title: MedLink: A Mobile Intervention to Address Failure Points in the Treatment of Depression in General Medicine.
abstract: Major depression is common, and imposes a high burden in terms of cost, morbidity, and suffering. Most people with depression are treated in general medicine using antidepressant medication. Outcomes are poor due to failure points across the care system, including patient non-adherence, failure of physicians to optimize the treatment regimens, and lack of patient-physician communication. This study reports on the 4-week pilot deployment of MedLink, a mobile intervention aimed at systemically addressing each of these failure points. A mobile app provides the patient with information and collects data on symptoms and side-effects. A cellularly enabled pill bottle monitors medication adherence. Data from these are provided to the physician and patient to foster communication and medication adjustments. Usability evaluation was generally favorable. Medication adherence rates in this first deployment were high with no patients discontinuing, and 84% of doses taken. Depressive symptom severity was significantly reduced. This study supports the use of a comprehensive, systemic approach to mHealth solutions to enhance processes of care for depression by general medicine physicians.
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Stiles-Shields
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brenner
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Palac
authors.affiliation: Division of General Internal Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Enid
authors.initials: E
authors.lastname: Montague
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kaiser
authors.affiliation: Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Carty-Fickes
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Duffecy
keywords: adherence; mHealth; mental health