As digital health moves toward broader implementation in US Healthcare, we are beginning to see more studies published on the early experience of deployment. One aspect of import is how well care providers accept digital tools- we know patients are unlikely to be referred to digital tools if the provider doesn’t believe they will help.
Liza Hoffman from the Cambridge Health Alliance and colleagues have published on augmenting care with apps in a primary care environment in Frontiers in Psychiatry. In this care model, a patient seeing their primary care doctor, may, if needed also see a behavioral health specialist as part of their visit with a view to supporting patients in that setting by increasing access to care. The study had three aims; to examine how feasible it is to deploy mental health apps in a primary care setting, to seek feedback from doctors and therapists about the digital mental health apps to support implementation and lastly, to develop an app implementation toolkit to support ongoing deployment.
The authors worked with providers serving a safety net population of 150,000 diverse patients around the Boston area across twelve primary care clinics. The implementation was staggered, and pilot sites were chosen to develop the toolkit in half the locations with broader rollout over a one-year follow-up timeframe. The apps were select by a small committee, and selection criteria included app privacy, and data use disclosures. The apps selected supported self-management support for anxiety, depression, post-traumatic stress disorder and supported elements of mindfulness and cognitive behavioral therapy. The apps were also free to use.
To support the use of apps by providers training about the different kinds of apps and their best applications across different patient populations were developed, this included pro/cons of each app in their self-management portfolio. Referring apps was also made more accessible by building tools in the Electronic Medical Record (EMR). Over the two-month pilot care managers referred 56 patients to the apps, 96% of whom agreed to use the tools. Of those referred, 35 provided feedback on their use of the apps, 65% found them helpful, 68% reported using the Breathe2Relax tool to manage their anxiety, they also said this tool is helpful for sleep issues and for coping with stressful situations. Patients also reported the apps were easy to use, provided educational value and were supportive for self-monitoring mood and symptoms. They also valued the provider’s role in encouraging them to use the app as part of their self-management routine.
Staff also provided feedback. Overall, 96% responded to follow-up surveys, 82% reported routinely using apps into their clinical workflow. A quarter of the team said they were referring members to the apps 25-50% of the time. The most frequent conditions addressed included anxiety (83%), stress (75%), depression (58%), alcohol use (25%), and tobacco use (25%. Also, 42% of staff requested more training and time to get acquainted with all the apps in the portfolio.
Overall this papers shows very encouraging signs of both patient and provider acceptability toward using digital mental health tools to augment ongoing care.
Thanks for reading – Trina
(Opinions are my own)
Frontiers in Psychiatry AUgmenting Mental Health in Primary Care