背景:多发性硬化症(MS)患者被诊断为抑郁症的可能性高于普通人群。尽管存在许多低成本的筛查工具和基于证据的干预措施,MS患者的抑郁症被低估了,未被临床医生确定,和未得到充分的对待。
目的:本研究旨在设计一种闭环工具来改善这些患者的抑郁症护理。它将支持定期的抑郁症筛查,联系到护理点,并支持共同决策和全面后续行动。经过最初的发展阶段,这项研究包括概念验证试点随机对照试验(RCT)验证阶段和详细的以人为中心的设计(HCD)阶段.
方法:在最初的开发阶段,利用面向临床医生的MS管理现场护理临床仪表板(BRIDGE)的技术基础设施来整合支持抑郁症筛查和全面护理的功能(CareTechnologytoAscertain,治疗,并让社区参与治愈患有MS[MSCATCH]的人的抑郁症)。这与患者调查有关,入篮消息,和临床医生仪表板。在飞行员RCT阶段,我们从一个由9项患者健康问卷评分为5~19分(轻度至中度重度抑郁症)的MS中心招募了50名MS成人的便利样本.在例行MS访问期间,他们的临床医生被要求或不要求使用MSCATCH检查他们的评分,并收集护理结果.在HCD阶段,MSCATCH组件根据利益相关者的反馈进行了迭代修改:与MS生活在一起的人,MS临床医生,和跨专业专家。
结果:MSCATCH链接了3个功能,旨在支持情绪报告和确定,全面的循证管理,和临床医生和患者的自我管理行为可能导致持续抑郁缓解。在试点RCT(n=50次访问)中,与未使用MSCATCH的患者相比,临床医师被随机分配使用MSCATCH的患者有更多记录抑郁症状讨论的记录(75%vs34.6%;χ21=8.2;P=.004).在HCD阶段,45人患有MS,临床医生,和其他专家参与了设计和改进。最后一轮测试包括20名MS患者和10名临床医生,其中5名与我们的卫生系统无关。最喜欢和可用性的评分目标,包括感知的易用性和感知的有效性,遇见了。患者的净启动子量表为50,临床医生为40。
结论:由广泛的利益相关者反馈创建,MSCATCH是一个闭环系统,旨在增加MS患者与其临床医生之间关于抑郁症的交流,并最终改善抑郁症护理。试点调查结果显示了加强沟通的证据。利益相关者还就国防部资助的为期一年的可行性和有效性试验的试验设计特征提供建议,现在正在进行中。
背景:ClinicalTrials.govNCT05865405;http://tinyurl.com/4zkvru9x。
BACKGROUND: People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated.
OBJECTIVE: This
study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this
study involved a proof-of-concept pilot randomized controlled
trial (RCT) validation phase and a detailed human-centered design (HCD) phase.
METHODS: During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts.
RESULTS: MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians.
CONCLUSIONS: Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on
trial design features of a full year long Department of Defense-funded feasibility and efficacy
trial, which is now underway.
BACKGROUND: ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x.