e-MBC for Major Depressive Disorder

重度抑郁症的 e-MBC

• 批准号: 8031204
• 负责人: David William Morris
• 金额: $ 7.93万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8031204
• 关键词: Address; Adherence; Adoption; Adverse effects; Affect; Age; Antidepressive Agents; Appointment; Back; Caring; Chronic; Client satisfaction; Clinic; Clinic Visits; Clinical; Communication; Continuity of Patient Care; Diabetes Mellitus; Disease; Drug Monitoring; Electronics; Elements; Evaluation; Family Practice; Feasibility Studies; Feedback; Frequencies; Healthcare; Hypertension; Information Systems; Information Technology; Instruction; Knowledge; Left; Major Depressive Disorder; Measurement; Measures; Medical; Mental Depression; Methods; Neck; Nurses; Office Visits; Patient-Centered Care; Patients; Personal Health Records; Persons; Pharmaceutical Preparations; Physicians; Pilot Projects; Publishing; Quality of Care; Questionnaires; Race; Randomized; Randomized Controlled Trials; Records; Resources; Schedule; Secure; Severities; Solutions; Surveys; Symptoms; System; Techniques; Telephone; Time; Training; Treatment outcome; Visit; arm; base; care systems; clinical care; clinical practice; compare effectiveness; compliance behavior; depressive symptoms; disability; disability-adjusted life years; effective therapy; experience; follow-up; improved; patient oriented; point of care; response; satisfaction; socioeconomics; tool; treatment program

DESCRIPTION (provided by applicant): Depression currently ranks fourth for disability-adjusted life-years worldwide and is projected to jump to the second leading cause of disability by 2020. In contrast to other chronic medical conditions clinicians do not routinely use MBC to treat depression. This project evaluates the feasibility of using an electronic measurement based care (e-MBC) treatment program for major depressive disorder. The e-MBC system will allow patients to reduce the burden associated with clinic visits and at the same time increase the quality of care by providing their physician necessary feedback on their treatment. e-MBC can easily be incorporated into the clinics existing secure electronic Personal Health Care records communication system, the same system that allows patients to request refills, make an appointment, or leave a message for their treating physician. The e-MBC system has the ability to provided patient-centered care and can be seamlessly integrated into the standard clinical care workflow, with no need for additional knowledge or IT training. The study will be conducted at the UTSouthwestern Family Medicine clinic using the MyChart PHR system. Eligible patients starting an antidepressant or having their antidepressant treatment changed will be randomly assigned to 2 groups: e-MBC (n=25) or office-based MBC (n=25). After brief instruction in the use of the MyChart e-MBC system patients in the e-MBC group will receive a MyChart message from the study physician requesting they use the MyChart system to fill-out the MBC assessments online. Patients in the e-MBC group will be scheduled for follow-up based on the clinician's interpretation of the MBC assessments. In parallel, patients in the office-based MBC group will be scheduled for follow-up on a monthly basis. MBC assessments of depressive severity, tolerability, and compliance take less than 5 minutes for the patient to fill-out during an office visit or using the e-MBC system. The physician's review of the MBC assessment takes less than 1 minute. Additionally, a patient satisfaction with treatment questionnaire will be administered (pre-post), as well as physician surveys of ease use and usefulness of the e-MBC system (post). The Specific Aims of the study are: 1) to determine if patients with MDD will utilize the e-MBC system to a greater extent than the office- based system; 2) to determine if physicians experience greater satisfaction with the e-MBC system than the office-based system; 3) to compare patient satisfaction between the e-MBC and office-based MBC care groups; with a Secondary Aim to compare patient treatment outcomes between the e-MBC group and a group receiving office-based MBC care. The results of the study will allow us to evaluate both physician and patient barriers to the adoption of e- MBC systems and develop techniques to overcome these barriers. If results are promising, the next critical steps for us would be to conduct a multicenter three-arm randomized controlled trial to compare the effectiveness of e-MBC, office-based MBC, and telephone nurse follow-up. PUBLIC HEALTH RELEVANCE: This project evaluates the feasibility of using an electronic measurement based care (e-MBC) treatment program to aid in the treatment of major depressive disorder. The system would allow patients to reduce clinic visits and at the same time increase the quality of care by providing their physician necessary feedback on their treatment using the clinic's exiting electronic Personal Health Record system. The e-MBC system can be seamlessly integrated into the standard clinical care workflow, with no need for additional knowledge or IT training, and requiring only a few minutes each month from patients and physicians.

描述（由申请人提供）：目前，抑郁症在全球范围内被残疾调整的终身年份排名第四，预计到2020年将跃升为残疾的第二大主要原因。与其他慢性医疗状况相比，临床医生不常规使用MBC来治疗抑郁症。该项目评估使用基于电子测量的护理（E-MBC）治疗计划的可行性。 E-MBC系统将允许患者减轻与临床就诊相关的负担，同时通过提供医生对治疗的必要反馈来提高护理质量。可以轻松地将E-MBC纳入诊所现有的安全电子医疗保健记录通信系统，该系统允许患者要求补充，预约或给他们的治疗医师留言。 E-MBC系统具有提供以患者为中心的护理的能力，并且可以无缝整合到标准的临床护理工作流程中，而无需进行其他知识或IT培训。 这项研究将使用Mychart PHR系统在Utsouth -Western家庭医学诊所进行。合格的患者开始使用抗抑郁药或进行抗抑郁治疗的改变将随机分配给2组：E-MBC（n = 25）或基于办公室的MBC（n = 25）。经过简要说明E-MBC组中Mychart E-MBC系统患者的使用，将收到研究医师的Mychart消息，要求他们使用Mychart系统在线填写MBC评估。 E-MBC组的患者将根据临床医生对MBC评估的解释进行安排进行随访。同时，将每月安排基于办公室的MBC组的患者进行随访。 MBC对抑郁严重性，耐受性和合规性的评估需要少于5分钟的时间才能让患者在办公室访问或使用E-MBC系统期间填写。医师对MBC评估的审查需要不到1分钟。此外，将对患者对治疗问卷的满意度（前）以及对E-MBC系统（POST）的轻松使用和有用性的医师调查。该研究的具体目的是：1）确定MDD患者是否比基于办公室的系统更大程度地利用E-MBC系统； 2）确定医生对E-MBC系统的满意度是否比基于办公室的系统更高； 3）比较E-MBC和基于办公室的MBC护理小组之间的患者满意度；以比较E-MBC组与基于办公室MBC护理的组之间的患者治疗结果的次要目标。 这项研究的结果将使我们能够评估通过电子MBC系统的医师和患者障碍，并开发克服这些障碍的技术。如果结果是有希望的，那么我们的下一个关键步骤将是进行多中心三臂随机对照试验，以比较E-MBC，基于办公室的MBC和电话护士随访的有效性。 公共卫生相关性：该项目评估了使用基于电子测量的护理（E-MBC）治疗计划来帮助治疗重大抑郁症的可行性。该系统将允许患者减少诊所就诊，同时通过使用诊所退出的电子个人健康记录系统提供医生对治疗的必要反馈来提高护理质量。 E-MBC系统可以无缝整合到标准的临床护理工作流程中，而无需进行其他知识或IT培训，并且每个月只需要几分钟的患者和医生。