Web and mobile solution for support of process of care: case of depression

Medicine 2.0

Introduction: In general practice 12% of patients are suffering from depression, which puts depression on the second place of most common chronic diseases in primary care. Results of DEPRES study have shown that only 1,5 % are properly treated - they are either undiagnosed, receive improper treatment or discontinue treatment and are not followed-up. Several interventions improve outcome of treatment: education of staff, care management, active patient involvement including self-assessment, follow-up with telephone reminders and access of general practitioner to patient progress results. All of these can effectively be joined together using an information system, employing workflow management. A recent study by Robertson et al has shown promising results of an internet based solution to provide several of these functionalities. Methods: to evaluate an integrated care management and patient involvement approach to treatment of depression a web-based information system has been developed, accessible by all actors in care process using computers and mobile phones. The solution enables process support through defining tasks and timelines to all involved actors, automated reminders, communication tool, access to patient data etc. Use of process matrices enables complex evaluation of patients' response to treatment. The effects of the approach in which all involved actors use the application as care support are being evaluated in a case-control study involving general practitioners and patients diagnosed with depression for the first time. A multivariate analysis of factors influencing patient compliance and treatment outcome will be conducted. Results: the research will show which functionalities of the system and related care management or patient empowerment approaches contribute to what extent to depression treatment outcome. Generalised model of defining and structuring the care process and the modalities of the ICT support has been tested. Discussion: information technology supported care management of chronic diseases with focus on active patient involvement and patient empowerment emerges as one of the most promising ways to ensure cost-effective way of treatment. It is in most cases tightly connected to organization change and financing change, To insure sustainability these rather complex financing and organizational issues need to be resolved.