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

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Depression-specific enhancements of patient portals increase patient activation and improve the ability of patients and providers to communicate.

Project Details -
Completed

One in five people in the United States experiences depression at some point in their lifetime. 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, with approximately one third of patients discontinuing antidepressants within the first month, and 44 percent discontinuing 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.

This research developed and evaluated ConnectCare, a depression intervention combining depression-specific patient portal features and the ability to communicate with providers. The goal was to increase patient activation, promote collaborative evidence-based decision making, support treatment adherence, and reduce depressive symptoms.

The specific aims of the research were the following:

  • 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 (RCT) with 50 patients.

The research was conducted in three phases. First, online surveys and interviews with patients and providers regarding their use of patient portals were conducted. Findings from the surveys and interviews informed the development of ConnectCare during the second phase. The last phase was a pilot RCT to test the acceptability and effectiveness of ConnectCare.

Of the 80 providers engaged, 95 percent worked at organizations with patient portals. Sixty-four percent endorsed patient access to general medical notes, 36 percent endorsed access to mental health notes, and 85 percent endorsed the use of secure messaging with their patients. Of the 168 patients who participated in the research, 90 percent endorsed access to patient portals, 22 percent endorsed access to mental health notes, and 83 percent endorsed secure messaging.

For the RCT, the final intervention needed to be modified because of constraints during the COVID pandemic. This may have limited the intervention’s impact and resulted in fewer enrolled patients than had been planned. While there was a trend in improvement on a 9-item Patient Health Questionnaire between the intervention and usual care group, it was not statistically significant, likely due to the small sample size. A revised intervention that better engages providers could increase impact and better promote adoption of portals and a collaborative tool that further empowers patients. The researchers concluded that ConnectCare lays the groundwork for similar interventions, but that further development is needed to improve overall impact and improvement of integration into day-to-day mental health treatment.