Patient-Centered Technological Assessment and Monitoring of Depression for Low-Income Patients

Abstract

Depression is a significant challenge for ambulatory care because it worsens health status and outcomes, increases health care utilizations and costs, and elevates suicide risk. An automatic telephonic assessment (ATA) system that links with tasks and alerts to providers may improve quality of depression care and increase provider productivity. We used ATA system in a trial to assess and monitor depressive symptoms of 444 safety-net primary care patients with diabetes. We assessed system properties, evaluated preliminary clinical outcomes, and estimated cost savings. The ATA system is feasible, reliable, valid, safe, and likely cost-effective for depression screening and monitoring for low-income primary care population.

Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care

“…The DCAT study recently completed testing of automated patient calls to assist timepressured medical and behavioral providers by routinely screening and monitoring patient depression symptoms, treatment adherence and communication with providers [30,31]. A fully automated telephonic depression assessment system, provided in Spanish or English, was selected as the communication platform because phones are the most accessible technology among safety net care patients.…”

“…The trial was a quasi-experimental comparative effectiveness clinical trial conducted on predominantly Hispanic patients with Type 2 diabetes in collaboration with the Los Angeles County Department of Health Services (DHS) at eight county-operated clinics comparing three delivery models in three groups: usual care (UC), supported care (SC) and supported and technology-facilitated care (TC) [30,31]. DCAT was approved by the University of Southern California, Olive View UCLA Medical Center and the Los Angeles Biomedical Research Institutional Review Boards.…”

“…The complete set of data collection instruments is described in detail elsewhere [30]. Depression was assessed using the PHQ-9 [34].…”

Low-income minority patient engagement with automated telephonic depression assessment and impact on health outcomes

“…Figure 1 illustrates the DCAT technology-facilitated care-management workflow and escalation system in the TC arm. The ATA system properties have been evaluated [ 14 ].

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“…The ATA system provides an innovative way to increase patient engagement to provide critical data for cost-efficient and effective clinical care to them [ 13 , 14 ]. To ensure the success of such systems in the future, we need to understand the level of patient engagement in such systems, impact on health outcomes, and barriers to patient engagement.…”