Patient-Centered Technological Assessment and Monitoring to Support Clinical Social Workers in Managing Depression Care

Background and Purpose: The landmark Affordable Care Act (ACA) and the certification of patient-centered medical home (PCMH) models, coupled with strong clinical evidence to include mental health within general health care, bring unprecedented political will among healthcare systems to increase psychosocial interventions in primary care. This emerging change offers opportunities to enhance social worker's participation in primacy care services to provide psychosocial care management. In light of the rapid rise in health intervention technologies, our most recent large trial with safety-net diabetes patients tested both patient-focused mental health automated symptom monitoring calls and facilitating primary care team communication technology.

Methods: The technology is an automatic telephonic assessment system (ATA) that is amalgamated with a disease management registry (DMR) to facilitate collaborative team care in safety-net clinics for low-income diabetes patients. In the collaborative care team, social workers work with primary care physicians, nurse practitioners and nurse care managers and are primarily responsible for psychosocial care. The technology uses a patient-centered ATA to assess diabetes patients’ depression symptoms, treatment adherence, self-care behaviors, and the need for a patient-provider communication. ATA is linked with clinic DMR to generate a tailored assessment based on the patient’s conditions and preferences; and, when patient’s needs are identified, to trigger tasks to prompt team-based providers to initiate timely follow-up. The technology was tested in a quasi-experimental trial with 442 patients in diabetes care management program (TC group), and compared to 484 patients in usual care (UC group) and 480 patients in care-management supported care (SC group). Cost analysis, generalized linear and logistic regression analyses with study group propensity score adjustment were conducted to compare group effectiveness on patient outcomes, controlling for care team, baseline, and patient characteristics.

Results: The average cost to complete an assessment and identify a patient in need of depression care was about $1 for ATA vs. $35 if performed by a nurse care manager. Compared to UC, at 6 months both TC and SC had significantly lower depression PHQ-9 scores and likelihood of a major depression, greater remission, and decreased disability. TC patients were more likely to have regular A1C tests and lower cholesterol levels. TC also demonstrated improved satisfaction with care. There were no significant differences across groups in A1C values, or patients’ exercise levels, body mass indices, and overall diabetes self-care. At 18 months, propensity score adjusted regression results for cost, disability days, and mental and physical health (SF-12) difference from baseline are favorable for TC.

Conclusions and Implications: ATA effectively complements collaborative team depression care and offers a means to efficiently target individuals for additional professional help. The system may foster the clinicians’ ability to provide more compassionate care and adopt population health management, and thus improve patient outcomes and reduce disparities. Social workers provided psychosocial care and benefited from technology activated patient and cross-provider team communication. Therefore this paper underscores both need and opportunity for social workers to adopt both patient-centered socio-culturally adapted psychosocial care and health technology.