Abstract
Background/Aims We assessed the effectiveness of eCare for Moods™ (patent pending), a patient-centered, highly interactive, web-delivered patient self-management and care management program on patients treated for recurrent or chronic depression in specialty psychiatry through a randomized clinical trial with two-year follow-up.
Methods Patients with recurrent or chronic depression were randomly assigned to eCare (N = 51) or usual specialty mental health care (N = 52). The 12-month eCare program provided patients with individualized self-monitoring, tailored patient education and training in depression self-management including relapse prevention. eCare was integrated with participants’ ongoing depression care, linked to their electronic medical records. It provided clinicians with panel management and clinical decision support. Participants were interviewed at baseline and 6, 12, 18, and 24 months after enrollment. Telephone interviewers blind to treatment assignment used a timeline follow-back method to estimate depression severity on a 6-point scale for each of the 105 study weeks (including the baseline). Differences between groups in weekly severity over two years were examined by generalized estimating equations.
Results Participants in eCare experienced more reduction in depressive symptoms (estimate=−.74 on the 6-point scale over two years; 95% confidence interval [CI]=−1.38 to −.09, P = .025) and were less often depressed (−.24 over two years; CI=−.46 to −.03, P = .026). At 24 months, 43% of eCare and 30% of usual-care participants were depression free; the number needed to treat to attain one additional depression-free participant was 8. eCare participants had other favorable outcomes: improved general mental health (P = .002), greater satisfaction with specialty care (P = .003) and with learning new coping skills (P <.001), and more confidence in managing depression (P = .006).
Conclusions Patient-centered, web-delivered care management improves outcomes in patients treated for recurrent and chronic depression.
