PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Depression is a long-lasting mental health condition that affects more than 350 million people worldwide. The majority of people who have depression have not been diagnosed, have not received treatment, or are not getting the best treatment.

Researchers want to understand how people with depression manage their condition and make decisions about care. This information can help doctors, patients, and families communicate better about signs of depression, managing symptoms, preferred types of treatment, staying on track with treatment, and getting the best response to treatment. New technologies such as apps for tablet computers may help patients, their families, and doctors to identify, manage, and monitor chronic conditions such as depression.

Project Purpose

This study developed an iPad app for use by Alaska Native and American Indian patients with depression, their families, and their doctors.

The researchers tested the app within a tribal health organization to see if the app had an effect on

• Patients’ health
• The health services patients use
• Patients’ healthcare costs

Methods

First, the researchers interviewed patients, doctors, and local health leaders to figure out their understanding of depression and their preferences for treatment. Then, using what they learned from the interviews, the researchers developed an app to help manage and treat a patient’s depression. The researchers tested the app with 20 Alaska Native and American Indian patients to see if they thought it was easy to use and if it helped them manage their depression.

To test the app, the researchers randomly selected three primary care clinics in a tribally owned and operated healthcare system. Patients who were receiving treatment at these clinics were screened for depression. A total of 131 patients showed signs of depression. The clinics offered these patients the opportunity to use the app to help manage their depression. The research team compared their experiences with 263 other patients with depression who got regular treatment at other tribal clinics but did not use the app. Patients were in the study for six months. During that time, 19 patients who were using the app dropped out of the study.

The researchers collected information from patients such as age, gender, and whether they had health insurance. The researchers also collected health information such as whether the patient had multiple health problems and if the patient used different healthcare services. The researchers tested whether there were differences between the two groups in the frequency and kind of healthcare services used.

Findings

Researchers found that patients who had access to the app visited primary care doctors and behavioral health consultants less often than patients who did not have the app. However, patients in the two groups continued to visit the emergency department equally as often and received the same amount of medication for depression. In addition, patients in both groups had the same healthcare costs.

Limitations

The research team was not able to get enough information from testing the app to be sure about how useful it was to patients. The researchers used billing information from the three primary care clinics to look at healthcare costs. The billing information may not have included all costs. Although the test did not find differences in healthcare costs between groups, it might take longer than six months for such differences to appear.

Conclusion

Patients who used the app visited their doctors less often. The app may have helped patients with depression manage their condition so that they did not need to go to the doctor as often.

Sharing the Results

The research team plans to let clinics in the tribally owned health system use the app.