Patient Management of Depression Through Technology: a Study of Digitally Enabled Engagement

• ClinicalTrials.gov Identifier: NCT03242213
• Recruitment Status: Completed
• First Posted: August 8, 2017
• Last Update Posted: January 22, 2021
• Sponsor: Advocate Health Care
• Collaborator: Takeda
• Information provided by (Responsible Party): David Kemp, Advocate Health Care

Study Description

Brief Summary:

The current randomized controlled trial is a pilot study that will assess the effectiveness and feasibility of a mobile phone application intervention. The objective is to determine whether the use of a mobile health application for patient self-management of depression improves patient-provider engagement for patients diagnosed with major depressive disorder.

Condition or disease	Intervention/treatment	Phase
Major Depressive Disorder	Behavioral: Mobile App	Not Applicable

Detailed Description:

This pilot study will be a randomized, real-world effectiveness study. Patients diagnosed with major depressive disorder starting a new prescription for an antidepressant monotherapy will be eligible for participation. The study will enroll 40 patients (20 in an observational arm of usual care and 20 with access to a mobile health application). No intervention will occur in the usual care arm. The intervention in this study is a mobile health app, which provides patients with a way to track emotional wellbeing and depression symptoms, set up medication reminders, track adherence to medications, record side effects experienced, and take surveys/tests to assess cognitive symptoms and depression. Patient reported outcomes and clinical data will be collected at baseline and at study primary endpoint (18 weeks) to assess changes over time and between groups for: patient-provider engagement, disease severity, quality of life, employment productivity, cognitive function, resource utilization, and medication adherence. Additionally, resource utilization will be assessed at the one year time point. A Student's t test, if allowed for by the data distribution, will be used to assess between group differences in patient reported outcome scales assessing patient-provider engagement.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 40 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Supportive Care
• Official Title: Patient Management of Depression Through Technology: a Study of Digitally Enabled Engagement
• Actual Study Start Date: July 20, 2017
• Actual Primary Completion Date: January 18, 2019
• Actual Study Completion Date: September 9, 2019

Arms and Interventions

Arm	Intervention/treatment
No Intervention: Usual Care; Standard of Care
Active Comparator: Mobile App; Standard of Care and Mobile App	Behavioral: Mobile App; The intervention in this study is a mobile health app, which provides patients with a way to track emotional wellbeing and depression symptoms, set up medication reminders, track adherence to medications, record side effects experienced, and take surveys/tests to assess cognitive symptoms and depression.

Outcome Measures

Primary Outcome Measures :

1. Patient activation [ Time Frame: 18 weeks ]
   This will be assessed by the Patient Activation Measure, a validated scale that measures patient knowledge, skills and confidence in disease self-management in the primary care setting.
2. Patient-provider engagement [ Time Frame: 18 weeks ]
   This will be assessed by the Patient-Provider Engagement Scale (PPES-7), an instrument developed for this study to measure patient knowledge, communication, and interaction with their provider specific to depression management.

Secondary Outcome Measures :

1. Depression symptoms [ Time Frame: 18 weeks ]
   This patient reported outcome is assessed by the clinical depression severity. PHQ-9 scale, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day).
2. Cognitive dysfunction [ Time Frame: 18 weeks ]
   This patient reported outcome is assessed by the cognitive dysfunction PDQ-D scale.
3. Medication changes [ Time Frame: 18 weeks ]
   This outcome will be assessed by clinical data on the frequency and types of medication switches.
4. Quality of Life [ Time Frame: 18 weeks ]
   This patient reported outcome is assessed by the quality of life WHO-5 survey.
5. Health care utilization [ Time Frame: 18 weeks ]
   This patient reported outcome is assessed by the healthcare resource utilization and cost RUQ-D survey.

Other Outcome Measures:

1. Long-term follow health care utilization [ Time Frame: 1 year ]
   This patient reported outcome is assessed by the healthcare resource utilization and cost RUQ-D survey.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 70 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Age 18 to 70
• Ability to consent and participate in study (technical requirements for app: iPhone version 5 or later, active data plan or regular WiFi access)
• Diagnosis with major depressive disorder
• PHQ-9 score greater than 5 at baseline
• Recent (0-14 days) start on monotherapy depression medication (either new prescription or a change from a previous medication)
• Outpatient care provided by participating Advocate Medical Group clinics

Exclusion Criteria:

• Diagnosis with major psychiatric disorder (e.g. bipolar disorder, manic depressive disorder)
• Contraindications to use of depression medications
• Patients with treatment resistant depression [defined as patients who have not responded to two or more separate different antidepressant monotherapy trials of adequate dose and duration (6 weeks or longer) in the current depressive episode]
• Considered at imminent risk for hospitalization due to severe depression in the opinion of the treating physician
• History of hospitalization due to major depressive disorder in prior 3 months
• Significant risk of suicide according to the treating physician's clinical judgment or previous suicide attempt in prior 6 months
• History of response only to combination or augmentation therapy in current depressive episode
• Receipt of any investigational compound in prior 30 days (or five half-lives, whichever is longer)
• Current participation in another clinical study
• Lack of functional English literacy

Contacts and Locations

Locations

United States, Illinois

Advocate Christ Medical Center

Oak Lawn, Illinois, United States, 60453

Sponsors and Collaborators

Advocate Health Care

Takeda

Investigators

• Principal Investigator: David Kemp, MD, MS; Advocate Health Care

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

McCue M, Blair C, Fehnert B, King J, Cormack F, Sarkey S, Eramo A, Kabir C, Khatib R, Kemp D. Mobile App to Enhance Patient Activation and Patient-Provider Communication in Major Depressive Disorder Management: Collaborative, Randomized Controlled Pilot Study. JMIR Form Res. 2022 Oct 27;6(10):e34923. doi: 10.2196/34923.

• Responsible Party: David Kemp, Medical Director, Behavioral Health Service Line, Advocate Health Care
• ClinicalTrials.gov Identifier: NCT03242213
• Other Study ID Numbers: 6680
• First Posted: August 8, 2017
• Last Update Posted: January 22, 2021
• Last Verified: January 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Depressive Disorder; Depressive Disorder, Major; Mood Disorders; Mental Disorders