Development of a Targeted Patient Portal Intervention to Improve Depression Treatment Adherence, Satisfaction, and Outcomes (Iowa)

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Project Details - Ended


One in five people in the United States experiences depression at some point in their lifetime. Depression is strongly associated with suicide as well as increased morbidity and mortality in comorbid chronic illnesses, including cardiovascular disorders and diabetes. While pharmacologic and behavioral treatments for depression are effective, patients often experience significant side effects after the first trial of antidepressants, and multiple attempts are required to find the optimal regimen. Patient adherence to depression treatment is also a challenge. Approximately one third of patients discontinue antidepressants within the first month, and 44 percent discontinue treatment by the third month. Discontinuation is associated with patient reports of ineffective provider communication, lack of explanations about side effects, and unclear treatment instructions.

The project will develop ConnectCare, an intervention that combines depression-specific patient portal features with provider communication strategies to increase patient activation, promote collaborative evidence-based decision making, support treatment adherence, and reduce depressive symptoms. ConnectCare will require both technical and clinical development as the clinical benefits of patient portals cannot be realized without addressing the clinical context in which these features are used.

The specific aims of the project are as follows:

  • Identify desired portal features and functions through stakeholder interviews. 
  • Integrate interview results to develop portal features and a clinical protocol for ConnectCare. 
  • Conduct formal usability testing of the portal interface with 25 patients receiving depression treatment. 
  • Estimate the effectiveness of ConnectCare in a pilot randomized controlled trial with 50 patients. 

A pilot randomized controlled trial will test the effectiveness of ConnectCare in improving patient engagement, improving medical adherence, and reducing depressive symptoms. Patients will be enrolled prior to their visit and randomized either to receive ConnectCare or to the control group, where patients will receive training about the general patient portal and support at each medical visit should they have questions. To determine effectiveness, patients in both arms will be assessed at baseline, 3 months and 6 months post-baseline. Researchers hypothesize that at 6 months post-baseline, patients receiving ConnectCare will have improved scores on patient activation, participation in care, and adherence to recommended treatment, as compared with those in the control group.