Portal-based population health screening appears effective for depression

Patients who received emails inviting them to complete an online screener via a patient portal were more likely to be screened for depression and had a higher rate of positive screens than those who received usual care, a single-center study found.

Using a population health screening approach via patient portals may be effective at identifying depression, a recent study found.

Researchers conducted a pragmatic clinical trial to compare the effectiveness of screening with a population health approach versus screening at appointments alone for detecting depression. Eligible adults at an outpatient internal medicine clinic at an urban academic tertiary care center were included if they had active portal accounts and were due for depression screening.

Those assigned to usual care were screened by medical assistants during clinic appointments, while those assigned to population health received email notifications to log in to their portal accounts and fill out an online screener. Invitations were sent every four to eight weeks until the screener was completed or until up to six invitations had been sent. Those in the population health arm could also be screened at clinic visits. Both clinic and portal-based screening used the Computerized Adaptive Test for Mental Health (CAT-MH). The rate of depression screening was the primary outcome. Results were published Sept. 20 by the Journal of General Internal Medicine.

Overall, 2,713 patients were included in the study, 1,372 randomly assigned to the usual care arm and 1,341 to the population health arm. Mean age was 55 years, 58% were women, and 47% were African American. The population health arm had higher depression screening rates and a higher rate of positive screens than the usual care arm (43% vs. 33% [P<0.0001] and 10% vs. 4% [P<0.001], respectively). Of the 578 patients screened in the population health arm, 58% were screened in the clinic and 42% were screened via the portal. Eight percent of patients in the population health arm and 3% of those in the usual care arm screened positive for moderate to severe depression symptoms. Twenty-four percent of those in the population health arm scheduled a primary care visit within two weeks of receiving a portal message regardless of whether they completed the online screener. Rates of telephone encounters and referrals to psychiatry/psychology were higher in the population health group (48% vs. 44% [P=0.04] and 4% vs. 3% [P=0.01], respectively).

The authors noted that their trial involved only one clinic and that portal engagement, clinician buy-in, and availability of integrated health care services were high, among other limitations. They concluded that a population health-based screening strategy using a patient portal yielded a higher screening rate for depression and better identification of moderate to severe symptoms than visit-based screening. “This evidence suggests incorporating population health approaches with quality measure recommendations may improve depression case identification in primary care,” they wrote. “Future directions include testing this strategy in other primary care settings with high prevalence of depression. Findings suggest depression screening via a portal as part of a population health approach can increase screening and case identification, compared to usual care.”

In related news, the U.S. Preventive Services Task Force issued a draft recommendation on Sept. 20 recommending screening for anxiety in adults ages 64 years and younger. The draft is open for public comment until Oct. 17.