Evolution of Telehealth in Ambulatory Psychiatry: A One Year Perspective

Under the direction of the leadership at our medical center, beginning March 16, 2020, all non-urgent in-person ambulatory visits were to be limited, either rescheduled or performed virtually, as the hospital braced for the surge of COVID-19 patients. The outpatient psychiatry department quickly transitioned to a telehealth model. This paper details our actions taken to implement this plan, reflections on our experience one year later, and areas for future study. On the one-year anniversary of our department implementing remote care practices around COVID-19, we reflect on lessons learned in the transition and maintenance phases of the last 12 months. Reflecting on next steps as a face-to-face care becomes more possible, we share three core factors in our decision making and research opportunities to better quantify the impact of telehealth in 2021 and beyond.

Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder

BACKGROUND

Accurate reporting of patient symptoms is critical for diagnosis and therapeutic monitoring in psychiatry. Smartphones offer an accessible, low-cost means to collect patient symptoms in real time and aid in care.

OBJECTIVE

To investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores.

METHODS

A total of 13 patients with major depressive disorder, referred by their clinicians, received standard outpatient treatment and, in addition, utilized their personal smartphones to run the study app to monitor their symptoms. Subjects downloaded and used the Mindful Moods app on their personal smartphone to complete up to three survey sessions per day, during which a randomized subset of PHQ-9 symptoms of major depressive disorder were assessed on a Likert scale. The study lasted 29 or 30 days without additional follow-up. Outcome measures included adherence, measured by the percentage of completed survey sessions, and estimates of daily PHQ-9 scores collected from the smartphone app, as well as from the traditionally administered PHQ-9.

RESULTS

Overall adherence was 77.78% (903/1161) and varied with time of day. PHQ-9 estimates collected from the app strongly correlated (r=.84) with traditionally administered PHQ-9 scores, but app-collected scores were 3.02 (SD 2.25) points higher on average. More subjects reported suicidal ideation using the app than they did on the traditionally administered PHQ-9.

CONCLUSIONS

Patients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence. These app-collected results correlate with the traditionally administered PHQ-9. Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9.

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