging

Abstract

Background

Quality of antidepressant treatment remains disturbingly poor. Rates of medication adherence and follow-up contact are especially low in primary care, where most depression treatment begins. Telephone care management programs can address these gaps, but reliance on live contact makes such programs less available, less timely, and more expensive.

Objective

Evaluate the feasibility, acceptability, and effectiveness of a depression care management program delivered by online messaging through an electronic medical record.

Design

Randomized controlled trial comparing usual primary care treatment to primary care supported by online care management

Setting

Nine primary care clinics of an integrated health system in Washington state

Participants

Two hundred and eight patients starting antidepressant treatment for depression.

Intervention

Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.

Main Measures

An online survey approximately five months after randomization assessed the primary outcome (depression severity according to the Symptom Checklist scale) and satisfaction with care, a secondary outcome. Additional secondary outcomes (antidepressant adherence and use of health services) were assessed using computerized medical records.

Key Results

Patients offered the program had higher rates of antidepressant adherence (81% continued treatment more than 3 months vs. 61%, p = 0.001), lower Symptom Checklist depression scores after 5 months (0.95 vs. 1.17, p = 0.043), and greater satisfaction with depression treatment (53% “very satisfied” vs. 33%, p = 0.004).

Limitations

The trial was conducted in one integrated health care system with a single care management nurse. Results apply only to patients using online messaging.

Conclusions

Our findings suggest that organized follow-up care for depression can be delivered effectively and efficiently through online messaging.

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Figure 1

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ACKNOWLEDGEMENTS

Authorship contributions:

• Study concept and design: Simon, Ralston, Operskalski, Pabiniak, Savarino, Wentzel

• Acquisition of data: Wentzel, Pabiniak, Savarino

• Analysis and interpretation of data: Simon, Ralston, Wentzel

• Drafting of manuscript: Simon

• Critical revision of manuscript for important intellectual content: Ralston, Savarino, Pabiniak, Wentzel, Operskalski

• Statistical analysis: Simon

• Obtained funding: Simon

• Administrative, technical, or material support: Operskalski, Savarino, Pabiniak

• Study supervision: Simon, Operskalski

Financial Interests: Drs. Simon and Ralston are both employees of the Group Health Permanente Medical Group; the remaining authors are all employees of Group Health Cooperative. The authors have no other relevant financial interests to disclose.

Funded by NIMH grant R21 MH082924. The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Dr. Simon had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest

None disclosed.

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Correspondence to Gregory E. Simon MD MPH.

Additional information

Trial Registration

Clinicaltrials.gov ID NCT00755235

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Simon, G.E., Ralston, J.D., Savarino, J. et al. Randomized Trial of Depression Follow-Up Care by Online Messaging. J GEN INTERN MED 26, 698–704 (2011). https://doi.org/10.1007/s11606-011-1679-8

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KEY WORDS

  • depression
  • randomized
  • follow-up
  • online messaging