e-MBC for Major Depressive Disorder

描述(申请人提供)：抑郁症目前在全球残疾调整寿命年中排名第四，预计到2020年将跃升至第二大残疾原因。与其他慢性疾病相比，临床医生并不经常使用MBC来治疗抑郁症。该项目评估了使用基于电子测量的护理(e-MBC)治疗重度抑郁障碍的可行性。E-MBC系统将允许患者减轻与诊所就诊相关的负担，同时通过向医生提供必要的治疗反馈来提高护理质量。E-MBC可以很容易地整合到诊所现有的安全电子个人健康护理记录通信系统中，该系统允许患者请求续杯、预约或给他们的治疗医生留言。E-MBC系统具有提供以患者为中心的护理的能力，可以无缝地集成到标准的临床护理工作流程中，而不需要额外的知识或IT培训。这项研究将在犹他州西南家庭医学诊所使用MyChart PHR系统进行。符合条件的开始服用抗抑郁药或更改抗抑郁药治疗的患者将随机分为2组：E-MBC组(n=25)或办公室MBC组(n=25)。在简要介绍MyChart e-MBC系统的使用后，e-MBC组的患者将从研究医生那里收到一条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评估的解释安排随访。同时，办公室MBC组的患者将被安排每月进行随访。在办公室就诊或使用e-MBC系统时，患者只需不到5分钟就可以完成抑郁严重程度、耐受性和依从性的MBC评估。医生对MBC评估的审查只需不到1分钟。此外，还将进行患者对治疗的满意度调查(事后)，以及医生对e-MBC系统易用性和有用性的调查(POST)。这项研究的具体目的是：1)确定MDD患者是否会比办公室系统更多地使用e-MBC系统；2)确定医生对e-MBC系统的满意度是否高于办公室系统；3)比较e-MBC和办公室MBC护理小组之间的患者满意度；第二目的是比较e-MBC小组和接受办公室MBC护理的小组之间的患者治疗结果。研究结果将使我们能够评估医生和患者对采用e-MBC系统的障碍，并开发克服这些障碍的技术。如果结果是有希望的，我们的下一个关键步骤将是进行一项多中心三臂随机对照试验，比较e-MBC、办公室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严重抑郁障碍的可行性。该系统将允许患者减少诊所就诊次数，同时通过使用诊所现有的电子个人健康记录系统向医生提供必要的治疗反馈，从而提高护理质量。E-MBC系统可以无缝地集成到标准的临床护理工作流程中，不需要额外的知识或IT培训，而且每个月只需要患者和医生几分钟的时间。

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.