Mobile app to enhance patient activation and patient-provider communication in major depressive disorder management: Collaborative, randomized controlled pilot study

• Published in: JMIR Formative Research
• Main Authors: McCue, Maggie, Blair, Christopher, Fehnert, Ben, King, James, Cormack, Francesca, Sarkey, Sara, Eramo, Anna, Kabir, Christopher, Khatib, Rasha, Kemp, David
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2022
• Subjects: depression; depression management; major depressive disorder; mobile app; mobile phone; patient engagement; patient satisfaction; patient-reported outcomes; Advocate Aurora Research Institute; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/allother/367; https://doi.org/10.2196/34923; https://libkey.io/libraries/1712/10.2196/34923

Background: Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). Objective: We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). Methods: In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50%) or usual care alone (20/40, 50%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire-Depression). Results: All 37 patients (app arm: n=18, 49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in ...