Date of Completion

7-2024

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Joanne Roman Jones, JD, PhD, RN

Site Advisor

Pedro Bonilla, MD

Second Reader

Elizabeth Mulcahy, DNP, FNP-C

Abstract

Background: Major Depressive Disorder (MDD) is extremely common and is difficult to treat. Evidenced-based interventions, promising medications, and care provided by experienced clinicians can be ineffective when patients disengage from treatment. Within an outpatient behavioral health program, low engagement in treatment among adult patients diagnosed with MDD negatively affects patient outcomes while contributing to provider burden. The most promising intervention to increase patient engagement based on evidence and needs of the local site is utilizing digital health technologies (DHTs), such as an online or smart-phone application.

Methods: Telehealth treatment augmented with digital health technologies among adult patients diagnosed with MDD was implemented in an outpatient behavioral health program to increase patient engagement in behavioral health treatment, in order to improve patient outcomes and reduce provider burden.

Intervention: DHTs were used to augment existing telehealth treatment to increase patient engagement for patients who met eligibility, based upon the DHT Guideline Algorithm. Providers and patients collaboratively selected a DHT application. Providers and patients were surveyed to assess feasibility, value added, and engagement with use of DHTs.

Results: A total of fifty-three patients screened eligible to participate in the project. Forty-seven percent of eligible patients (n=25) augmented telehealth treatment with DHTs. All of these patients remained engaged in treatment. The program disengagement rate reduced from pre to post implementation for both clinicians and prescribers. Patient Health Questionare-9 (PHQ-9) scores reduced by thirty-three percent and Generalized Anxiety Disorder-7 (GAD-7) scores reduced by forty-five percent. The patient satisfaction survey showed a majority of patients found DHTs to be feasible to use (n=15), adding value to their treatment (n=12), and enjoyable to use (n=14). The provider satisfaction survey showed that sixty percent of providers (n=3) found that DHTs added value to treatment and improved patient outcomes.

Conclusions: Implementation of telehealth treatment augmented with DHTs among adult patients diagnosed with MDD receiving care from an outpatient behavioral health program was effective in increasing patient engagement in treatment for the project site, while also showing improvement in patients’ symptoms. Future work should explore provider training to increase confidence and competence with incorporating DHTs into practice.

Download

Share

COinS