Real-World Implementation and Evaluation of a Digitally Enabled Care Pathway to Improve Depression Management in Primary Care: Controlled Pre-Post Analysis of the Pathway Platform.

backgroundMeasurement-based care (MBC) and shared decision-making can improve clinical outcomes for patients with major depressive disorder (MDD) in primary care. However, primary care providers often have limited time to administer patient-reported outcome measures recommended for MBC. Digital health tools like the Pathway Platform can help facilitate MBC and patient-provider engagement, aiding enhanced shared decision-making.

objectiveThis study aimed to assess whether implementation of the Pathway Platform improves adherence to MBC practices in primary care clinics compared with standard care. Secondary objectives included whether implementation of Pathway Platform improves additional clinical process measures and MDD remission and response.

methodsThis real-world, longitudinal implementation study screened participants aged ≥18 years with MDD who started an antidepressant or switched within 3 months in primary care clinics in Illinois. Data were collected 6 months retrospectively (from the preimplementation period) using electronic health records and manual chart reviews (control cohort), and 6 months prospectively (postimplementation, conducted 2021 to 2023) using electronic health records, manual chart reviews, and the Pathway Platform mobile app (Pathway cohort). The primary outcome was the proportion of participants with ≥2 completed 9-Item Patient Health Questionnaires (PHQ-9) at 6 months. Secondary outcomes included health care resource usage, patient-provider engagement (13-Item Patient Activation Measure [PAM-13]), and overall functioning (Work and Social Adjustment Scale [WSAS]). Exploratory outcomes included cognitive functioning (5-Item Perceived Deficits Questionnaire-Depression [PDQ-D-5]) and MDD symptom improvement.

resultsThe control cohort had 90 participants (58% female), and the Pathway cohort had 89 (80% female). A significantly higher proportion of Pathway cohort participants completed ≥2 PHQ-9s than control cohort participants (19%, n=17 vs 12%, n=11; P=.01). All Pathway cohort participants completed ≥1 PHQ-9 assessment, and 45% (n=40) of participants opened the app at least once per week. Pathway participants were significantly less likely than controls to have behavioral health referrals (9%, n=8 vs 23%, n=21; P=.01). Patient-provider engagement assessed using PAM-13 showed significant improvement from baseline to 6 months among Pathway participants (n=54; median change from baseline 4, Q1 0 to Q3 9.2], 95% CI 0-4.9; P<.001). Median change from baseline to last available scores for WSAS (-4.0, Q1 -9 to Q3 1; P<.001) and PDQ-D-5 (-2, Q1 -6 to Q3 0; P<.001) showed improvement among patients in the Pathway cohort. Median PHQ-9 total score at 6 months was significantly lower in the Pathway cohort than the control cohort (6.5, Q1 3.0 to Q3 12.5 vs median 17.0, Q1 14.5 to Q3 20.0; P=.02), indicating improvement in MDD symptoms.

conclusionsThe Pathway Platform significantly improved PHQ-9 completion rates, patient-provider engagement (improved PAM-13 scores), and clinical outcomes for MDD, with fewer behavioral health referrals. These findings suggest that use of the Pathway Platform supports improved MBC, offering a promising tool to improve MDD outcomes in primary care settings.

trial registrationClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43788.