Technology-Assisted Collaborative Care Program for People with Diabetes and/or High Blood Pressure Attending Primary Health Care: A Feasibility Study.

Pablo Martínez,Paulina Baeza,Viviana Guajardo,Maryam Farhang,Wilsa Szabo,Sebastián Brandt,Solange Campos,Graciela Rojas,Pablo Herrera,Gonzalo Soto-Brandt,Víctor E Gómez

doi:10.3390/ijerph182212000

Abstract

The comorbidity of depression with physical chronic diseases is usually not considered in clinical guidelines. This study evaluated the feasibility of a technology-assisted collaborative care (TCC) program for depression in people with diabetes and/or high blood pressure (DM/HBP) attending a primary health care (PHC) facility in Santiago, Chile. Twenty people diagnosed with DM/HBP having a Patient Health Questionnaire-9 score ≥ 15 points were recruited. The TCC program consisted of a face-to-face, computer-assisted psychosocial intervention (CPI, five biweekly sessions), telephone monitoring (TM), and a mobile phone application for behavioral activation (CONEMO). Assessments of depressive symptoms and other health-related outcomes were made. Thirteen patients completed the CAPI, 12 received TM, and none tried CONEMO. The TCC program was potentially efficacious in treating depression, with two-thirds of participants achieving response to depression treatment 12 weeks after baseline. Decreases were observed in depressive symptoms and healthcare visits and increases in mental health-related quality of life and adherence to treatment. Patients perceived the CPI as acceptable. The TCC program was partially feasible and potentially efficacious for managing depression in people with DM/HBP. These data are valuable inputs for a future randomized clinical trial.

Highlights

Depressive disorders and chronic diseases are among the leading causes of disability worldwide [1]
25 subjects were reassessed with the Patient Health Questionnaire 9-item (PHQ-9); 20 of these had 15 or more points in this questionnaire, being assigned to the technology-assisted collaborative care (CC) program (Figure 1)
Considering that the participants could report more than one occupation, most reported being retired (n = 11) or in household chores (n = 9), while six indicated they were working for a living

Summary

Introduction

Depressive disorders and chronic diseases are among the leading causes of disability worldwide [1]. Comorbidity is the norm rather than the exception [2], as up to two-thirds of depressed patients in primary healthcare (PHC) may present a chronic disease [3]. Such a frequent phenomenon has been linked to poor clinical outcomes and functional status [4,5], less adherence to treatment [6], higher health-care expenses, and mortality [7,8,9]. Its implementation and sustainability may be challenging in developing countries [16]

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