Deploying eHealth: A new approach to face depression

PURPOSE: The main objective of this project is to deploy a Computerized Cognitive Behavioral Therapy (cCBT) solution, within an integrated care intervention, as well as to identify and analyze the barriers and facilitators of this process, both in the clinical and organizational fields. CONTEXT: Depression is one of the most frequent mental health diseases worldwide, with approximately 350 million of individuals affected. Antidepressants are still the mainstay of treatment for depression in healthcare settings. Computerized Cognitive Behavioral Therapy (cCBT) has proven to be effective to fight depression, enabling the patient to change destructive patterns. This type of cCBT can be self-administrated at any time and place; this is why it contributes to improve accessibility to treatment. Also, it enables the delivery of care at the natural environment, minimizing the negative effect of mental health stigma, and contributing to the acceptance of the one's own condition. 1, 2 METHODS: The practice being implemented comprises three main work areas: 1. Development of a cCBT platform, taking into account the needs for patient-professional interaction and fluid communication, integration within information systems and therapeutic content that nurtures the platform. 2. The deployment of a protocol for comprehensive care that includes key professionals (primary care, mental health and emergency). 3.  Put into practice an integrated care intervention targeting 300 individuals over the age of 18, diagnosed of mild or moderate depression. The status of the patient will be evaluated at the baseline, in the middle of the treatment and at the end of the treatment. The assessment of the professionals and organizations involved will be carried out at the end of the treatment. RESULTS AND DISCUSSION: The results are to be measured according to the MAST model (Model of Assessment of Telemedicine) in terms of health problems, application features, safety, clinical effectiveness, patient perspective and economic, organizational, socio-cultural, ethical and legal aspects. This project is expected to raise awareness about the key issues underpinning online cCBT integration within regular care, generating the knowledge and expertise needed for the extension of this type of care in a safe, efficient and effective way. Some lessons learnt: As to the cCBT platform, the length of the contents has to be limited and the number of activities to be carried out by patients has to be reduced. In addition, patients' perspective has to be taken into account to ensure the online therapy meets their needs, and consequently improves their adherence. In order to engage patients and professionals, a major barrier have been computer problems concerning the platform and the need to strengthen the training both patients and professionals, to solve problems of access and use of the application. REFERENCES Ragnhild Sorensen Hoifodt, Matthias Mittner, Kjersti Lillevoll,  Susanne Kvam Katla, Nils Kolstrup, Martin Eisemann, Oddgeir Friborg, and Knut Waterloo. Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis. J Med Internet Res. 2015 Sep; 17(9): e197. Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM . The effectiveness of telemental health: a 2013 review . Telemed J E Health. 2013 Jun;19(6):444-54.