Mobile Technology-Supported Shared Decision-Making and Goal Setting for Management of Depression in Primary Care

Objective: Evaluate use of Primary Care Path program for depression management in primary care clinical settings and its impact on shared decision-making (SDM), treatment, symptoms, and goal setting and attainment. Study Design: Four primary care practices were randomized to program use (intervention) or usual care (control). Intervention was 18-week use of Primary Care Path program. Patient participants completed online surveys at baseline, 6, 12, and 18 weeks. A subset of care team members and intervention patients completed interviews at study end. Outcome Measures: SDM-9, treatment changes, PHQ-9, goal setting and attainment. Population: Patient participants were aged ≥18, being treated for depression, and smartphone users. Clinical care team participants were from all study sites. Principal Findings: 76 patients (34 intervention; 42 control) were enrolled; majority were female (79%; 76%), White (91%; 95%), non-Hispanic/Latino (85%; 100%), and employed (77%; 81%). No significant differences were observed in SDM-9 between groups; however, in interviews, care team and patient participants reported using the program data to assist in the SDM process. More intervention patients initiated antidepressant medication by weeks 12 (P=0.030) and 18 (P=0.040) and switched medications by week 6 (P=0.009) and 12 (P=0.040) versus control. At week 18, intervention participants felt more successful than control in achieving their personalized treatment goals (P=0.048). Conclusions: Digitizing goal setting may support physician-patient conversations and has potential clinical value. Future studies should address whether using mobile apps will improve measurement-based care, SDM and goal-setting processes, leading to better outcomes for patients with MDD managed in primary care settings.