Using Apps to Improve Depression Care: 2 Models


How did you create the remedy method applied in your app?

Dr Shah: I teamed up with John Mann, MD, who is a professor of Translational Neuroscience and a former vice chair for analysis in the Department of Psychiatry at Columbia University. He is also the director of analysis and director of molecular imaging in the Neuropathology Division of the New York State Psychiatric Institute.

Dr Mann had written a overview in the New England Journal containing a remedy algorithm for healthcare management of depression.10 Many psychiatrists regard the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study11 as a remedy algorithm, but despite the fact that it was an instructive and useful clinical trial to teach us about depression and medication, it is not necessarily the most optimal way to treat depression today.

How does your method differ from that of the STAR*D?

Dr Shah: Here are a handful of examples. The STAR*D studied improvement in symptoms just about every 4 weeks, but we assume the information recommend it is greater to verify for improvement just about every 2 weeks. The STAR*D recommend that if 1 selective serotonin reuptake inhibitor (SSRI) does not work, the patient ought to switch to one more SSRI.11 In our remedy algorithm, if folks do not strengthen on a single SSRI, they can switch to a serotonin and norepinephrine reuptake inhibitor (SNRI).

What else does the app present?

Dr Shah: The app presents clinical pearls for depression remedy in a stepwise style titration protocols for the 7 vital generic medicines used to treat depression develop-in calculators for the PHQ-9 and the Columbia Depression Scale Suicide Risk Assessment (C-SSRS), and security arranging.

The tool suggests “gateway” screening inquiries that, if the patient responds by saying “yes,” more formal tools are recommended. For instance, if the patient indicates that they have necessary a great deal significantly less sleep, it is advised that the patient has a longer, more formal bipolar screening scale, which is also integrated in the app.

If a patient presents and you assume they have depression, you can open the app. It will remind you of the diagnostic criteria for depression. You can pick irrespective of whether the patient is presenting for an initial or a comply with-up stop by. The app prompts you to ask significant query about suicide dangers as nicely as inquiries to see if the patient may well have bipolar disorder rather than unipolar depression. When a medication is recommended, there is facts about how to initiate and titrate the medication, the most frequent side effects, and the complete FDA prescribing facts if you want to do additional reading about the medication.

The app will also aid as the patient comes up for comply with-up to ascertain if the patient is enhancing, has not changed, or is in remission, and will recommend solutions, primarily based on these outcomes. Should you transform the medication? Change the dose? How quickly ought to the patient be observed once more? This tool can aid you longitudinally in managing the patient.

It sounds a small like a “cookbook” method. Where does clinical judgment match into the image?

Dr Shah: Even in the kitchen, you have to have to combine use of a cookbook with your personal judgment. That’s surely the case in a clinical setting. You are treating human beings and you are a educated clinician. No app can be applied in a robotic manner or replace clinical judgment. Rather, it is one more tool in the toolkit and a way to aid you incorporate the most current analysis into practice. No matter what algorithm we develop, it can by no means recreate just about every situation in humankind, but it is most likely to cover a great deal of what is observed in routine clinical practice. We count on clinicians to use their judgment, just as they would with any clinical tool.

And does facts automatically get transferred to the patient’s electronic healthcare records (EMR)?

Dr Shah: The app is downloadable through the internet onto a smartphone or computer system and has exportable PDFs. We do not at present gather any information that is on your personal computer system or smartphone. We are in the procedure of building a technique of integrating the facts with the patient’s EMR, and of course as soon as we do that, any transmission mode will be HIPAA-compliant. In addition, we have an automatically generated text to document the clinician’s choice-producing procedure and the clinician can add that to the patient’s notes.

How can your app be accessed?

It is obtainable on our web page:

We also interviewed Hari Prasad, MS, cofounder and CEO of Yosi Health.

What is Yosi Health?

Mr Prasad: Yosi Health is a patient engagement platform that presents a suite of options to engage patients prior to, throughout, and just after their stop by. This creates maximum efficiency for physicians and other overall health care providers.

Hari Prasad, MS

How did you come to discovered Yosi Health? What was the impetus behind it?

Mr Prasad: In my background, I worked for substantial payers and provider organization and what I noticed in my expert knowledge as nicely as my knowledge as a customer and patient, is that there have been not adequate tools to aid overall health care providers realize their patients’ healthcare requirements.

Typically, facts is collected from patients through pages on a clipboard in the waiting area. Patients sit next to every other and fill out these types. Everyone is pressed for time. Handwriting can be illegible. Some folks have difficulty reading the types. During the pandemic, the added time spent in the waiting area can lay some patients open to the possible of COVID-19 contagion.

Additionally, we have noticed that substantial amounts of very important facts are frequently lost in the clipboards. And the inquiries on the preprinted types do not usually capture what is most relevant and significant to a offered provider, primarily based on his or her approaches to the healthcare circumstances for which the patient is coming.

The proverbial camel’s back broke for me when I was attempting to fill out my patient paperwork with a dislocated shoulder in the emergency area. It was each annoying and painful. I had to rummage by means of my issues to uncover my insurance coverage card, bear in mind all the medicines I was taking, sign a bunch of consent types, and do all of this when in severe discomfort. Having worked for hospitals and insurers and possessing an academic background in overall health informatics, finance, and information analytics, I knew there had to be a greater way.

To create this “better way,” I assembled a group of respected physicians in a quantity of disciplines, such as psychiatry, to weigh in on building a platform that could aid strengthen waiting area productivity and permit physicians to get a sense ahead of time what complaints their patients have been presenting with and any salient facts possessing to do with that complaint, so the platform had to be customized to the requirements of just about every doctor. To save the physicians work and time, we wanted to streamline the platform with the industry’s major EMR/EHR [electronic health record] providers so that the facts could straight be entered into the patient’s record.

How does your tool work?

Mr Prasad: We present a easy internet-primarily based tool that patients can fill out in the comfort of their residences. We use a mixture of obtainable standardized questionnaires and augment these with other proof-primarily based inquiries that every clinician would like to ask. The inquiries integrated are chosen by every provider, so it is very customized and individualized, primarily based on the exceptional set of priorities approaches of the doctor. We genuinely really feel that a single-size-fits-all does not work in behavioral overall health, simply because every psychiatrist or other clinician will have his or her personal set of inquiries. After we have collected the facts, we score the assessments from the patient and provide it to the clinician prior to the patient arrives at the appointment.

We are not only cognizant of every provider’s exceptional set of inquiries but also the workflow and structure of the healthcare practice. A substantial group practice is not the exact same as a solo practice, or an outpatient clinic, for instance.

Our application is cloud-primarily based and functions on a subscription basis and all of the workflow is totally automated. Once an appointment has been booked, we instantaneously make contact with the patients in a basic, seamless, engaging way through a HIPAA-compliant platform that is totally internet-primarily based, can be applied on any smartphone or computer system, and serve a wide variety of demographics.

One of the most frequent and significant issues in the remedy of patients in common and specially these with mental overall health problems is poor engagement. And however doctor surveys have discovered that a increasing quantity of providers are interested in adopting digital clinical tools. A substantial population of patients with psychiatric problems, such as serious mental illness, are comfy making use of digital devices and tools when they are tailored to this population.5 Since a lot of of these patients do not readily adapt to digital tools, we make it extremely basic and patient centric. We do not ask them to download apps or develop logins or passwords and we gather all the facts we have to have, ranging from previous healthcare history to allergies, family members history, present medicines, overview of symptoms, and history of the present complaint. As pointed out, we use recognized, established, proof-primarily based depression and anxiousness screening tools and then we transfer the facts straight into the patient’s EMR, therefore removing all of the documentation time that a provider spends and wastes.

Can you please speak more to the screening questionnaires you use for depression and anxiousness?

Mr Prasad: As pointed out, our technologies automates the sending of screening questionnaires that flag depression, anxiousness, or at threat addiction patients primarily based on criteria supplied by the providers and care centers. We present a wide variety of standardized, proof-primarily based screening tools such as the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GaD-7), the Alcohol Use Disorders Identification Test (AUDIT), the Screen for Child Anxiety Related Disorders (SCARED), and a lot of other folks, with each other with customized input from the clinician.

By automating these screeners prior to the patient’s stop by, not only will just about every acceptable particular person/patient have a safe and effortless private strategy of answering the inquiries safely, remotely, and accurately, but the providers will also have the potential to provide to and/or flag a higher quantity of at threat patients substantially more quickly than the regular point of care in particular person at the workplace, more than the telephone, or through video.

Is psychiatry the only specialty you work with?

Mr Prasad: While we work with 22 specialties across the nation with shoppers in all 50 States, we focus largely on psychiatry/behavioral overall health, pediatrics, discomfort management, and women’s overall health. Within psychiatry, we work with an array of mental overall health circumstances, of which depression is only a single instance.

How can clinicians access your app?

Mr Prasad: You can stop by us at: https://yosi.health/patient-intake/

Table 1: Potential Perils and Pitfalls of Mental Health Apps

● Offering incorrect or misleading facts to patients.
● Claiming to present therapeutic interventions or services but really be ineffective, major to belief the patient is remedy refractory.
● Not becoming safe, or improperly disclosing or permitting access to the private overall health information.
● Selling patient collected information but not naturally disclosing this facts to customers.
● Not really collecting clinically valuable or actionable information.
● Being a new technologies whose use in a clinical setting is nonetheless not totally understood.  
App Advisor. American Psychiatric Association. Accessed: January 28, 2022.
https://www.psychiatry.org/psychiatrists/practice/mental-health-apps.

Table 2: Evaluating an App: Questions to Ask

● On which platforms/operating systems does the app work?
● Does it also work on a desktop computer system?
● Has the app been updated in the final 180 days?
● Is there a transparent privacy policy that is clear and accessible prior to use?
● Does the app gather, use, and/or transmit sensitive information?
● If yes, does it claim to do so securely?
● Is there proof of precise advantage from academic institutions, finish use feedback, or analysis research?
● Does the app have a clinical/recovery foundation relevant to your intended use?
● Does the app look effortless to use?
● Can information be quickly shared and interpreted in a way that is constant with the stated goal of the app?
● What are the key engagement types of the app?
● Do the app and its attributes align with your requirements and priorities?
● Is it customizable?
● Does the app clearly define functional scope?
● Does the app look effortless to use?
● Can the app share information with EMR?  
App Advisor. The Evaluation Model. American Psychiatric Association. Accessed February 1, 2022. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/the-app-evaluation-model.

References

1.  App Advisor. American Psychiatric Association. Accessed: January 28, 2022. https://www.psychiatry.org/psychiatrists/practice/mental-health-apps.

2.  Ventola CL. Mobile devices and apps for health care professionals: uses and benefits. P T. 201439(5):356-364.

3.  BinDhim NF, Shaman AM, Trevena L, Basyouni MH, Pont LG, Alhawassi TM. Depression screening via a smartphone app: cross-country user characteristics and feasibility. J Am Med Inform Assoc. 2015 Jan22(1):29-34. doi:10.1136/amiajnl-2014-002840. doi:10.1186/s12888-021-03064-x

4.  Patoz MC, Hidalgo-Mazzei D, Blanc O, et al. Patient and physician perspectives of a smartphone application for depression: a qualitative study. BMC Psychiatry. 2021 Jan 2921(1):65. doi:10.1186/s12888-021-03064-x

5.  Skoufalos A, N’Dri LA, Waters D. Leveraging digital medicine to support providers and their patients in managing serious mental illness. Popul Health Manag. 2021 Aug24(S2):S55-S61. doi:10.1089/pop.2021.0083

6.  Depression. World Health Organization. Published September 13, 2021. Accessed: January 20, 2022. https://www.who.int/news-room/fact-sheets/detail/depression.

7.  Ettman CK, Cohen GH, Abdalla SM, et al. Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults. Lancet Reg Health Am. 2022 Jan5:100091. doi.org:10.1016/j.lana.2021.100091

8.  Depression. National Institute of Mental Health. Updated: January 2022. Accessed: January 20, 2022. https://www.nimh.nih.gov/health/statistics/major-depression

9.  Park LT, Zarate CA Jr. Depression in the primary care setting. N Engl J Med. 2019380(6):559-568. doi:10.1056/NEJMcp1712493

10.  Mann JJ. The medical management of depression. N Engl J Med. 2005 353:1819-1834. doi:10.1056/NEJMra050730

11.  Sequenced remedy options to relieve depression (STAR*D) study. National Institute of Mental Health. Accessed: January 19, 2022. https://www.nimh.nih.gov/funding/clinical-research/practical/stard.

12.  Sinyor M, Schaffer A, Levitt A. The sequenced treatment alternatives to relieve depression (STAR*D) trial: a review. Can J Psychiatry. 2010 Mar55(3):126-35. doi:10.1177/070674371005500303



Originally published in www.psychiatryadvisor.com