ABSTRACT
OBJECTIVE: Deficiencies in Australia's mental health systems persist despite over a decade of mental health reform. Recent developments in e-health provide the opportunity to facilitate health reform and improve services. This paper presents preliminary findings from the implementation of a comprehensive e-health system, called RecoveryRoad, which was designed to augment the routine clinical treatment of depression. METHODS: Depressed patients (n = 144) were referred to RecoveryRoad from a public hospital and public and private clinics in Perth, Western Australia. Online features included secure e-consultations, progress monitoring questionnaires, psychoeducation and evidence-based therapy. Treating clinicians had online access to patients' progress monitoring outcomes and e-consultations. There were two types of adherence reminders: automated email reminders and personalized case management delivered by email and telephone. RESULTS: Adherence to the system was high (from 53% to 84%, depending on the modality of reminder), and self-reported medication adherence was over 90%. Average depression severity declined from severe to mild by the eighth session, a large effect (d = 1.0). Both clinicians and patients were generally satisfied with the programme and reported that it improved clinician-patient relationships. Clinicians also reported that it helped patients to better manage depression. CONCLUSIONS: Preliminary findings support the feasibility of comprehensive e-health systems in enhancing the delivery of mental health care.
Subject(s)
Depressive Disorder, Major/therapy , Internet/instrumentation , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Humans , Patient Compliance/statistics & numerical data , Referral and Consultation , Time Factors , Treatment OutcomeABSTRACT
Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.
