E-monitoring System for Clinicians who Prescribe E-therapy for Depressed Adolescents: They Want It and They Don't
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Abstract
Background: We have developed an effective e-therapy for depressed adolescents, called SPARX. SPARX takes form of an innovative fantasy game that lets young people learn cognitive behavioural therapy skills in a virtual world and apply them in real settings. SPARX was designed as a self-help intervention but clinicians wanted to know how well their patients are progressing and/or if they are doing the program. We set out to design an e-monitoring system.
Objective: 1) to consult with clinicians and young people to determine ‘needs and wants’; 2) To design a electronic monitoring system allowing clinicians to ‘prescribe’ SPARX to their patients and monitor their mood, risk and adherence. 3) To pilot the system in a real clinical practice.
Method: We used qualitative methods (focus groups) to consult with stakeholders. Groups were audio-recorded, transcribed and analysed thematically. The pilot study was an open implementation trial with patients seeking help for low mood from a multidisciplinary youth help clinic.
Results: Feedback from the focus groups suggested clinicians wanted a simple and user-friendly system. Clinicians wanted key information presented visually and ‘push’ alerts based on certain triggers (e.g. significantly lower mood or high risk endorsed). General Practitioners wanted the system to be embedded into an electronic patient management system but this proved to be out of scope for this project. Young people trusted their clinicians with the information being sent to them. The results from the implementation trial showed that the clinicians did not use the e-monitoring system as actively as they or we expected. The dashboard (passive information) was used infrequently. Clinicians relied on email alerts before checking their patients’ progress. Some clinicians were concerned about their clinical responsibility when email alerts were received out of business hours and patients’ (false) perception that a clinician would be able to intervene immediately.
Conclusions: The clinicians in our study supports the use of self-help interventions for young people with mild to moderate depression. The e-monitoring interface has complexities of medico-legal issues, which require more thought before the system can be implemented clinically on a wider scale.
Objective: 1) to consult with clinicians and young people to determine ‘needs and wants’; 2) To design a electronic monitoring system allowing clinicians to ‘prescribe’ SPARX to their patients and monitor their mood, risk and adherence. 3) To pilot the system in a real clinical practice.
Method: We used qualitative methods (focus groups) to consult with stakeholders. Groups were audio-recorded, transcribed and analysed thematically. The pilot study was an open implementation trial with patients seeking help for low mood from a multidisciplinary youth help clinic.
Results: Feedback from the focus groups suggested clinicians wanted a simple and user-friendly system. Clinicians wanted key information presented visually and ‘push’ alerts based on certain triggers (e.g. significantly lower mood or high risk endorsed). General Practitioners wanted the system to be embedded into an electronic patient management system but this proved to be out of scope for this project. Young people trusted their clinicians with the information being sent to them. The results from the implementation trial showed that the clinicians did not use the e-monitoring system as actively as they or we expected. The dashboard (passive information) was used infrequently. Clinicians relied on email alerts before checking their patients’ progress. Some clinicians were concerned about their clinical responsibility when email alerts were received out of business hours and patients’ (false) perception that a clinician would be able to intervene immediately.
Conclusions: The clinicians in our study supports the use of self-help interventions for young people with mild to moderate depression. The e-monitoring interface has complexities of medico-legal issues, which require more thought before the system can be implemented clinically on a wider scale.
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