Feasibility of Depression Care Management by E-Mail

Symptoms of depression, such as persistent sadness, problems sleeping, and inability to feel
pleasure, interfere with the daily lives of more than 20 million Americans. Previous
research indicates that telephone care management systems improve the quality and outcomes
of depression care, but are too expensive to be used widely. Using secure messaging over
e-mail would be more cost effective than telephone care. This study will examine whether a
secure messaging care management program would be feasible, based on whether participants
are willing to sign up for and continue with the program, and whether the program has a
positive effect on those participants enrolled in the program.

Potential participants for this study will be contacted via e-mail, with a follow-up
telephone call if they do not respond to the e-mail message. Only people who have used
e-mails in the past year and who are starting antidepressant treatment will be contacted.
The percentage of people contacted who enroll will be recorded.

Participation in this study will last 6 months. Participants will be randomly assigned to
receive either a secure messaging care management program, based on effective telephone
management programs, or their usual care with no intervention. Those receiving the secure
messaging program will receive an initial welcome message and monitoring messages
approximately 2, 6, and 10 weeks after treatment has begun. The monitoring messages will
include structured assessments of depression severity, medication adherence, medication side
effects, and barriers to continuing treatment. Participants who do not respond to monitoring
messages will receive up to two e-mailed reminders. Care managers will analyze the results
of monitoring messages, provide feedback and recommendations to physicians, coordinate
physician follow-ups, and facilitate emergency care or specialty referrals. Care managers
will also provide patients with motivation, based on semi-scripted protocols, and education
concerning their disorder and treatment. Measures of the success of the study will be taken
at enrollment and after 6 months of participation. Specific measurements will include the
response rate of recruitment e-mails, response rate for follow-up data collection,
proportion of those in the secure messaging program who complete the monitoring assessments,
effects of the program on antidepressant treatment, and effects of the program on patient
satisfaction.