OBJECTIVE: We have developed an information technology enabled management system for depression (ITEMS-D) in CMI to serve as a set of clinical decision support algorithms for use by nurse disease managers (DMs). ITEMS-D uses data from multiple information sources and creates alerts in real-time to allow DMs to intervene with patients to manage the psychological distress of living with CMI. ITEMS-D modules include monitoring of mood, social support, perceived stress, hopelessness and treatment compliance.
METHODS: We conducted focus groups and in-depth interviews of primary care physicians (PCPs), disease managers, and CMI patients for content, acceptability and ease of use of ITEMS-D that exists on a computerized assisted telephone interview platform. To facilitate implementation and adoption of ITEMS-D, we engaged users of the system in the design and development process.
RESULTS: The prototype was widely accepted by users. PCPs perceived ITEMS-D as a parallel and independent system of care and one in which alerts would only be sent to the PCP regarding issues previously unknown by the PCP. DMs felt that distress typically emerges when CMI is unattended or deteriorating, suggesting that longitudinal monitoring and tailored ITEMS-D assistance could improve care.
CONCLUSION: User input into the content and function of ITEMS-D are essential for successful implementation and dissemination of the system in community settings. The rationale behind the creation of ITEMS-D is to explore whether a health delivery system can employ interventions tailored to patients by which depression and other areas of patient concern arising in CMI can be improved.