Integrating Patient-Reported Outcomes and Electronic Health Record Data to Improve Clinical Decision Support for Depression Treatment

Depression is a common and burdensome health condition with many barriers to treatment, even though effective treatment options exist. A recent study of electronic prescriptions found that 26 percent of new prescriptions for antidepressants were never filled. Non-adherence after initial fill was also high, with up to 68 percent of patients stopping their antidepressants within 3 months of initiation. Tolerability—the occurrence, severity, and burden of side effects—is known to be associated with decreased treatment adherence. Bothersome side effects may increase the risk of treatment discontinuation. Many clinicians may not be aware that their patient is experiencing side effects or has discontinued their medication. These barriers to effective pharmacologic treatment of depression represent an area for needed intervention, particularly in primary care practices where depression is likely to be diagnosed.

The EffectRx project developed, implemented, and assessed a scalable system of patient data collection and clinician feedback to improve depression care management among primary care practices. Providing clinicians with actionable point-of-care feedback reports that integrate electronic health record (EHR) data, medication fulfillment data, and patient-reported data can better inform patient-centered care for depression. The project team collaborated with the Electronic National Quality Improvement and Research Network (eNQUIRENet), a network of non-integrated primary care practices, to collect data.

The specific aims of the project were as follows:

• Enhance an existing clinician feedback report by integrating novel data collected electronically from patients between clinical visits with medication adherence and EHR data. 
• Pilot test the data collection and enhanced report in eight eNQUIRENet practices. 
• Assess the feasibility and utility of the patient data collection and enhanced clinician feedback. 

The EffectRx team collected data on medication-related side effects, depression severity, medication adherence, and receipt of cognitive behavioral therapy from patients using an existing EHR system at the University of Colorado. Patient-specific data were provided to clinicians in automatically generated reports to use at the point of care. Though final data are not yet available, initial findings indicate that 65 percent of patients had filled their antidepressant at baseline. The most common side effects at baseline were agitation and headaches, as reported by 75 percent of patients. Frequency of side effects decreased over the study for most patients; among patients who completed more than one survey, 77 percent reached treatment response by the time they completed their last survey. Informal feedback from clinicians indicated they valued receiving information about their patients between clinic visits. Similar systems are scalable to practices with existing electronic patient-clinician information exchange systems and stand to be a less-burdensome method for monitoring depressed patients throughout their treatment.