e-MBC for Major Depressive Disorder

描述（由申请人提供）：抑郁症目前在全球残疾调整生命年中排名第四，预计到2020年将跃升为第二大残疾原因。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。本项目评估使用基于电子测量的护理（e-MBC）治疗方案治疗重度抑郁症的可行性。e-MBC系统将使患者减轻与门诊就诊有关的负担，同时通过向医生提供有关治疗的必要反馈，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保健记录通信系统中，该系统可以让患者要求补充，预约或给他们的主治医生留言。e-MBC系统能够提供以患者为中心的护理，并且可以无缝集成到标准临床护理工作流程中，不需要额外的知识或IT培训。该研究将在西南大学家庭医学诊所使用MyChart PHR系统进行。符合条件的患者开始使用抗抑郁药或改变抗抑郁药治疗将被随机分配到2组：e-MBC （n=25）或办公室MBC （n=25）。在简要说明使用MyChart e-MBC系统后，e-MBC组的患者将收到来自研究医生的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评估的解释安排随访。同时，以办公室为基础的MBC组的患者将按月安排随访。在办公室访问或使用e-MBC系统时，患者只需不到5分钟即可完成抑郁严重程度、耐受性和依从性的MBC评估。医师对MBC评估的回顾不超过1分钟。此外，将进行患者治疗满意度问卷调查（上岗前），以及医生对e-MBC系统的易用性和有效性的调查（上岗后）。本研究的具体目的是：1)确定重度抑郁症患者是否会比基于办公室的系统更广泛地使用e-MBC系统；2)确定医生对e-MBC系统的满意度是否高于基于办公室的系统；3)比较e-MBC与办公室MBC护理组的患者满意度；次要目的是比较e-MBC组和接受办公室MBC护理组的患者治疗结果。这项研究的结果将使我们能够评估医生和患者采用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，我们接下来的关键步骤将是进行一项多中心三组随机对照试验，比较电子MBC、办公室MBC和电话护士随访的有效性。

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.