Abstract:
A method for patient bi-directional messaging to improve patient adherence to case management, is disclosed. The method extends the provider/patient communication beyond the provider premises. The method includes comparing source characteristics to target characteristics of both source and target patients, respectively thus updating questions posed to the target patients to promote a learning protocol. A PAR3 communication device communicates patient information from the provider to the patient and vice-versa. The bi-directional messaging system improves patient medication adherence, follow-up visits, hospitalization information, quality of life indicators, and a comprehension of educational content related to a particular medical condition.

Description:
FIELD OF THE INVENTION  
       [0001]     The present invention is generally related to a medical information management system and, more particularly, is related to a system and method for using bi-directional messaging to improve patient adherence to care management by extending provider/patient communication beyond provider premises.  
       BACKGROUND OF THE INVENTION  
       [0002]     Medication adherence tends to be problematic among patients. For example, Bipolar Disorder (BPD) is a persistent, severe, long-term illness with associated mortality and morbidity. The treatment of BPD requires prevention of recurrent mood episodes and control of symptoms. One study found that between one half and two thirds of patients may be non-adherent to medications within the first 12 months of treatment. Education and reminders may help improve those adherence outcomes.  
         [0003]     There are a number of electronic devices that assist with the administration of prescribed medication and monitor the medical treatment progress. Medication and medical monitoring devices such as those disclosed in U.S. Pat. Nos. 5,200,891 and 5,642,731 provide a number of functions for facilitating patient adherence to prescribed therapies, and for facilitating cross-correlation of compliance data and clinical information about the patient. Those devices rely on program schedules for providing audible and/or visual alert signals at the scheduled times for taking certain medications and indicate the specific compartment from which a particular medication is to be taken, and quantity to be taken. However, that prior art does not have a system for the mass customizing of patient protocols and regimens that is simple to use.  
         [0004]     Existing reminder programs provide a unique opportunity to reach patients treated with a specific medication however, there exist a number of limitations. Although refill reminder programs provide additional education on the disease state, it usually is secondary to refill reminders. Studies have demonstrated that in order to improve compliance, patient beliefs regarding their condition and the role of the medications have to change first. Therefore, it is just as important to educate patients about their condition as it is to remind them to refill their medications. Intervention is started shortly before refill is due and stopped if medication is not refilled within thirty days. That intervention method does not utilize the opportunity to educate the patient throughout the period of medication intake and after refills are missed. It might be argued that even if a reminder letter issued five days prior to calculated completion of the medication fill is effective in convincing a patient to take his/her medication regularly, it is not going to result in a timely refill. Further, patient communication is unidirectional. There is an inability to gather patient feedback that introduces a major flaw to the intervention process. In the existing reminder programs, cessation and refill activity is considered as failure, however, without patient input the behavior can be misinterpreted.  
         [0005]     Another important aspect of the invention is that it provides a feedback loop to the physician to optimize medication management. For example, based upon daily mood information aggregated from daily contact with patients, the treating physician is better able to titrate an optimal medication regimen. Likewise, if the patient does not seem to benefit from a treatment medication regimen and the provider learns that a patient is not adhering to the prescribed regimen, he/she may avoid changing the medication/dose inappropriately. Rather, the provider focuses his attention on better understanding the reason for the patient&#39;s non-adherence (side effects, beliefs about disease state, etc.) and dealing directly with that problem.  
         [0006]     Thus a heretofore, unaddressed need exists in the industry to address the aforementioned deficiencies and inadequacies.  
       SUMMARY OF THE INVENTION  
       [0007]     Embodiments of the present invention provide a system and method for providing bi-directional messaging initiatives to extend provider/patient communication beyond provider premises.  
         [0008]     Briefly described, in architecture, one embodiment of this system, among others, is implemented as follows. A method is disclosed that leverages the technology to complement care management extending the reach of providers to support care beyond provider office settings. An automated exchange is used to educate, remind, collect and aggregate patient self-reports to enhance and optimize patient treatment and medication management. Communication is established with patients with a goal of setting up actionable items in response. Evidence based medicine data is transmitted to the patient to improve the quality of the provider-patient interface. The method is customized/personalized and loaded with individual patient specific and condition specific data elements that drive the bi-directional messaging system.  
         [0009]     Feedback data from the patient updates the overall patient specific database and is communicated via a communication medium such as a personal data assistant (PDA), a land-line telephone, pagers, personal computers, Internet terminals, cellular telephones, and digital/cable television. In a preferred embodiment, a PAR3 messaging system, from PAR3 Communications, is used as the bi-directional messaging communications system.  
         [0010]     The PAR3 platform is a combination of telephony, Internet, and database technologies that delivers interactive alerts to customers in an automated, timely manner. The bi-directional messaging system ‘learns’ from the patient&#39;s responses and, via a patient specific algorithm, is highly specific to gaps in the patient&#39;s knowledge or deficit in his compliance with a care plan. The PAR3 system allows the patient to respond to questions through the telephone keypad and store the responses in a database. Information is delivered in “chunks” and the content of the information is assessed through the bi-directional discourse during the course of any particular contact and subsequent contacts. Information that is mastered is extinguished or repeated less frequently, and vice versa for information that is not been mastered, until mastery is achieved. Of significance is that communication to the patient is preference driven. Not only does the patient specify what days/times he wants to receive contacts, he also selects a primary, secondary and tertiary contact preference (first try cell phone; then try land-line telephone and finally leave a message via e-mail) or any permutation thereof.  
         [0011]     Although in the preferred embodiment, the PAR3 system is utilized, it is only one of the many commercially available platforms that may be employed as the interface platform to deliver bi-directional communications to the patient. Any communication platform that intrinsically includes updating to retrieved information, and learning from the retrieved information and re-structuring questions accordingly can be used.  
         [0012]      FIG. 1  illustrates a proposed layout of a bi-directional messaging system using a PAR3 system setup. The main interaction between this system and the patients is the 2-way messaging function provided by PAR3. This is an automated telephone bi-directional message system that provides information and asks questions of the patients. This system allows the patient to respond to the questions through the telephone keypad and stores the responses in a database. The software interacts with the PAR3 messaging system in two ways, uploading a comma-limited, uncompressed ASCII data file to control the messages (the Message Control file) and downloading a similarly-formatted file containing the results of a previous patient interaction (the Message Results file). Transfer of the data files occurs using SFTP with 128-bit encryption (or a comparably secure method). The PAR3 system acts as the SFTP server for this transaction.  
         [0013]     Message Control  
         [0014]     This software controls the delivery of information and questions from the automated telephone system via uploading a control file to a specific location. One control file is provided each day as an automated process. A unique identifier identifies each user. Unique item numbers identify blocks of information and questions. Logic is incorporated into the control file to identify branches based on responses to specific question.  
         [0015]     Message Results  
         [0016]     This software retrieves the results of the previous day&#39;s surveys via downloading a results file from a specific location. One results file is collected each day as an automated process. A clearly defined format identifies each user, identifies the question and provides the response.  
         [0017]     Claims Database Integration  
         [0018]     This software will query against the patient claims database(s) to gather information to incorporate into the patient data reports. Because of the potential complexity of the claims database(s), a project-specific “view” or set of summary tables will likely be added to the database to simplify query processing. 
        Hardware Requirements        
 
         [0020]     Hardware is needed to support the operation of this software. The following hardware is required:  
         [0021]     Server hardware for a Web server and a database server. 
        Internet connection—This includes the physical wiring as well as any firewall protection.     Power protection (recommended).     Dedicated printer     Dedicated fax machine or fax/modem.     Off-the-Shelf Software Requirements        
 
         [0027]     A software environment is needed to support the operation of this software. The following software is required: 
        Web server—IIS Windows2000 based Web server.     ASP client-server development environment.     Database—SQL Server 2000     HTTPS SSL security        
 
         [0032]     PAR3 needs secure FTP (SSL) for its host server  
         [0033]     Events that drive the bidirectional messaging are: 
    1) back end of an electronic medical record (ambulatory or hospital) or Continuity of Care Record;     2) back end of a disease or drug registry;     3) managed care organization pharmacy or medical claims systems;     4) state Medicaid or Medicare pharmacy or medical claims database;     5) disease/care management system;     6) pharmacy benefit management system;     7) retail pharmacy system;     8) pharmaceutical or clinical research organization systems for patients participating in clinical trials or for post market surveillance;     9) laboratory systems; and     10) home remote diagnostic/monitoring systems.    
 
         [0044]     In one embodiment, the bi-directional messaging system communicates with asthma patients.  
         [0045]     In another embodiment, the bi-directional messaging system communicates with diabetes patients.  
         [0046]     In another embodiment, the bi-directional messaging system communicates with patients suffering from depression.  
         [0047]     In another embodiment, the bi-directional messaging system communicates with bipolar patients.  
         [0048]     Other embodiments of the bi-directional messaging system are possible to encompass various disease conditions such as: hypertension; coronary artery disease; congestive heart failure, and chronic obstructive pulmonary disease. Heretofore, the list of embodiments is limited only by the number of disease conditions.  
         [0049]     Other systems, methods, features, and advantages of the present invention will be or become apparent to one with skill in the art upon examination of the following drawings and detailed description. It is intended that all such additional systems, methods, features, and advantages be included within this description, be within the scope of the present invention, and be protected by the accompanying claims. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0050]     Many aspects of the invention can be better understood with reference to the following drawings. The components in the drawings are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the present invention. Moreover, in the drawings, like-reference numerals designate corresponding parts throughout the several views:  
         [0051]      FIG. 1  is a flow diagram illustrating a general layout of a preferred embodiment of the invention with a PAR3 intelligent response platform;  
         [0052]      FIG. 2  is flow diagram of an embodiment of the invention for asthma patients;  
         [0053]      FIG. 3  is a flow diagram of an embodiment of the invention for bipolar patients;  
         [0054]      FIG. 3A  is a flow diagram of the suicide screen module in  FIG. 3 ;  
         [0055]      FIG. 3B  is a flow diagram of the education module in  FIG. 3 ;  
         [0056]      FIG. 3C  is a flow diagram of the medication adherence module in  FIG. 3 ;  
         [0057]      FIG. 3D  is a flow diagram of the mood rating module in  FIG. 3 ;  
         [0058]      FIG. 3E  is a flow diagram of the severity rating module in  FIG. 3 ;  
         [0059]      FIG. 3F  is a flow diagram of the sleep rating module in  FIG. 3 ;  
         [0060]      FIG. 4  is a flow diagram of an embodiment of the invention for diabetes patients; and  
         [0061]      FIG. 5  is a flow diagram of an embodiment of the invention for patients experiencing depression. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0062]      FIG. 1  illustrates a preferred method  100  for extending provider-patient communication beyond the office setting using a PAR3 intelligent response platform  108  for bi-directional messaging. A patient data storage database  102  that feeds into a target patient data source  104  is accessible via a website server  106 , the PAR3 intelligent response platform  108  and another device such as a fax server  116 . Information may be shared between a service provider and the patient via the different modes of communication. The patient data storage database  102  includes all of the patients that might be considered for a particular inquiry, and may be supplied by a provider, managed care organization, State Medicaid/Medicare databases, disease management company, clinical research organization, and hospital records. Depending upon a particular medical application, a second target patient data source  104  is created from the patient data storage database  102  from which actual messaging will be prompted. The target patient data source  104  may be accessed by a fax server  116 , a computer  110  via a website server  106  which may include e-mail capability, and the PAR3 intelligent response platform  108 . The PAR3 intelligent response platform  108  includes a cell phone  114 , a land-line telephone  112 , and other communication devices of similar character. The patient data storage database  102  may also include claims of numerous patients that have had some contact with a particular hospital environment.  
         [0000]     Asthma Patient  
         [0063]     An embodiment of the invention for pediatric asthma patients is herein described. This embodiment involves investigations of children with asthma-examined factors related to medication adherence, however, the embodiment can encompass adults wherein bi-directional communication is directly to the patient without an intervening caregiver.  
         [0064]     Asthma is the most common chronic childhood disease, with over a two-thirds increase in prevalence in the last twenty years. Asthma differentially affects racial and ethnic minorities living in inner cities. Assessments of children in inner-city settings estimate the prevalence of asthma to be two to three times the average US rate. Risk factors that may contribute to this disparity include race/ethnicity, socioeconomic status (SES), environment (indoor and outdoor), psychosocial factors, and inner-city health care delivery.  
         [0065]     Direct and indirect costs of asthma are high. With approximately 3 million individuals up to age 18 affected with asthma, 200,000 require hospitalization each year. In the early 1990&#39;s between $2 to $3.4 billion were attributed to the total cost of asthma in children under age 18. Medication non-adherence contributes to morbidity and mortality as well as to increased costs of treatment.  
         [0066]     Results indicate that many caregivers are concerned with side effects of medications (81.1% of caretakers who were adherent and 89.5% of caretakers who were non-adherent). Many respondents also indicate having doubts regarding the usefulness of medications (34.4% of those considered adherent and 54.2% who admitted non-adherence). The use of preventive medicines occurs in 23.5%. The embodiment suggests that underserved families may be at risk for non-adherence as a result of inaccurate perceptions about asthma and appropriate treatments.  
         [0067]     This embodiment is intended for communicating with caregivers of children with asthma. The intervention will consist of bi-directional messaging via cell phones. Messages provide educational information about asthma, assess condition status, and provide behavioral reminders related to treatment plan adherence.  
         [0068]     This embodiment optimizes treatment plan adherence in children with asthma by facilitating and reinforcing education and behavioral modification. Extending provider reach beyond emergency room encounters results in a paradigm shift in the treatment of pediatric asthma in an urban setting.  
         [0069]     The embodiment provides value to both the patient and the provider by acting as an extension of the physician-patient dialogue. Information is provided to the caregivers to help them manage their patient&#39;s asthma, and allow them to communicate back about their patient&#39;s condition. The active intervention consists of customized (patient-specific) bi-directional messaging via a cellular phone. Patient messages provide asthma self-management education, reinforcement, and reminders, as well as assess treatment plan adherence.  
         [0070]     The embodiment includes a prospective, randomized, between-groups analysis. Patients are randomly assigned to Messaged Group and Non-Messaged Group. The Non-Messaged Group is further divided into the Automated Group and the Manual Group.  
         [0000]     Patients:  
         [0071]     The following are preliminary enrollment criteria developed for patient enrollment: 
        Caregivers of children presenting with acute asthma exacerbation     Children of the following age range—1 to 11 years     Treatment with a controller medication or discharge with a prescription for an asthma controller (including inhaled corticosteriods, combination inhaled steroids, inhaled beta agonists, leukotriene inhibitors, and mast cell stabilizers)     English or Spanish as the primary language 
 
 Patient Enrollment: 
       
 
         [0076]     During enrollment, proper information is collected, including: study enrollment form, consent form, discharge sheet, and hospital chart cover sheet. Following patient enrollment, patients are assigned to one of three groups: 
        Messaged Group—active intervention group     Automated Control Group—control group     Manual Control Group—control group        
 
         [0080]     Upon discharge from a hospital, patients/caregivers are provided with a packet of documentation including copies of enrollment forms and materials, as well as educational materials related to the proposed treatment plan. A free cellular phone is distributed to the patient.  
         [0000]     Protocol Execution:  
         [0000]    
       
         
           
              Messaged Group patient intervention: 
            Following an initial registration survey, the Messaged Group receives three telephonic messages per week, to which they are asked to reply via the cell phone keypad. 
                Messaging provides education, reinforcements, and reminders with focus on medication adherence, trigger control, self-monitoring, follow-up visits, etc.     Messaging content is available in two languages: English and Spanish.     Messaging content is customized to patient&#39;s name, gender, age, asthma drugs (based on information captured during enrollment), and any self-reported information.     During bi-directional messaging, condition-specific information is collected directly from patients/caregivers.     Questioning the patients using the asthma bi-directional algorithm  202  ( FIG. 2 ).     During bidirectional messaging, patients are provided access to available community resources.    
                Monthly qualitative surveys are delivered to and completed by patients/caregivers through bi-directional messaging to assess condition status, treatment plan adherence, and quality of life.    
         
              Non-Messaged Automated Group: 
            Monthly qualitative surveys are delivered to and completed by patients/caregivers through bi-directional messaging to assess condition status, treatment plan adherence, and quality of life.    
         
              Non-Messaged Manual Group: 
            Monthly qualitative surveys are conducted with patients/caregivers by the Advanced Concepts interviewers to assess condition status, treatment plan adherence, and quality of life. 
 
 Ongoing Analytics and Reporting: 
   
         
           
         
       
     
         [0094]     Ongoing analytic analyses will be conducted. Summary information is provided to medical personnel in the format of ongoing periodic reports. Outcomes are assessed using: 
        Service (bi-directional messaging) utilization data     Self-reported data collected from patients     Spirometry assessments (when available for children ≧6 years old)        
 
         [0098]      FIG. 2  is a flow diagram of the bi-directional messaging algorithm  202  that is used for questioning the asthma patients. The bi-directional messaging algorithm  202  controls the sequence of questioning to the asthma patients and, based on the patient&#39;s responses, updates the questions asked to promote a more learned protocol.  
         [0099]     In the introduction/authentication module  204 , the asthma patient is asked criteria such as his name, address, phone number, gender etc. After the introduction/authentication module  204  authenticates the identity of the asthma patient, the assess asthma condition module  206  reviews the asthmatic condition of this target asthma patient. The review includes assimilating any feedback data that may have been received from the asthma patient from a previous contact or event. Based on the results from the review of the asthma patient&#39;s condition via the assess asthma condition module  206 , the asthma patient receives educational information through a series of questions regarding his specific/customized medical condition from the education module  208 .  
         [0100]     The education module  208  familiarizes the asthma patient with the specifics of his medical condition and how the prescribed medications affect the current medical condition. Such topics as sneezing, coughing, heavy breathing and shortness of breath are discussed in education module  208 .  
         [0101]     Once acquainted with his medical condition, the asthma patient receives reinforcement via the medication adherence module  210 . The asthma patient is queried on topics that reinforce the continued adherence to the medication regimentation as prescribed, and to take care of his asthma.  
         [0102]     As a reminder, the behavioral reminder module  212 , through a series of questions, reminds the asthma patient to refill his medications promptly and to keep an asthma diary. Further instructions are also given regarding questions to present to his medical provider at the next scheduled visit, the date of which is also reinforced.  
         [0103]     In conclusion, the conclusion module  214  summarizes the encounter with the asthma patient and reinforces that the asthma patient follow his provider&#39;s medical advice. The patient is also reminded that the observations from the asthma diary are to be brought to the follow-up office visit.  
         [0104]     An example of a bi-directional contact using the above-described asthma managing algorithm  202  with an asthma patient is described below.  
       EXAMPLE OF BI-DIRECTIONAL CALL EXERPT/PROTOCOL  
       [0000]     Previous Reinforcement:  
         [0105]     True or False: Due to the swelling, the airways in people with asthma are narrower than in healthy people 
        OPTION #1: IF FALSE—Actually, this statement is true. Asthma makes the sides of the airways in your child&#39;s lungs inflamed or swollen all the time. This swelling makes the airways narrower than healthy airways     OPTION #2: IF TRUE—Exactly! This statement is true. Asthma makes the sides of the airways in your child&#39;s lungs inflamed or swollen all the time. This swelling makes the airways narrower than healthy airways. 
 
 Education: 
       
 
         [0108]     When [CHILD&#39;S NAME] airways narrow or become smaller, any of the following signs and symptoms can appear: coughing; wheezing—which is a whistling sound made during breathing; feeling short of breath or easy winded; feeling tightness in the chest as if someone is squeezing or sitting on your chest; feeling tired; trouble breathing out; heavy breathing; waking up often in the middle of the night.  
         [0109]     It is important to know that [CHILD&#39;S NAME] asthma doesn&#39;t go away when [HIS/HER] symptoms go away. Remember that your child&#39;s airways can be swollen even when no signs or symptoms are present. That&#39;s why it&#39;s important to keep taking care of [HIS/HER] asthma.  
         [0000]     Reinforcement:  
         [0110]     True or False: If [CHILD&#39;S NAME] has no signs or symptoms of asthma, [HIS/HER] airways are not swollen 
        OPTION #1: IF FALSE—You are right! This statement is false. [CHILD&#39;S NAME] asthma doesn&#39;t go away when [HIS/HER] symptoms go away. Remember that [CHILD&#39;S NAME] airways can be swollen even when no signs or symptoms are present. That&#39;s why it&#39;s important to keep taking care of [HIS/HER] asthma.     OPTION #2: IF TRUE—Not exactly. This statement is false. [CHILD&#39;S NAME] asthma doesn&#39;t go away when [HIS/HER] symptoms go away. Remember that [CHILD&#39;S NAME] airways can be swollen even when no signs or symptoms are present. That&#39;s why it&#39;s important to keep taking care of [HIS/HER] asthma. 
 
 Reminders: 
       
 
         [0113]     According to our last call, you indicated that [CHILD&#39;S NAME] takes [RELIEVER] to relieve asthma symptoms or to manage attacks. Did you know that if [CHILD&#39;S NAME] uses [RELIEVER] more than 2 times a week OR if you refill it at the pharmacy more than 2 times a year, [CHILD&#39;S NAME] asthma may not be well controlled and adjustment in treatment may be required? Next time, monitor how frequently [HE/SHE] uses [RELIEVER].  
         [0114]     Remember to keep an asthma diary and bring it to your next appointment. This is a good way to tell if [CHILD&#39;S NAME] asthma is getting better or worse  
         [0115]     IF HAS ACTION PLAN—Be prepared for your appointment with [CHILD&#39;S NAME] primary care doctor. Here is what you can do:  
         [0116]     First, write down your home observations of [CHILD&#39;S NAME] asthma  
         [0117]     Second, bring to the visit your written observations along with [CHILD&#39;S NAME] medicines, and written action plan  
         [0118]     During the visit, ask questions to make sure you understand your doctor&#39;s instructions. Tell your doctor if you or your child may have hard time following his or her directions. Be honest your doctor is there to help  
         [0119]     Lastly, don&#39;t forget to write down your doctor&#39;s instructions before leaving the office  
         [0120]     IF HAS NO ACTION PLAN—Be prepared for your appointment with [CHILD&#39;S NAME] primary care doctor. Here is what you can do:  
         [0121]     First, write down your home observations of [CHILD&#39;S NAME] asthma  
         [0122]     Second, bring to the visit your written observations along with [CHILD&#39;S NAME] medicines. Also, since you indicated in our last survey that you don&#39;t have an action plan for [CHILD&#39;S NAME], don&#39;t forget to ask your doctor about getting one  
         [0123]     During the visit, ask questions to make sure you understand your doctor&#39;s instructions. Tell your doctor if you or your child may have hard time following his or her directions. Be honest your doctor is there to help  
         [0124]     Lastly, don&#39;t forget to write down your doctor&#39;s instructions before leaving the office.  
         [0000]     Bipolar Patient  
         [0125]     An embodiment of the invention for bipolar patients is herein described.  
         [0126]     Bipolar disorder (BPD) is a persistent, severe, long-term illness with associated mortality and morbidity. The treatment of BPD requires the prevention of recurrent mood episodes and the control of symptoms. Medication adherence tends to be problematic among patients with bipolar disorder. One study found that between one half and two thirds of patients become non-adherent to medications within the first 12 months of treatment. Education and reminders are designed to help improve those adherence outcomes.  
         [0127]     Methods for psychiatrists to collect long-term monitoring information from patients regarding medication use, mood status, social functioning, sleep duration, and other relevant status indicators are available. Those types of charts are relatively easy for patients to complete, but the workload on the clinician is very heavy. In order for information to be useful to clinicians, it must be represented graphically over time, which is a costly and time-consuming process. One study estimated the data costs for one patient using the Life Chart Method (LCM) at $5,000 per year. Automating this process could assist clinicians in monitoring their patients&#39; status and making any necessary adjustments in treatment regimens without delay.  
         [0128]     In this embodiment, what is disclosed is a treatment plan for adherence and monitoring in patients with BPD by facilitating communication between a patient and his psychiatrist. Collecting and disseminating the patient information to providers results in a paradigm shift in the treatment of BPD.  
         [0129]     The embodiment provides value to both the patient and the psychiatrist by acting as an extension of the physician-patient dialogue. Information is provided to the patient to help him manage his bipolar disorder, and allow him to communicate back about his condition. The active intervention consists of customized (patient-specific) bi-directional messaging via the modality of choice for each patient (i.e., landline, cellular/SMS, email/web, wireless devices, etc.). Patient messages assess the condition status by collecting mood chart information and provide basic education related to treatment plan adherence.  
         [0130]     To assist psychiatrists in managing their patients, patient self reports are sent back to psychiatrists to facilitate long-term monitoring.  
         [0131]     Patients are randomly assigned to Messaged Group and Non-Messaged Group. 
    Patient enrollment criteria: 
        age ≧18 years     Diagnosis of Bipolar Disorder     Give consent to receive their respective pharmacy claims data     Treated with pharmacotherapy for BPD 
 
 Program Execution: 
   
       
 
         [0137]     The program execution embraces the following components: 
        Patient enrollment and randomization     Protocol execution     Ongoing analytics and reporting 
 
 Patient Enrollment: 
       
 
         [0141]     Each psychiatrist enrolls eligible patients during the period immediately following psychiatrist recruitment. In subsequent phases, patients are offered the opportunity to enroll a family member or a friend as an option. During enrollment at the psychiatrist office, information is collected from patients, including: consent to participate, insurance information, and authorization to access patient claims data, demographics, contacts, and baseline mood chart information (diagnoses, comorbidities, medication dosages, and daily regimens). Patients are provided with a packet of documentation including copies of enrollment forms and materials explaining the treatment program. Following patient enrollment, psychiatrists submit enrollment information, and the patients are randomly assigned to one of two groups: 
    Messaged Group—active intervention group     Non-Messaged Group—control intervention group 
 
 Protocol Execution: 
    Messaged Group patient intervention: 
        Patients receive bi-directional messages, via their preferred modality (phone, cell phone, or email) 7 times a week 
            Mood charts are adapted for use in the messaging modality selected by the patient    
            Mood chart information is collected automatically during the course of bi-directional messaging     Periodic qualitative surveys are delivered to and completed by patients through bi-directional messaging (every 1-3 months)     Patients are able to requests copies of their mood chart reports by mail, fax, or web according to preference    
        Non-Messaged Group patient intervention: 
        Patients receive mood charts, accompanying manual, and educational content via mail periodically (every 1-3 months)     Patients are asked to complete mood charts and bring them to the psychiatrist for subsequent visits     Periodic qualitative surveys are mailed to the patients along with the mood charts by mail. Patients are asked to complete paper surveys and return them by mail.    
        Psychiatrist intervention 
        Psychiatrists receive the following periodic reports sent according to the method of preference selected: 
            Bi-weekly Activity Reports—provide patient activity status as it relates to group assignment, medication regimen on file, and two-week activity with bi-directional messaging for Messaged Group or activity with submitting mood charts and surveys for Non-Messaged Group. These reports will serve as the mechanism to alert or remind psychiatrists about patients&#39; inactivity and as a prompt for updating patient information     Monthly Chart Reports—will provide patient mood chart data for each patient enrolled in Messaged Group only     Priority Update Reports—will be generated based on mood chart information or patient reports of medication change from Messaged Group only.    
            Psychiatrists are able to, on demand (via secure website, mail or fax), view their patient&#39;s mood chart reports, medication adherence feedback, sleep patterns, etc. at any time during the patient evaluation.     Periodically psychiatrists and patients are asked to complete surveys related to their bi-directional intervention. 
 
 Ongoing L Analytics and Reporting: 
   
       
 
         [0161]     Throughout the execution period, ongoing analytic analyses are conducted. Summary information is provided in the format of ongoing periodic reports. Outcomes are assessed using pharmacy claims data and self-reported data collected from the patients. Qualitative information collected through surveys is assessed.  
         [0000]     Final Analytics and Reporting:  
         [0000]    
       
         
           
              Quantitative Assessment: 
            Compare treatment plan adherence in Messaged and Non-messaged Groups utilizing self-reports and pharmacy claims (when available)    
         
              Qualitative assessment: 
            Psychiatrists—expectations, perceived value, and experiences     Patients—expectations, perceived value, and experiences    
         
           
         
       
     
         [0167]      FIG. 3  is a flow diagram of one embodiment of the bi-directional messaging algorithm  302  that might be used for questioning the bipolar patients. The bi-directional messaging algorithm  302  controls the sequence of questioning to the bipolar patients and, based on the patient&#39;s responses, updates the questions asked to promote a more learned protocol. Table X lists a sample source code that may be used for the flow diagram depicted in  FIG. 3 .  
         [0168]     In the introduction/authentication module  304 , the bipolar patient&#39;s identity and demographic information is assimilated. After the introduction/authentication module  304  authenticates the identity of the bipolar patient, the suicide screen module  306  queries the bipolar patient on suicide topics.  FIG. 3A  illustrates a flow diagram of the suicide screen module  306 . Table I lists sample questions that are asked in the suicide screen module  306 . In the suicide screen module  306 , the suicide screen sub-module  307  queries the patient on the degree of his ‘feelings’. Based on a positive response, the suicide-yes sub-module  309  directs the patient to contact professional help.  
         [0169]      FIG. 3B  illustrates the education module  308  and highlights three optional questions that may be posed to the bipolar patient. Table II lists those three sample questions that are asked in the education module  308  along with the rationale for asking. In the education module  308 , the education introduction sub-module  311  presents the three optional questions referenced above. The education option 1 sub-module  313 , the education option 2 sub-module  315 , and the education option 3 sub-module  317  pose questions to the patient to test the educational level of the patient&#39;s awareness of his medical condition. Based on his response to the education option 3 sub-module  317 , the patient is questioned on the medication regimen related to Lithium in the Lithium check sub-module  319 .  
         [0170]      FIG. 3C  illustrates the medication adherence module  310  and shows sample queries regarding medications and dosages. Table III further discloses the sample questions posed in the medication adherence module  310 . Table III also lists areas of concern that arise with the current questions posed in the medication adherence module  310 . In the medication adherence module  310 , the patient&#39;s name is verified in the medical name check sub-module  321 . The patient is then asked whether he has missed any medication doses in sub-module  323 , and whether there are any discrepancies in the number of pills taken, via sub-module  325 . Based on the patient&#39;s response to sub-module  323 , the number of pills missed is ascertained in sub-module  333  and, via sub-module  327 , the patient is further queried as to whether there is a medication dose change. Based on the patient&#39;s response to sub-module  327 , an overdose or under-dose is determined with the latter forwarded to sub-module  329  to determine the reason for the under-dose. Sub-module  329  asks the patient whether the under-dose is due to problems in medications such as zero medications remaining and stores the response in sub-module  331 .  
         [0171]      FIG. 3D  illustrates the mood rating module  312  which requests the bipolar patient to rate his general mood on a graduated scale of 0-100. Table IV lists the questions that are asked in the mood rating module  312  with regard to the mood rating. In the mood rating module  312 , the patient is told his last mood rating via sub-module  335 . The current mood questioning is initiated by sub-module  337  and is forwarded to two different paths depending on the response. If the response to sub-module  337  is ‘yes’, the patient is forwarded to sub-module  339  that gives samples of mood ratings and requests the patient to rate his mood via sub-module  341 . Sub-module  341  continues the questioning by requesting the patient to delineate the number of cycles of his mood and storing the response in sub-module  343 . If the response to sub-module  337  is ‘no’, sub-module  345  requests the patient to rate his mood, but only in a general way. Mood examples are also given to assist the patient in the rating via sub-module  347 .  
         [0172]      FIG. 3E  further illustrates the mood ratings illustrated in  FIG. 3D  and highlights the questions posed to the bipolar patient to rank the severity of his mood via the mood severity module  314 . Table V, lists the questions that are presented in the mood severity module  314 . In the mood severity module  314 , the patient&#39;s last severity rating is reviewed via sub-module  349 . The patient&#39;s current questioning as to his mood severity rating is split into two paths. If the ‘yes’ path of questioning is taken, the patient is requested to rate the severity of the highest to the lowest mood via sub-module  355 . Severity mood examples are given in sub-module  353 . The extreme ratings obtained from sub-module  355  are highlighted for further investigation in sub-module  357 . If the response to mood severity in sub-module  351  is ‘no’, then the rate severity sub-module  359  requires less extensive ratings of the mood severity. Sample severity ratings are presented in sub-module  363  to assist in the ratings. The extreme ratings are flagged in sub-module  361 .  
         [0173]      FIG. 3F  illustrates the sleep rating module  316  that queries the bipolar patient on the number of hours of sleep he receives. Table VI lists the sample questions posed to the bipolar patient via the sleep module  316 . In the sleep module  316 , the patient&#39;s prior sleep results are reviewed by sub-module  365 . In sub-module  367 , the patient is then asked for the number of hours of sleep he received last night.  
         [0174]     The conclusion module  318  thanks the bipolar patient for his participation and assistance in managing the short and long-term treatment of his medical condition.  
         [0175]     An example of the bi-directional contact related to mood charting is as follows. The questions presented relate to  FIGS. 3D-3F  and the sequence that is followed for investigating the patient&#39;s mood and severity of the mood.  
       EXAMPLE OF BI-DIRECTIONAL CALL EXERPT/PROTOCOL RELATED TO MOOD CHARTING  
       [0000]     Medications:  
         [0176]     Your LAMICTAL regimen is set at [one 200-mg tablet] per day. How many tablets of LAMICTAL did you take yesterday? 
         [0177]     Your LITHIUM regimen is set at [three 300-mg tablets] per day. How many tablets of [LITHIUM] did you take yesterday? 
         [0178]     Your [SYNTHROID] regimen is set at [one 0.1 mg tablet] per day. How many tablets of [SYNTHROID] did you take yesterday? 
         [0000]     Sleep:  
         [0179]     Please estimate how many hours of sleep you had last night  
         [0000]     Mood Changes:  
         [0180]     Throughout the course of the previous day, did you experience any episodes of sudden, distinct, and significant mood changes—that is opposite of gradual mood changes: Keep in mind that sudden mood changes may occur within the same mood state or between depressive and manic states 
        Option 1 [IF YES]—Please indicate the number of sudden, distinct, and significant mood change episodes or mood switches that you experienced yesterday. A mood switch should be counted each time your mood suddenly changes from one level to another. Keep in mind that sudden mood changes may occur within the same mood state or between depressive and manic states.     Option 2 [IF NO]—Since you indicated that you had no episodes of sudden, distinct, and significant mood changes yesterday, would you describe your mood state yesterday as        
 
         [0183]     OPTION 2A—stable mood state defined as the state when you are not depressed or manic.  
         [0184]     OPTION 2B—unstable mood state that is gradually or slowly changing over the course of previous day.  
         [0000]     Mood Severity:  
         [0185]     OPTION 1[IF STABLE MOOD]—You just rated your mood state for the previous day as stable. In a stable state people typically do not experience changes in sleep, ebullience or exuberance, higher or lower than normal mood, energy, sociability. So, think about yesterday and let us know if you DID experience any of the features just mentioned or any functional impairment. 
        IF YES—it&#39;s possible that your mood changed so gradually over the course of yesterday and you did not notice it.     IF NO—NO ACTION        
 
         [0188]     OPTION 2 [IF GRADUAL MOOD CHANGE OR NOT STABLE MOOD]—You just rated your mood state for the previous day as gradually changing. Please think about the most severe or extreme point in your mood yesterday. Would you describe it as some state of depression or mania?
        OPTION 2A [IF MANIC]—Please indicate how your mood has affected your ability to function yesterday by selecting your most severe level of manic mood: 
            1. Severe mania—when you essentially feel incapacitated, require hospitalization or are hospitalized. IF REQUIRES MORE INFO—The state of severe mania is when you have very significant symptoms such as very decreased need for sleep or lack of sleep, significantly increased level of energy, you may feel all powerful or out of control, your thoughts and speech may be extremely rapid. And you get much insistence from your family, friends that you need medical attention, that your behavior is out of control, or they might take you to the hospital concerned that they and you cannot keep you safe any longer.     2. High moderate mania—when you may experience great difficulty with goal-oriented activity and may get much feedback about unusual behavior. [IF REQUIRES MORE INFO]—The state of high moderate mania is when you may have very significant symptoms such as very decreased need for sleep or lack of sleep, a much increased level of energy, you may feel all powerful or out of control, your thoughts and speech may be extremely rapid. In addition, you may get much feedback from your family, friends, or coworkers that your behavior is different or difficult, expressing great concern about your ability to look after yourself or others, while other people may appear angry or frustrated with your behavior.     3. Low moderate mania—when you may experience some difficulty with goal oriented activity and may get some feedback about unusual behavior. [IF REQUIRES MORE INFO]—The state of low moderate mania is when you may have some moderate symptoms such as decreased need for sleep, increased energy, some irritability or very elated mood, an increase in the rate of thought, speech or sociability. In addition, you may begin to be less productive and more unfocused and you may get some feedback from your family, friends, or coworkers that your behavior is different from your usual self.     4. Mild mania or hypomania—when you may feel more energized and productive with little or no functional impairment. [IF REQUIRES MORE INFO]—The state of mild mania is when you may experience mild symptoms such as decreased need for sleep, increased energy, some irritability or very elated mood, an increase in the rate of thought, speech or sociability. Unlike low moderate mania, at the state of mild mania there might be no negative impact and might even be initial enhancement of your ability to function. Also, please indicate if your mood state for the previous day fits the conditions for dysphoric hypomania or mania. These conditions are: increase in energy, activity, rate of thinking, and interactions, with anger and irritability in the context of decreased need for sleep. In this state of depressive, unhappy or dysphoric hypomania or mania your feeling of activation is accompanied by feelings of anxiety, irritability, and anger. Lack of sense of fatigue distinguishes this state from depression.    
            OPTION 2B [IF DEPRESSED]—Please indicate how your mood has affected your ability to function yesterday by selecting your most severe level of depressive mood: 
            1. Severe depression—when you essentially feel incapacitated and require hospitalization or are hospitalized. [IF REQUIRES MORE INFO]—The state of severe depression is when you are unable to function in any one of your usual social and occupational roles. For example, you may be unable to get out of bed, go to school or work, carry out any of your routine functions, require much extra care at home, or need to be hospitalized.     2. High moderate depression—when you may feel marked difficulty in usual routines and that great effort is needed. [IF REQUIRES MORE INFO]—The state of high moderate depression indicates that functioning is very difficult and requires great extra time or great extra effort with very marked difficulty in your usual routines. You basically feel that you could barely scrape by.     3. Low moderate depression—when you may feel that some extra effort is needed in usual roles. [IF REQUIRES MORE INFO]—The state of low moderate depression indicates that functioning in your usual roles is more difficult due to depressive mood symptoms and requires extra time or effort. You basically have to push yourself to get things done.     4. Mild depression—when you may experience low mood with little or no functional impairment. [IF REQUIRES MORE INFO]—The state of mild depression represents a subjective sense of distress, a low mood, some social isolation, but you continue to function with little or no functional impairment.    
               
 
         [0199]     OPTION 3 [IF SUDDEN/SIGNIFICANT MOOD CHANGE]—You just indicated yesterday you had [NUMBER OF EPISODES] episodes of mood changes. Did you experience these changes within the same mood state or between depressive and manic states [IF WITHIN THE SAME STATE]—would you categorize this mood state as depressed or manic?
        OPTION 3A [MANIC EPISODES]—Please indicate how your mood has affected your ability to function yesterday by selecting the highest and the lowest manic mood levels for the previous day: 
            1. Severe mania—when you essentially feel incapacitated and require hospitalization or are hospitalized. [IF REQUIRES MORE INFO]—The state of severe mania is when you have very significant symptoms such as very decreased need for sleep or lack of sleep, significantly increased level of energy, you may feel all powerful or out of control, your thoughts and speech may be extremely rapid. And you get much insistence from your family, friends that you need medical attention, that your behavior is out of control, or they might take you to the hospital concerned that they and you cannot keep you safe any longer.     2. High moderate mania—when you may experience great difficulty with oriented activity and may get much feedback about unusual behavior. [IF REQUIRES MORE INFO]—The state of high moderate mania is when you may have very significant symptoms such as very decreased need for sleep or lack of sleep, a much increased level of energy, you may feel all powerful or out of control, your thoughts and speech may be extremely rapid. In addition, you may get much feedback from your family, friends, or coworkers that your behavior is different or difficult, expressing great concern about your ability to look after yourself or others, while other people may appear angry or frustrated with your behavior.     3. Low moderate mania—when you may experience some difficulty with goal-oriented activity and may get some feedback about unusual behavior. [IF REQUIRES MORE INFO]—The state of low moderate mania is when you may have some moderate symptoms such as decreased need for sleep, increased energy, some irritability or very elated mood, an increase in the rate of thought, speech, or sociability. In addition, you may begin to be less productive and more unfocused and you may get some feedback from your family, friends, or coworkers that your behavior is different from your usual self.     4. Mild mania or hypomania—when you may feel more energized and productive with little or no functional impairment. [IF REQUIRES MORE INFO]—The state of mild mania is when you may experience mild symptoms such as decreased need for sleep, increased energy, some irritability or very elated mood, an increase in the rate of thought, speech, or sociability. Unlike low moderate mania, at the state of mild mania there might be no negative impact and might even be initial enhancement of your ability to function    
               
 
         [0205]     Also, please indicate if your mood state for the previous day fit the conditions for dysphoric hypomania or mania. These conditions are: increase in energy, activity, rate of thinking, and interactions, with anger and irritability in the context of decreased need for sleep. In this state of depressive, unhappy or dysphoric hypomania or mania your feeling of activation is accompanied by feelings of anxiety, irritability, and anger. Lack of sense of fatigue distinguishes this state from depression. 
        OPTION 3B [IF DEPRESSED EPISODES]—Please indicate how your mood has affected your ability to function yesterday by selecting the highest and the lowest depressed mood levels for the previous day:: 
            1. Severe depression—when you essentially feel incapacitated and require hospitalization or are hospitalized. [IF REQUIRES MORE INFO]—The state of severe depression is when you are unable to function in any one of your usual social and occupational roles. For example, you may be unable to get out of bed, go to school or work, carry out any of your routine functions, require much extra care at home, or need to be hospitalized.     2. High moderate depression—when you may feel marked difficult in usual routines and that great effort is needed. [IF REQUIRES MORE INFO]—The state of high moderate depression indicates that functioning is very difficult and requires great extra time or great extra effort with very marked difficulty in your usual routines. You basically feel that you could barely scrape by.     3. Low moderate depression—when you may feel that some extra effort is needed in usual roles. [IF REQUIRES MORE INFO]—The state of low moderate depression indicates that functioning in your usual roles is more difficult due to depressive mood symptoms and requires extra time or effort. You basically have to push yourself to get things done.    
               
 
         [0210]     4. Mild depression—when you may experience low mood with little or no functional impairment. [IF REQUIRES MORE INFO]—The state of mild depression represents a subjective sense of distress, a low mood, some social isolation, but you continue to function with little or no functional impairment. 
        OPTION 3C [IF DEPRESSED AND MANIC]—Please indicate how your mood has affected your ability to function yesterday by selecting the highest and the lowest mood levels for the previous day. Please select your highest mood level for yesterday: 
            1. Severe mania—when you essentially feel incapacitated and require hospitalization or are hospitalized. [IF REQUIRES MORE INFO]—The state of severe mania is when you have very significant symptoms such as very decreased need for sleep or lack of sleep, significantly increased level of energy, you may feel all powerful or out of control, your thoughts and speech may be extremely rapid. And you get much insistence from your family, friends that you need medical attention, that your behavior is out of control, or they might take you to the hospital concerned that they and you cannot keep you safe any longer.     2. High moderate mania—when you may experience great difficulty with goal-oriented activity and may get much feedback about unusual behavior. [IF REQUIRES MORE INFO]—The state of high moderate mania is when you may have very significant symptoms such as very decreased need for sleep or lack of sleep, a much increased level of energy, you may feel all powerful or out of control, your thoughts and speech may be extremely rapid. In addition, you may get much feedback from your family, friends, or coworkers that your behavior is different or difficult, expressing great concern about your ability to look after yourself or others, while other people may appear angry or frustrated with your behavior.     3. Low moderate mania—when you may experience some difficulty with goal-oriented activity and may get some feedback about unusual behavior. [IF REQUIRES MORE INFO]—The state of low moderate mania is when you may have some moderate symptoms such as decreased need for sleep, increased energy, some irritability or very elated mood, an increase in the rate of thought, speech or sociability. In addition, you may begin to be less productive and more unfocused and you may get some feedback from your family, friends, or coworkers that your behavior is different from your usual self.     4. Mild mania or hypomania—when you may feel more energized and productive with little or no functional impairment. [IF REQUIRES MORE INFO]—The state of mild mania is when you may experience mild symptoms such as decreased need for sleep, increased energy, some irritability or very elated mood, an increase in the rate of thought, speech, or sociability. Unlike low moderate mania, at the state of mild mania there might be no negative impact and might even be initial enhancement of your ability to function 
 
 Please select your lowest mood level for yesterday: 
   
            1. Severe depression—when you essentially feel incapacitated and require hospitalization or are hospitalized. [IF REQUIRES MORE INFO]—The state of severe depression is when you are unable to function in any one of your usual social and occupational roles. For example, you may be unable to get out of bed, go to school or work, carry out any of your routine functions, require much extra care at home, or need to be hospitalized.     2. High moderate depression—when you may feel marked difficulty in usual routines and that great effort is needed. [IF REQUIRES MORE INFO]—The state of high moderate depression indicates that functioning is very difficult and requires great extra time or great extra effort with very marked difficulty in your usual routines. You basically feel that you could barely scrape by.     3. Low moderate depression—when you may feel that some extra effort is needed in usual roles. [IF REQUIRES MORE INFO]—The state of low moderate depression indicates that functioning in your usual roles is more difficult due to depressive mood symptoms and requires extra time or effort. You basically have to push yourself to get things done.     4. Mild depression—when you may experience low mood with little or no functional impairment. [IF REQUIRES MORE INFO]—The state of mild depression represents a subjective sense of distress, a low mood, some social isolation, but you continue to function with little or no functional impairment.        
 
         [0220]     Also, please indicate if your mood state for the previous day fit the conditions for dysphoric hypomania or mania. These conditions are: increase in energy, activity, rate of thinking and interactions, with anger and irritability in the context of decreased need for sleep. In this state of depressive, unhappy or dysphoric hypomania or mania your feeling of activation is accompanied by feelings of anxiety, irritability, and anger. Lack of sense of fatigue distinguishes this state from depression.  
         [0000]     Overall Mood:  
         [0221]     Please rate your mood for the previous day and select a number between 0 and 100, with 0 indicating most depressed ever, 50 indicating balanced, and 100 indicating most manic ever. [IF SUDDEN/SIGNIFICANT MOOD CHANGE]—Since you reported having sudden, distinct mood switches yesterday, please rate the highest and lowest moods that you experienced yesterday.  
         [0000]     Comorbid Symptoms:  
         [0222]     Did you experience feelings of anxiety yesterday? 
         [0223]     Did you have panic attacks yesterday? [IF YES]—How many panic attacks did you experience yesterday? 
         [0224]     [QUESTIONS FOR CUSTOMIZED COMORBID SYMPTOMS] 
         [0000]     Menses:  
         [0225]     [IF FEMALE AND MENSTRUATING] Did you have your menstrual period yesterday? 
         [0226]     Tables VII and VIII depict a suggested event/data algorithm and associated definitions, respectively, for a bidirectional message events flow for bipolar patients.  
         [0227]     Table IX depicts a suggested database for use with bipolar patients as illustrated in  FIGS. 3A-3F .  
         [0000]     Diabetes Patient  
         [0228]     An embodiment of the invention for diabetes patients is herein described.  
         [0229]     Diabetes is the fifth leading cause of death by disease in the U.S., and is associated with increased morbidity and mortality. Patients with diabetes are at higher risk for chronic conditions such as heart disease, blindness, and kidney disease. Direct medical costs associated with diabetes are estimated at $92 billion in 2002.  
         [0230]     Although studies found strong association between diabetes treatment plan adherence and metabolic control, national adherence rates remain sub-optimal. Furthermore, non-adherence rates are higher among ethnic/racial minority and low socioeconomic status patients. Due to constraints currently facing primary care providers and state-sponsored health plans, provision of proper diabetes management care during outpatient visits is becoming increasingly difficult. This is especially relevant for Medicaid populations that are associated with limited access to care.  
         [0231]     The extension of provider-patient communications beyond the constraints of an encounter through automated means will enhance patient adherence to diabetes treatment plans and will assist providers in monitoring their patients. Several studies reported improved adherence associated with automated telephone interventions, including low-income patients with diabetes.  
         [0232]     In the age of increasing budget pressures, Medicaid administrators are evaluating various approaches for negotiating with pharmaceutical manufacturers. In an effort to control drug spending, states have taken various measures ranging from supplemental rebates to pharmaceutical sponsorship of value-added programs.  
         [0233]     This embodiment optimizes a treatment plan adherence and monitoring of patients with diabetes by facilitating communication among patients, their primary care physicians, and their d health plan. Collecting and disseminating this patient information to providers results in a paradigm shift in the treatment of diabetes.  
         [0234]     The treatment plan provides value to all parties involved in the patient management—the patient, the provider, administrators, and the state—by acting as an extension of the physician-patient dialogue. Information is provided to the patients to help them manage their diabetes, and allow them to communicate back about their condition. The active intervention consists of customized (patient-specific) bi-directional messaging via the modality of choice for each patient (i.e., landline, cellular, etc.). Patient messages provide diabetes self-management education and reminders, as well as assess treatment plan adherence. To assist physicians in managing their patients, patient self-reports are summarized and are sent back to physicians along with medication refill activity and laboratory tests.  
         [0235]     The treatment plan is designed as a prospective, randomized, between-groups analysis. Patients are randomly assigned to a Messaged Group and Non-Messaged Group. It is believed that patients in the Messaged Group will demonstrate higher treatment plan adherence than patients in the Non-Messaged Group, due to the support of bi-directional messaging.  
         [0000]     Plan Execution:  
         [0236]     The treatment plan embraces the following components: 
        Patient enrollment and randomization     Protocol execution     Ongoing analytics and reporting 
 
 Patient Enrollment and Randomization: 
       
 
         [0240]     Interested patients are scheduled for a live enrollment visit with a coordinator. During the enrollment visit, coordinators obtain enrollment information and patient consents/authorizations, and distribute patient materials and cellular phones, if necessary.  
         [0241]     Coordinators enroll eligible patients. Following patient enrollment, coordinators randomly assign the selected patients to one of two groups: 
        Messaged Group—active intervention group     Non-Messaged Group—control intervention group 
 
 Protocol Execution: 
       
 
         [0244]     Following enrollment, the patient contact begins. 
        Messaged Group patient intervention: 
            Patients receive bi-directional messages, via phones and/or cell phones ˜3 times a week. 
                Messaging provides education, reinforcements, and reminders with focus on medication adherence, glycemic testing and control, lipid testing and control, blood pressure measurement and control, eye exams, foot exams, follow-up visits, and lifestyle modifications.     Messaging content is available in four languages: English, Spanish, Brazilian Portuguese, and Haitian Creole.     Messaging content is customized to patient&#39;s name, gender, age, provider practice, diabetes drugs), labs (based on lab data), and any self-reported information.     During bi-directional messaging, condition-specific information is collected directly from patients.    
                Monthly qualitative surveys are delivered to and completed by patients through bi-directional messaging to assess condition status, treatment plan adherence, and quality of life.     Patients are able to request copies of their summary progress reports by mail, fax, or web according to preference.    
            Non-Messaged Group patient intervention: 
            Monthly qualitative surveys are delivered to and completed by patients through bi-directional messaging to assess condition status, treatment plan adherence, and quality of life.    
            Intervention 
            Based on the guidance provided, physicians and coordinators receive the following periodic reports via preferred methods of communication: 
                Activity Reports—provide patient activity status as it relates to group assignment and activity with bi-directional messaging.     Progress Reports—provide patient self-reported, pharmacy, and labs data for each patient enrolled in Messaged Group only.     Priority Update Reports—are generated based on patient reports requiring follow up for Messaged Group only.    
                Physicians are able to request up-to-date progress reports for Messaged Group patients at any time during the program.     Periodically physicians are asked to complete surveys related to the program experience (˜3 surveys). 
 
 Ongoing Analytics and Reporting: 
   
               
 
         [0262]     Throughout the program execution period, ongoing analyses are conducted. Summary information at an aggregate level is provided in the format of ongoing periodic reports. Outcomes are assessed using pharmacy claims data, lab data, and self-reported data collected from study participants. Qualitative information collected through surveys are also assessed.  
         [0263]      FIG. 4  is a flow diagram of the bi-directional messaging algorithm  402  used for diabetes patients. The bi-directional messaging algorithm  402  controls the sequence of questioning to the diabetes patient and, based on the patient&#39;s responses, updates the questions asked to promote a more learned protocol.  
         [0264]     In the introduction/authentication module  404  the diabetes patient is identified via criteria as to his name, address, phone number, gender, etc. After the introduction/authentication module  404  authenticates the identity of the diabetes patient, the previous reinforcement module  406  queries the diabetes patient to address the damage that diabetes can cause to the human body.  
         [0265]     Based on the results from the previous reinforcement module  406  the diabetes patient is then prompted to answer questions regarding the management of diabetes, including the monitoring of blood sugars via the education module  408 . The education module  408  has been updated from previous contacts with the diabetes patient to not repeat the same questions, but to ask more specific questions related to the patient&#39;s particular medical condition. Thus, a customized educational tutorial is available to the diabetes patient.  
         [0266]     The medication adherence/reinforcement module  410  stresses to the diabetes patient the importance of taking home blood sugar levels. The diabetes patient is reminded that by monitoring his blood sugar levels, both the patient and his provider can track his sugar levels and adjust his medications accordingly.  
         [0267]     The reminders module  412  reminds the diabetes patient to get his hemoglobin A1C tested every three to six months, or as directed by his doctor. The reminders module  412  also questions the diabetes patient on the status of his medication refills. Reminders to get refills are posted, as needed.  
         [0268]     The conclusion module  414  thanks the diabetes patient for his participation in the management of his medical condition.  
         [0269]     An example of a bi-directional encounter for diabetes patients is listed below.  
       EXAMPLE OF BI-DIRECTIONAL CALL EXERPT/PROTOCOL  
       [0000]     Previous Reinforcement: (Module  406 )  
         [0270]     True or False: Long-term problems that diabetes can cause include damage to the heart and blood vessels, kidneys, eyes, and nerves. 
        OPTION #1: IF TRUE—You are right! This statement is true. It is important to keep your diabetes under control to prevent or delay some of the long-term problems of diabetes.     OPTION #2: IF FALSE—Actually, this statement is true. Diabetes is not just a problem of glucose in the blood stream. It can cause damage to the heart and blood vessels, kidneys, eyes, and nerves. 
 
 Education: (Module  408 ) 
       
 
         [0273]     Managing diabetes includes monitoring blood sugar levels and keeping them as close as possible to those of a person without diabetes. There are 2 ways to monitor your blood sugar levels. The first is by having your doctor measure your glycosylated hemoglobin, which is also known as hemoglobin A1c. The second way is by measuring your blood sugar at home.  
         [0274]     Your hemoglobin A1c tells you what your average blood sugar level was over the past 2 to 3 months. The more sugar in the bloodstream, the higher the hemoglobin A1c. Doctors recommend measuring hemoglobin A1c every 3 to 6 months. In general, a target A1c of less than 7 percent can help you avoid the harmful complications of diabetes. A hemoglobin A1c of 7 means your average blood sugar level stayed around 150 during the past 2-3 months. 
        OPTION #1 [IF LAB NOT AVAILABLE FROM CHA DATA]—It looks like Doctor [DOCTOR NAME] doesn&#39;t have a record of your A1c test on file. Next time you visit Doctor [DOCTOR NAME] make sure to ask about having your hemoglobin A1c measured, because it will help keep your sugar under control.     OPTION #2 [IF LAB &gt;7 AND PATIENT DOESN&#39;T KNOW]—According to our last survey, you indicated that you don&#39;t know your A1c number. When Doctor [DOCTOR NAME] measured it last time, it was [CHA AIC LEVEL]. It is very important to know your hemoglobin A1c so that you will know how well you are controlling your diabetes. Next time you visit Doctor [DOCTOR NAME] make sure to discuss how you can work together to get your A1c number closer to the goal of 7.     OPTION #3 [IF LAB ≦7 AND PATIENT DOESN&#39;T KNOW]—According to our last survey, you indicated that you don&#39;t know your A1c number. When Doctor [DOCTOR NAME] measured it last time, it was [CHA AIC LEVEL]. It is very important to know your hemoglobin A1c so that you will know how well you are controlling your diabetes. It looks like you are doing great and your A1c number is at goal. That&#39;s great, keep it up! Next time you visit Doctor [DOCTOR NAME] make sure to discuss how you can continue working together to keep your A1c number at goal of 7.     OPTION #4 [IF LAB &gt;7 AND PATIENT KNOWS BUT IT DOESN&#39;T MATCH]—According to our last survey, you indicated that your last A1c number is [PATIENT A1C LEVEL]. Actually, that number doesn&#39;t match with Doctor [DOCTOR NAME]&#39;s records, which show the last A1c level of [CHA AIC LEVEL]. It is very important to know your hemoglobin A1c so that you will know how well you are controlling your diabetes. Next time you visit Doctor [DOCTOR NAME] make sure to discuss your latest test results and how you can work together to get your A1c number closer to the goal of 7.     OPTION #5 [IF LAB ≦7 AND PATIENT KNOWS BUT IT DOESN&#39;T MATCH]—According to our last survey, you indicated that your last A1c number is [PATIENT A1C LEVEL]. Actually, that number doesn&#39;t match with Doctor [DOCTOR NAME]&#39;s records, which show the last A1c level of [CHA AIC LEVEL]. It is very important to know your hemoglobin A1c so that you will know how well you are controlling your diabetes. Next time you visit Doctor [DOCTOR NAME] make sure to discuss your latest test results and how you can continue working together to keep your A1c number at goal of 7.     OPTION #6 [IF LAB &gt;7 AND PATIENT KNOWS AND MATCHES]—According to our last survey, you indicated that your last A1c number is [PATIENT A1C LEVEL]. That&#39;s great that you know your A1c number! Next time you visit Doctor [DOCTOR NAME] make sure to discuss how you can work together to get your A1c number closer to the goal of 7.     OPTION #7 [IF LAB ≦7 AND PATIENT KNOWS AND MATCHES]—According to our last survey, you indicated that your last A1c number is [PATIENT A1C LEVEL]. That&#39;s great that you know your A1c number and it is at goal! Keep it up! Next time you visit Doctor [DOCTOR NAME] make sure to discuss how you can continue working together to keep your A1c number at goal of 7. 
 
 Reinforcement: (Module  410 ) 
       
 
         [0282]     True or False: If you get your blood sugar measured at home, your doctor does not need to monitor your hemoglobin A1c regularly. 
        OPTION #1: IF FALSE—Exactly! This statement is false. When you are measuring blood sugar levels at home, it tells what your sugar level is at the moment of measurement, helping you know what immediate effect food, exercise, stress, and medications might have on your blood sugar levels. Hemoglobin A1c provides a long view of your diabetes management by telling you what your average blood sugar level was over the past 2 to 3 months. Therefore, you need to monitor your glucose levels with both hemoglobin A1c tests and home blood glucose tests.     OPTION #2: IF TRUE—Not quite, this statement is false. When you are measuring blood sugar levels at home, it tells what your sugar level is at the moment of measurement, helping you know what immediate effect food, exercise, stress, and medications might have on your blood sugar levels. Hemoglobin A1c provides a long view of your diabetes management by telling you what your average blood sugar level was over the past 2 to 3 months. Therefore, you need to monitor your glucose levels with both hemoglobin A1c tests and home blood glucose tests. 
 
 Reminders: (Module  412 ) 
       
 
         [0285]     Don&#39;t forget to get your hemoglobin A1c tested every 3 to 6 months or as directed by your doctor.  
         [0286]     According to your pharmacy records, you are taking the following medications to manage your diabetes—[DIABETES MEDICATIONS]. These medications will help keep your diabetes under control. Remember to take them every day as directed by your doctor.  
         [0287]     IF DIABETES MEDICATIONS ARE DUE WITHIN TWO WEEKS—According to your pharmacy records, [DIABETES MEDICATIONS WITH REFILL DUE WITHIN 2 WEEKS] might need to be refilled within 2 weeks. Make sure you get your refills on time.  
         [0288]     IF DIABETES MEDICATIONS ARE PAST DUE WITHIN TWO WEEKS—According to your pharmacy records you did not refill [DIABETES MEDICATIONS WITH REFILL PAST DUE ˜2 WEEKS] on time. It is important to take these medications regularly. Please select one of the following reasons for not refilling [DIABETES MEDICATION #1 WITH REFILL PAST DUE ˜2 WEEKS] on time: 
        You forgot to refill it     You forgot to take [DIABETES MEDICATION #1 WITH REFILL PAST DUE ˜2 WEEKS] several times in the past month and you still have some medication left from the last fill     Your doctor changed the directions on how to take it and you still have some medication left from the last fill     Your doctor told you to stop taking that medication     Your doctor gave you samples     Other reasons. 
 
 Depression Patients 
       
 
         [0295]     An embodiment of the invention for patients experiencing depression is described herein.  
         [0296]     According to the latest RAND study on quality of care, Americans receive care consistent with evidence-based medicine only in 50% of the cases. This failure to deliver appropriate care results in 57,000 deaths, $1 billion in avoidable hospital costs, and 41 million lost workdays each year. These losses lead to the staggering costs of $11.5 billion for American businesses.  
         [0297]     It is believed that an improvement in quality and appropriateness of depression care could result in averted hospitalizations, medical/psychiatric outpatient care, and work absenteeism (˜3 million work days/year) which are currently estimated at an annual cost of $44 billion to the American society.  
         [0298]     Since 1999, HEDIS (Health Plan Employer Data and Information Set) measures related to medical management of depression and follow-up for mental health issues have remained almost stagnant. In 2002, only 60% of members in average commercial health plans were compliant with their antidepressant medication during the acute phase of treatment (first 84 days), and only 43% of members were compliant with their antidepressant medication during the continuation phase (subsequent 6 months). Furthermore, just 19% of members treated with antidepressants had at least three follow-up appointments during acute phase of treatment. The National Committee for Quality Assurance identified consumer engagement in care decisions as one of the keys to closing the “quality gap.” 
         [0299]     It is believed that the extension of provider-patient communications beyond the constraints of an encounter through automated means will enhance patient adherence to antidepressant treatment and will assist providers in monitoring their patients.  
         [0300]     This embodiment discloses a treatment plan using HEDIS measures related to medical management of depression by engaging targeted physicians and their consumers through an automated, interactive telephone messaging campaign.  
         [0301]     The embodiment provides value to all parties involved in the patient management—the patient, the provider, and the health plan—by acting as an extension of the physician-patient dialogue. Information is provided to the patients to help them adhere to the antidepressant regimen. The active intervention consists of customized (patient-specific) bi-directional messaging via the phone (i.e., landline, cellular, etc.). Patient messages provide antidepressant adherence education and reminders, as well as assess treatment plan adherence. To assist physicians in managing their patients, patient self-reports are summarized and sent back to physicians along with medication refill activity.  
         [0302]     The embodiment is designed as a prospective, randomized, between-groups analysis. Patients will be randomly assigned to a Messaged Group and Non-Messaged Group. It is believed that patients in the Messaged Group will demonstrate higher treatment plan adherence than patients in the Non-Messaged Group, due to the support of bi-directional messaging.  
         [0303]     The embodiment targets physicians (and their corresponding group practice(s)) identified as having a considerable number patients who have discontinued antidepressant therapy during acute or continuation phase within one year prior and their affiliated insurance members that initiate new-onset antidepressant therapy.  
         [0000]     Patient Enrollment and Randomization:  
         [0304]     Insurance claims are reviewed periodically to target patients who were initiated on new onset antidepressant therapy by the participating physicians (Physician Intervention group). Subsequently, participating physicians are contacted (fax and reminder via phone or email) to obtain physician authorization for enrolling targeted patients. Physicians are able to authorize patient enrollment via fax, web, or phone.  
         [0305]     Once enrolled, patients are randomized into two groups: 
        Messaged group (active intervention group)     Non-messaged group        
 
         [0308]     A third group of patients—Control group—is identified through prescribing activity of the Physician Control group. Patients initiated on new onset antidepressant therapy by these physicians will be allocated to the control group.  
         [0000]     Protocol Execution:  
         [0309]     Following enrollment, the patient encounter is started. Messaged group patient intervention: 
        The intervention consists of a series of  3  automated personalized interactive calls (one, three, and six months after initiation of therapy). 
            Patients are contacted on behalf of a provider group and/or the health plan. Content personalization and customization are based on the information maintained by the health plan (i.e., name, age, medications, etc.) and any modifications that physician might provide.     Each call begins with confirmation and authentication of the patient.     Messaging provides education, reinforcements, and reminders with focus on medication adherence and follow-up visits.     Messaging content is customized to patient&#39;s name, gender, age, asthma drugs (based on information captured during enrollment), and any self-reported information.     During bi-directional messaging, self-reported medication adherence is collected directly from patients.     During bidirectional messaging, patients are provided access to available online, print materials, and crisis management hotline.    
            Non-messaged group patient intervention: 
            No intervention is performed for this group    
            Control group patient intervention: 
            No intervention is performed for this group    
            Physician intervention group: 
            Based on the guidance provided by insurances and group practice, physicians receive periodic progress and priority reports via fax and/or reminders via preferred method of communication     Progress reports—provide patient group assignment, response to bi-directional messaging, and pharmacy data for each patient enrolled in Messaged Group only.     Priority reports—are generated based on patient reports requiring follow up for Messaged Group only.     Physicians are able to request up-to-date progress reports for Messaged Group patients at any time.     Periodically physicians are asked to complete surveys related to the treatment plan.    
            Physician Control group: 
            No intervention is performed for this group    
               
 
         [0329]      FIG. 5  is a flow diagram of the bi-directional messaging algorithm  502  used for patients experiencing depression. The bi-directional messaging algorithm  502  controls the sequence of questioning to the depression patient and, based on the patient&#39;s responses, updates the questions asked to promote a more learned protocol.  
         [0330]     The introduction/authentication module  504 , the previous reinforcement module  506 , the education module  508 , the medication adherence/reinforcement module  510 , the reminders module  512 , and the conclusion module  514  all function in the same manner as described above in  FIG. 4 , with one exception. The questions presented in the depression module  502  are customized for patients with depression disorders only.  
         [0331]     It should be emphasized that the above-described embodiments of the present invention, particularly, any preferred embodiments, are merely possible examples of implementations, merely set forth for a clear understanding of the principles of the invention. Many variations and modifications may be made to the above-described embodiments of the invention without departing substantially from the spirit and principles of the invention. All such modifications and variations, are intended to be included herein within the scope of this disclosure, and the present invention and protected by the following claims.  
                             TABLE I                           Below, you will find the content and description of the flow for the       Suicide Screen section of the algorithm.                Content/Description/Questions   Comments                       The current suicide screen text reads as               follows: “This is not a crisis management           hotline, however because we&#39;re concerned           about your safety, we&#39;d like to ask if there           were any times today when you were           feeling so bad that you felt life was not           worth living, when you were thinking           about suicide or harming yourself?”           [yes/no]           If someone says “Yes”, the text reads as           follows: “If you have a plan for harming           yourself and urgency to do so, hang up the           phone and call 911 right now. If you are           having thoughts of harming yourself but do           not have a plan, please contact your doctor           as soon as you complete this call. If you           are having rare or fleeting thoughts of           harming yourself and do not have a plan,           please contact your doctor if these thoughts           continue.”           “Press 1 to hear these instructions again,           press 2 to end this call so you can contact           someone, press 3 if you answered yes           accidentally, press 4 to continue the call.”                      
 
         [0332]    
       
         
               
             
               
               
               
             
           
               
                 TABLE II 
               
             
             
               
                   
               
               
                   
               
               
                 Below, you will find the content and description of the flow for the 
               
               
                 Education section of the algorithm. 
               
             
          
           
               
                   
                 Content/Description/Questions 
                 Comments 
               
               
                   
                   
               
               
                   
                 We are proposing playing one of the three 
                   
               
               
                   
                 educational messages below to the patient 
               
               
                   
                 each time s/he goes through the call. The 
               
               
                   
                 educational messages will rotate, so that 
               
               
                   
                 the first time the patient calls, message 1 
               
               
                   
                 will play, the second time s/he calls 
               
               
                   
                 message 2 plays, etc.; and then the rotation 
               
               
                   
                 begins again at message 1. 
               
               
                   
                 Are these 3 educational messages 
               
               
                   
                 sufficient? Should we have more (or 
               
               
                   
                 should we have fewer or not any at all)? 
               
               
                   
                 (see the content of the messages below) 
               
               
                   
                 Should we give the patient the option to 
               
               
                   
                 skip these messages after they have 
               
               
                   
                 heard them once (or some number of 
               
               
                   
                 times) each? 
               
               
                   
                 The text for the first educational message 
               
               
                   
                 reads as follows: “About 1 in 3 people 
               
               
                   
                 with bipolar disorder will remain 
               
               
                   
                 completely free of symptoms just by taking 
               
               
                   
                 mood stabilizing medication for life. Most 
               
               
                   
                 other people experience a great reduction in 
               
               
                   
                 the frequency and severity of episodes 
               
               
                   
                 during maintenance treatment.” 
               
               
                   
                 The text for the second educational 
               
               
                   
                 message reads as follows: “It is important 
               
               
                   
                 not to become overly discouraged when 
               
               
                   
                 episodes do occur and to recognize that the 
               
               
                   
                 success of treatment can only be evaluated 
               
               
                   
                 over the long term, by looking at the 
               
               
                   
                 frequency and severity of episodes. Be 
               
               
                   
                 sure to report changes in mood to your 
               
               
                   
                 doctor immediately, because adjustments in 
               
               
                   
                 your medicine at the first warning signs can 
               
               
                   
                 often restore normal mood and head off a 
               
               
                   
                 full-blown episode.” 
               
               
                   
                 The text for the third educational message 
               
               
                   
                 reads as follows: “Continuing to take 
               
               
                   
                 medication correctly and as prescribed 
               
               
                   
                 (which is called adherence) on a long-term 
               
               
                   
                 basis is difficult whether you are being 
               
               
                   
                 treated for a condition such as high blood 
               
               
                   
                 pressure, diabetes, or bipolar disorder. 
               
               
                   
                 Individuals with bipolar disorder are often 
               
               
                   
                 tempted to stop taking their medication 
               
               
                   
                 during maintenance treatment for several 
               
               
                   
                 reasons. They may feel free of symptoms 
               
               
                   
                 and think they don&#39;t need medication 
               
               
                   
                 anymore. They may find the side effects 
               
               
                   
                 too hard to deal with. Or they may miss 
               
               
                   
                 the mild euphoria they experience during 
               
               
                   
                 hypomanic episodes. However, research 
               
               
                   
                 clearly indicates that stopping maintenance 
               
               
                   
                 medication almost always results in 
               
               
                   
                 relapse, usually in weeks to months after 
               
               
                   
                 stopping.” 
               
               
                   
                 If someone is taking Lithium, the third 
               
               
                   
                 educational message continues as follows: 
               
               
                   
                 “In the case of stopping lithium, the rate of 
               
               
                   
                 suicide rises sharply after stopping. There 
               
               
                   
                 is some evidence that stopping lithium in 
               
               
                   
                 an abrupt fashion carries a much greater 
               
               
                   
                 risk of relapse. Therefore, if you must stop 
               
               
                   
                 your medication, it should be done 
               
               
                   
                 gradually under the close medical 
               
               
                   
                 supervision of your doctor.” 
               
               
                   
                 Do you have any suggestions for 
               
               
                   
                 additional content? 
               
               
                   
                   
               
             
          
         
       
     
         [0333]    
       
         
               
             
               
               
               
             
           
               
                 TABLE III 
               
             
             
               
                   
               
               
                   
               
               
                 Below, you will fing the content and description of the flow for the 
               
               
                 Medication Adherence section of the algorithm. 
               
             
          
           
               
                   
                 Content/Description/Questions 
                 Comments 
               
               
                   
                   
               
               
                   
                 First, we confirm the name of the 
                   
               
               
                   
                 medication that the patient is taking. If 
               
               
                   
                 there is a discrepancy in our records, we 
               
               
                   
                 place the medication on “hold” (i.e., we 
               
               
                   
                 don&#39;t ask anything more about this 
               
               
                   
                 medication until we confirm the med with 
               
               
                   
                 the patient&#39;s doctor) 
               
               
                   
                 Then, we ask if the patient missed any 
               
               
                   
                 doses yesterday. 
               
               
                   
                 We are proposing that the patient 
               
               
                   
                 answers about the medications that s/he 
               
               
                   
                 took YESTERDAY as the time of the 
               
               
                   
                 call may vary and doses may remain for 
               
               
                   
                 the day of the call. Does this approach 
               
               
                   
                 make sense? 
               
               
                   
                 The number of pills taken is also tracked 
               
               
                   
                 (this is an outcome measure for the study). 
               
               
                   
                 Discrepancies are flagged and education is 
               
               
                   
                 pushed depending on over or underdose 
               
               
                   
                 and the reported reason (e.g., ran out of 
               
               
                   
                 meds, forgot, etc.) 
               
               
                   
                 Under what circumstances should the 
               
               
                   
                 psychiatrist be notified? (e.g., overdose? 
               
               
                   
                 Underdose? Zero meds taken for X 
               
               
                   
                 days?) 
               
               
                   
                 If a doctor should be notified, by what 
               
               
                   
                 means? (e.g., pager, phone, fax, email). 
               
               
                   
                 Note, we have questions about the ability 
               
               
                   
                 to immediately reach the doctor, and the 
               
               
                   
                 implication of a potential time delay. 
               
               
                   
                 If a patient takes fewer pills than 
               
               
                   
                 prescribed the following message is 
               
               
                   
                 played: “There are a number of reasons 
               
               
                   
                 why people may take fewer pills than they 
               
               
                   
                 are prescribed. Press 1 if you ran out of 
               
               
                   
                 medication. Press 2 if you forgot. Press 3 
               
               
                   
                 if you think you took the correct number 
               
               
                   
                 of pills. Press 4 if you took fewer pills in 
               
               
                   
                 an attempt to reduce side effects you were 
               
               
                   
                 experiencing. Press 5 if you took fewer 
               
               
                   
                 pills because you want to feel like you used 
               
               
                   
                 to feel before you started taking 
               
               
                   
                 medication. Press 6 if you incorrectly 
               
               
                   
                 entered the number of pills you took.” 
               
               
                   
                 Educational statements follow each option. 
               
               
                   
                 If a patient takes more pills than 
               
               
                   
                 prescribed, the following message is 
               
               
                   
                 played: “It appears that you may have 
               
               
                   
                 taken more than your prescribed number of 
               
               
                   
                 pills today. Taking too many pills can have 
               
               
                   
                 a number of serious side effects and should 
               
               
                   
                 never be done unless your doctor has 
               
               
                   
                 instructed you to increase your dose. If 
               
               
                   
                 you have intentionally or accidentally 
               
               
                   
                 overdosed on your medication and need 
               
               
                   
                 medical assistance, please hang up and call 
               
               
                   
                 911 right now. If you are not sure if you 
               
               
                   
                 have taken too many pills, please contact 
               
               
                   
                 your doctor as soon as possible. 
               
               
                   
                 Press 1 to hear these instructions again, 
               
               
                   
                 press 2 to end this call so you can contact 
               
               
                   
                 someone, press 3 if you believe you have 
               
               
                   
                 taken the correct number of pills and have 
               
               
                   
                 received this message in error, press 4 if 
               
               
                   
                 you incorrectly entered the number of pills 
               
               
                   
                 you took”, press 5 to continue.” 
               
               
                   
                 What should we do about half pills? 
               
               
                   
                 How common is it for a dose to entail 
               
               
                   
                 splitting a pill? 
               
               
                   
                 What is the maximum number of 
               
               
                   
                 medications that should be tracked? 
               
               
                   
                 (note that each medication that is tracked 
               
               
                   
                 must go through the entire loop of 
               
               
                   
                 questions regarding adherence) 
               
               
                   
                 Should PRN medication NOT be 
               
               
                   
                 tracked? 
               
               
                   
                 Do we need to (how important is it to) 
               
               
                   
                 provide education about side effects of 
               
               
                   
                 specific medication? (options are to 
               
               
                   
                 provide no information, to provide a 
               
               
                   
                 generic statement about contacting doctor 
               
               
                   
                 if experiencinge troubling side effects, to 
               
               
                   
                 discuss the most common side effects 
               
               
                   
                 across all drugs, to discuss the most 
               
               
                   
                 common side effects for each individual 
               
               
                   
                 drug, or something even more 
               
               
                   
                 comprehensive. Keep in mind length of 
               
               
                   
                 call) 
               
               
                   
                   
               
             
          
         
       
     
         [0334]    
       
         
               
             
               
               
               
             
           
               
                 TABLE IV 
               
             
             
               
                   
               
               
                   
               
               
                 Below, you will find the content and description of the flow for the 
               
               
                 Mood Rating section of the algorithm. 
               
             
          
           
               
                   
                 Content/Description/Questions 
                 Comments 
               
               
                   
                   
               
               
                   
                 How useful is it to tell the patient what 
                   
               
               
                   
                 their mood rating was the last time they 
               
               
                   
                 did a rating? 
               
               
                   
                 If a mood rating was not made the 
               
               
                   
                 previous day, this message plays: “Last 
               
               
                   
                 time, you did not make a mood rating. If 
               
               
                   
                 possible, it is important to rate your mood 
               
               
                   
                 every day. It will make it easier for you 
               
               
                   
                 and [doctor name] to evaluate how well a 
               
               
                   
                 treatment works and what is most effective 
               
               
                   
                 in the short and long-term management of 
               
               
                   
                 your condition.” 
               
               
                   
                 The general mood rating statement is: 
               
               
                   
                 “On a scale of 0 to 100, where 0 is the 
               
               
                   
                 most depressed you could imagine being, 
               
               
                   
                 50 is a balanced or level mood, and 100 is 
               
               
                   
                 the most energetic, activated, or manic you 
               
               
                   
                 could ever be, how would you rate your 
               
               
                   
                 mood today?” “Please enter a number 
               
               
                   
                 between 0 and 100, followed by the # key. 
               
               
                   
                 If you would like to hear some example 
               
               
                   
                 ratings on the 0 to 100 scale, press 999 
               
               
                   
                 followed by the # key.” 
               
               
                   
                 We are proposing that the patient 
               
               
                   
                 answers about their mood TODAY as we 
               
               
                   
                 believe it would be difficult to recall a 
               
               
                   
                 mood from a previous day. Does this 
               
               
                   
                 approach make sense? 
               
               
                   
                 The example statement is: “Example 
               
               
                   
                 ratings. If today you felt moderately 
               
               
                   
                 depressed, you might rate your mood as 32 
               
               
                   
                 or 35, or if you felt mildly hypomanic, you 
               
               
                   
                 might rate your mood as 54 or 57.” 
               
               
                   
                 Are there any cases where the 
               
               
                   
                 psychiatrist should be notified? For 
               
               
                   
                 example, an extreme mood rating of 25 or 
               
               
                   
                 lower or 75 or higher? (note: 50 = balanced 
               
               
                   
                 mood, 0 = most possible 
               
               
                   
                 depression, 100 = most possible mania) 
               
               
                   
                 If a doctor should be notified, by what 
               
               
                   
                 means? (e.g., pager, phone, fax, email). 
               
               
                   
                 Note, we have questions about the ability 
               
               
                   
                 to immediately reach the doctor, and the 
               
               
                   
                 implication of a potential time delay. 
               
               
                   
                 Should the psychiatrist be notified if a 
               
               
                   
                 rating has not been made for (e.g., 7) 
               
               
                   
                 days? If so, how many days should 
               
               
                   
                 trigger an alert? 
               
               
                   
                   
               
             
          
         
       
     
         [0335]    
       
         
               
             
               
               
               
             
           
               
                 TABLE V 
               
             
             
               
                   
               
               
                   
               
               
                 Below, you will fond the content and description of the flow for the 
               
               
                 Severity Rating section of the algorithm. 
               
             
          
           
               
                   
                 Content/Description/Questions 
                 Comments 
               
               
                   
                   
               
               
                   
                 How useful is it to tell the patient what 
                   
               
               
                   
                 their severity rating was the last time 
               
               
                   
                 they did a rating? 
               
               
                   
                 If a severity rating was not made the 
               
               
                   
                 previous day, this message plays: “Last 
               
               
                   
                 time, you did not make a severity rating. If 
               
               
                   
                 possible, it is important to rate the severity 
               
               
                   
                 of your mood every day. It will make it 
               
               
                   
                 easier for you and [doctor name] to 
               
               
                   
                 evaluate how well a treatment works and 
               
               
                   
                 what is most effective in the short and 
               
               
                   
                 long-term management of your condition.” 
               
               
                   
                 The general severity rating statement is: 
               
               
                   
                 “Now we are going to ask you to rate how 
               
               
                   
                 much your mood affected your ability to 
               
               
                   
                 function today.” 
               
               
                   
                 Then, based on the patients mood rating, 
               
               
                   
                 one the following three messages is 
               
               
                   
                 triggered: 
               
               
                   
                 If patient rated mood 0-49: “Please rate 
               
               
                   
                 the functional impairment that you 
               
               
                   
                 experienced today due to your mood 
               
               
                   
                 symptoms, which from your mood rating 
               
               
                   
                 appear to be within the depressed to normal 
               
               
                   
                 range.” 
               
               
                   
                 If patient rated mood 51-100: “Please 
               
               
                   
                 rate the functional impairment that you 
               
               
                   
                 experienced today due to your mood 
               
               
                   
                 symptoms, which from your mood rating 
               
               
                   
                 appear to be within the manic to normal 
               
               
                   
                 range.” 
               
               
                   
                 If patient rated mood 50: “Please rate the 
               
               
                   
                 functional impairment that you experienced 
               
               
                   
                 today due to your mood symptoms, which 
               
               
                   
                 from your mood rating appear to be within 
               
               
                   
                 the normal range.” 
               
               
                   
                 The depressed range statement is 
               
               
                   
                 followed by the prompt: “Press 9 to hear 
               
               
                   
                 further explanation of the levels of 
               
               
                   
                 impairment. If you are already familiar 
               
               
                   
                 with these levels, please make your entry 
               
               
                   
                 now. Press 4 if you were essentially 
               
               
                   
                 incapacitated or hospitalized, press 3 if you 
               
               
                   
                 were functioning with great effort, press 2 
               
               
                   
                 if you were functioning with some effort, 
               
               
                   
                 press 1 if you experienced little or no 
               
               
                   
                 functional impairment, press 0 if you 
               
               
                   
                 experienced absolutely no impairment. 
               
               
                   
                 Please enter a number 0 through 4.” 
               
               
                   
                 The manic range statement is followed 
               
               
                   
                 by the prompt: 
               
               
                   
                 “Press 9 to hear further explanation of the 
               
               
                   
                 levels of impairment. If you are already 
               
               
                   
                 familiar with these levels, please make 
               
               
                   
                 your entry now. Press 4 if you were 
               
               
                   
                 essentially incapacitated or hospitalized, 
               
               
                   
                 press 3 if you had great difficulty with 
               
               
                   
                 goal-oriented activity, press 2 if you had 
               
               
                   
                 some difficulty with goal-oriented activity, 
               
               
                   
                 press 1 if you were more energized and 
               
               
                   
                 productive with little or no functional 
               
               
                   
                 impairment, press 0 if you experienced 
               
               
                   
                 absolutely no impairment. Please enter a 
               
               
                   
                 number 0 through 4.” 
               
               
                   
                 The example explanations for 
               
               
                   
                 depression-related severity ratings are: 
               
               
                   
                 “A rating of 1 indicates that you have a 
               
               
                   
                 mild level of distress and low mood, and 
               
               
                   
                 may experience some social isolation, 
               
               
                   
                 however your sleep and appetite are OK, 
               
               
                   
                 and you function well at work and at home. 
               
               
                   
                 This rating could be called a mild 
               
               
                   
                 depression.” 
               
               
                   
                 “A rating of 2 indicates that your sleep and 
               
               
                   
                 appetite have changed (increased or 
               
               
                   
                 decreased), you may have decreased energy 
               
               
                   
                 and concentration, you may be anxious, 
               
               
                   
                 lack pleasure in things you do, and you 
               
               
                   
                 may have thoughts of suicide. You feel 
               
               
                   
                 some impairment at work and home, you 
               
               
                   
                 may miss work, and you have to push 
               
               
                   
                 yourself to get things done. This rating 
               
               
                   
                 could be called a low moderate 
               
               
                   
                 depression.” 
               
               
                   
                 “A rating of 3 indicates that you may feel 
               
               
                   
                 slowed down, withdrawn, and have low 
               
               
                   
                 energy, or agitated. You have great 
               
               
                   
                 difficulty reading or concentrating, and you 
               
               
                   
                 may neglect your personal hygiene. You 
               
               
                   
                 have great difficulty functioning, you rarely 
               
               
                   
                 get to work, and you have to push yourself 
               
               
                   
                 very hard to get things done. This rating 
               
               
                   
                 could be called a high moderate 
               
               
                   
                 depression.” 
               
               
                   
                 “A rating of 4 indicates that you are 
               
               
                   
                 immobilized and possibly mute; you can&#39;t 
               
               
                   
                 read or concentrate, or you may be 
               
               
                   
                 extremely agitated. You may be isolated or 
               
               
                   
                 in bed, and you may need to go to the 
               
               
                   
                 hospital. You are essentially incapacitated. 
               
               
                   
                 This rating could be called a severe 
               
               
                   
                 depression.” 
               
               
                   
                 The example explanations for mania- 
               
               
                   
                 related severity ratings are: 
               
               
                   
                 “A rating of 1 indicates that you have 
               
               
                   
                 experienced very mild symptoms such as a 
               
               
                   
                 decrease in sleep, you are energetic, more 
               
               
                   
                 social, and you may notice yourself talking 
               
               
                   
                 more than usual. You experience little or 
               
               
                   
                 no impairment, and you can be focused and 
               
               
                   
                 productive. This rating could be called a 
               
               
                   
                 mild level of hypomania.” 
               
               
                   
                 “A rating of 2 indicates that you are 
               
               
                   
                 irritable, euphoric, intrusive, and/or 
               
               
                   
                 grandiose; you may have an increase in 
               
               
                   
                 energy, decrease in sleep, and/or an 
               
               
                   
                 increase in spending or phone calls. You 
               
               
                   
                 may experience poor judgment, may be 
               
               
                   
                 disruptive at work and home, and may have 
               
               
                   
                 difficulty with goal-oriented activity. You 
               
               
                   
                 are noticeably impaired and may receive 
               
               
                   
                 feedback about your behavior from others; 
               
               
                   
                 you are unfocused and less productive. 
               
               
                   
                 This rating could be called a low moderate 
               
               
                   
                 level of mania.” 
               
               
                   
                 “A rating of 3 indicates that you may be 
               
               
                   
                 grandiose and/or very disruptive; you may 
               
               
                   
                 experience little or no sleep, reckless 
               
               
                   
                 behavior, and an increase in energy and 
               
               
                   
                 activities. You may show poor judgment, 
               
               
                   
                 difficulty with goal-oriented activity, and 
               
               
                   
                 you may be disruptive at work and home. 
               
               
                   
                 It&#39;s hard to focus, you have a very hard 
               
               
                   
                 time with your behavior and goal directed 
               
               
                   
                 activities, and you are not productive. This 
               
               
                   
                 rating could be called a high moderate level 
               
               
                   
                 of mania.” 
               
               
                   
                 “A rating of 4 indicates that you have had 
               
               
                   
                 little or no sleep, you may experience 
               
               
                   
                 beliefs that no one else confirms, or 
               
               
                   
                 hallucinations. You may feel invincible or 
               
               
                   
                 explosive. In such a state, you may need to 
               
               
                   
                 be hospitalized and require close 
               
               
                   
                 supervision, as your judgment is severely 
               
               
                   
                 impaired. Others around you will insist 
               
               
                   
                 that you go to the hospital, and you will be 
               
               
                   
                 unable to function in any goal directed 
               
               
                   
                 activity. This rating could be called a 
               
               
                   
                 severe level of the manic mood state.” 
               
               
                   
                 Are there any cases where the 
               
               
                   
                 psychiatrist should be notified? For 
               
               
                   
                 example, severity ratings of 3 or higher? 
               
               
                   
                 If a doctor should be notified, by what 
               
               
                   
                 means? (e.g., pager, phone, fax, email). 
               
               
                   
                 Note, we have questions about the ability 
               
               
                   
                 to immediately reach the doctor, and the 
               
               
                   
                 implication of a potential time delay. 
               
               
                   
                 Should the psychiatrist be notified if a 
               
               
                   
                 rating has not been made for (e.g., 7) 
               
               
                   
                 days? If so, how many days should 
               
               
                   
                 trigger an alert? 
               
               
                   
                   
               
             
          
         
       
     
         [0336]    
       
         
               
             
               
               
               
             
           
               
                 TABLE VI 
               
             
             
               
                   
               
               
                   
               
               
                 Below, you will find the content and description of the flow for the 
               
               
                 Sleep Rating section of the algorithm. 
               
             
          
           
               
                   
                 Content/Description/Questions 
                 Comments 
               
               
                   
                   
               
               
                   
                 The text is: “Please enter the number of 
                   
               
               
                   
                 hours of sleep (rounded to the nearest hour) 
               
               
                   
                 that you slept last night. If you slept, for 
               
               
                   
                 example, 4.5 hours, please round to 5 
               
               
                   
                 hours. If you slept 4 hours and 15 minutes, 
               
               
                   
                 round down to 4 hours. Please count only 
               
               
                   
                 nighttime sleep and do not include naps 
               
               
                   
                 you might have taken several hours after 
               
               
                   
                 you got up. Please enter a number of hours 
               
               
                   
                 of sleep now, followed by the # sign.” 
               
               
                   
                 How important is this section? It adds 
               
               
                   
                 length to the call. Please rate the important 
               
               
                   
                 on a scale from 1 to 10 where 1 is not at all 
               
               
                   
                 important and 10 is extremely important. 
               
               
                   
                   
               
             
          
         
       
     
         [0337]    
       
         
               
             
               
               
               
               
               
               
             
               
             
               
               
               
               
               
               
             
               
             
               
               
               
               
               
               
             
               
             
               
               
               
               
               
               
             
               
             
               
               
               
               
               
               
             
               
             
               
               
               
               
               
               
             
               
             
               
               
               
               
               
             
           
               
                 TABLE VII 
               
             
             
               
                   
               
               
                   
               
               
                 Bipolar Bidirectional Messaging Events 
               
               
                 Event and Data Algorithm 
               
               
                 Variables: 
               
               
                 varName (EF) - external flag variable for condition tests, provided via csv file. 
               
               
                 varName (EX) - external string variable used within text scripts, provided via csv file. 
               
               
                 varName (IF) - internal flag variable that needs persistance, captured locally. 
               
               
                 varName (IX) - internal variable to be returned, captured locally and returned via csv file. 
               
               
                 varName (IS) - internal flag variable used internally at runtime, not captured. 
               
             
          
           
               
                 ID 
                 Title 
                 Description 
                 Actions 
                 Needed 
                 Collected 
               
               
                   
               
             
          
           
               
                 INTRODUCTION (0-99) 
               
             
          
           
               
                 10 
                 Introduction message 
                 Hello. 
                 Go to 20 
                 PatientName (EX) 
                   
               
               
                   
                   
                   
                   
                 StudyTitle (EX) 
               
               
                 20 
                 Introduction prompt 
                 Ready? 
                 1 - go to 30 
                 PatientName (EX) 
               
               
                   
                   
                   
                 2 - go to 25 
               
               
                   
                   
                   
                 3 - go to 29 
               
               
                 25 
                 Call back instructions 
                 How to call back. 
                 End call. 
                   
                 CallBack (IX) 
               
               
                   
                 message 
               
               
                 29 
                 Bad call message 
                 Wrong number. 
                 End call. 
                   
                 BadCall (IX) 
               
               
                 30 
                 Enter ID prompt 
                 Enter your id. 
                 good id - go to 40 
                 PatientID (EF) 
                 PatientID (IX) 
               
               
                   
                   
                   
                 bad id - go to 39 
               
               
                 35 
                 Call back prompt 
                 Enter your id. 
                 good id - go to 40 
                   
                 PatientID (IX) 
               
               
                   
                   
                   
                 bad id - go to 39 
               
               
                 39 
                 Invalid ID 
                 Invalid id entered. 
                 Go to 30 
               
               
                 40 
                 Welcome message 
                 Welcome. 
                 Go to 50 
                 DoctorName (EX) 
               
               
                 50 
                 Suicide screen 
                 Suicide thoughts 
               
               
                   
                 message 
                 today? 
               
               
                 53 
                 Suicide screen prompt 
                 Yes or no? 
                 1 - go to 55 
               
               
                   
                   
                   
                 2 - go to 60 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 55 
                 Suicide yes prompt 
                 Suicide severity? 
                 1 - go to 55 
                   
                 Suicide (IX) 
               
               
                   
                   
                   
                 2 - end call 
               
               
                   
                   
                   
                 3 - go to 50 
               
               
                   
                   
                   
                 4 - go to 60 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 60 
                 Education message 
                 Education intro. 
                 Go to 61, 62 or 63 
               
               
                   
                   
                   
                 Need logic for this. 
               
               
                 61 
                 Education option 1 
                 Info message 1 
                 Go to 70 
                   
                 EdOp (IF) = 1 
               
               
                   
                 message 
               
               
                 62 
                 Education option 2 
                 Info message 2 
                 Go to 70 
                   
                 EdOp (IF) = 2 
               
               
                   
                 message 
               
               
                 63 
                 Education option 3 
                 Info message 3 
                 Go to 70 
                   
                 EdOp (IF) = 3 
               
               
                   
                 message 
               
               
                 70 
                 Lithium message 
                 Placeholder 
                 Lithium = false - go to 
                 Lithium (EF) 
               
               
                   
                   
                   
                 100 
                 EdOp (IF) 
               
               
                   
                   
                   
                 else EdOp = 3 - go to 
               
               
                   
                   
                   
                 71 
               
               
                   
                   
                   
                 else go to 72 
               
               
                 71 
                 Lithium option 1 
                 Lithium info 
                 Go to 100 
               
               
                   
                 message 
               
               
                 72 
                 Lithium option 2 
                 Lithium info 
                 Go to 100 
               
               
                   
                 message 
               
             
          
           
               
                 MEDICINE (100-199) 
               
             
          
           
               
                 100 
                 Med name 
                 Placeholder 
                 If MedNameStatus 
                 MedNameStatus[MedNum] 
                   
               
               
                   
                 check 
                   
                 is ‘on hold’ - go to 
                 (EF) 
               
               
                   
                   
                   
                 180 
               
               
                   
                   
                   
                 If MedNameStatus 
               
               
                   
                   
                   
                 is ‘released’ and 
               
               
                   
                   
                   
                 MedNameError is 
               
               
                   
                   
                   
                 ‘corrected’ - go to 
               
               
                   
                   
                   
                 102 
               
               
                   
                   
                   
                 If MedNameStatus 
               
               
                   
                   
                   
                 is ‘released’ and 
               
               
                   
                   
                   
                 MedNameError is 
               
               
                   
                   
                   
                 ‘no error’ - go to 
               
               
                   
                   
                   
                 103 
               
               
                   
                   
                   
                 Go to 101 
               
               
                 101 
                 Med name check 
                 Are you 
                 1 - go to 110 
                 MedName[MedNum] (EX) 
               
               
                   
                 prompt 
                 taking . . . ? 
                 2 - go to 105 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 102 
                 Med name check 
                 Is this correct? 
                 1 - go to 110 
                 MedName[MedNum] (EX) 
               
               
                   
                 update prompt 
                   
                 2 - go to 105 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 103 
                 Med name check 
                 Are you 
                 1 - go to 110 
                 MedName[MedNum] (EX) 
               
               
                   
                 update wrong 
                 taking . . . ? 
                 2 - go to 105 
               
               
                   
                 prompt 
                   
                 Other entries? 
               
               
                 105 
                 Med name check 
                 Wrong med 
                 Go to 180 
                   
                 MedNameStatus[MedNum] 
               
               
                   
                 discrepancy 
                 name. 
                   
                   
                 (IX) - set to ‘on hold’ 
               
               
                   
                 message 
               
               
                 110 
                 Med dose 
                 Miss any 
                 1 - go to 120 
                 MedName[MedNum] (EX) 
                 MedMissDose[MedNum] 
               
               
                   
                 compliance 
                 yesterday? 
                 2 - go to 120 
                   
                 (IX) 
               
               
                   
                 prompt 
                   
                 Other entries? 
               
               
                 120 
                 Med dose count 
                 Placeholder 
                 If MedCountStatus 
                 MedCountStatus[MedNum] 
               
               
                   
                 logic 
                   
                 is ‘on hold’ - go to 
                 (EF) 
               
               
                   
                   
                   
                 180 
               
               
                   
                   
                   
                 If MedCountStatus 
               
               
                   
                   
                   
                 is ‘released’ AND 
               
               
                   
                   
                   
                 MedCountError is 
               
               
                   
                   
                   
                 ‘corrected’ - go to 
               
               
                   
                   
                   
                 122 
               
               
                   
                   
                   
                 If MedCountStatus 
               
               
                   
                   
                   
                 is ‘released’ AND 
               
               
                   
                   
                   
                 MedCountError is 
               
               
                   
                   
                   
                 ‘no error’ - go to 
               
               
                   
                   
                   
                 123 
               
               
                   
                   
                   
                 Else go to 121 
               
               
                 121 
                 Med dose count 
                 How many pills? 
                 Go to 124 
                 MedName[MedNum] (EX) 
                 MedCount[MedNum] (IF) 
               
               
                   
                 prompt 
               
               
                 122 
                 Med dose count 
                 Corrected 
                 Go to 121 
                 MedName[MedNum] (EX) 
                 MedCount[MedNum] (IF) 
               
               
                   
                 update message 
                   
                   
                 MedDoseCount[MedNum] 
               
               
                   
                   
                   
                   
                 (EX) 
               
               
                 123 
                 Med dose count 
                 Please check 
                 Go to 121 
                 MedName[MedNum] (EX) 
                 MedCount[MedNum] (IF) 
               
               
                   
                 update wrong 
                   
                   
                 MedDoseCount[MedNum] 
               
               
                   
                 message 
                   
                   
                 (EX) 
               
               
                 124 
                 Med dose count 
                 Placeholder 
                 If MedCount is 0 
                 MedCount[MedNum] (IF) 
               
               
                   
                 check 
                   
                 OR MedCount not 
                 MedDoseCount[MedNum] 
               
               
                   
                   
                   
                 equal to 
                 (EF) 
               
               
                   
                   
                   
                 MedDoseCount -  
               
               
                   
                   
                   
                 go to 126 
               
               
                   
                   
                   
                 Else go to 125 
               
               
                 125 
                 Med dose count 
                 Good work. 
                 Go to 180 
               
               
                   
                 correct message 
               
               
                 126 
                 Med dose count 
                 Did doc change 
                 1 - go to 127 
                   
                 DoseChange[MedNum] 
               
               
                   
                 confirm prompt 
                 dose? 
                 2 - go to 128 
                   
                 (IX) 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 127 
                 Valid med dose 
                 We&#39;re checking. 
                 Go to 180 
                   
                 MedCountStatus[MedNum] 
               
               
                   
                 change message 
                   
                   
                   
                 (IX) (set to ‘on hold’) 
               
               
                 128 
                 Invalid med dose 
                 Placeholder 
                 If MedCount is 0 
                 MedCount[MedNum] (IF) 
               
               
                   
                 change 
                   
                 OR MedCount less 
                 MedDoseCount[MedNum] 
               
               
                   
                   
                   
                 than 
                 (EF) 
               
               
                   
                   
                   
                 MedDoseCount -  
               
               
                   
                   
                   
                 go to 140 
               
               
                   
                   
                   
                 Else go to 160 
               
               
                 140 
                 Med number 
                 Placeholder 
                 If MedNumber &gt; 1 -  
                 MedNum (IS) 
               
               
                   
                 check 
                   
                 go to 150 
               
               
                   
                   
                   
                 Else go to 141 
               
               
                 141 
                 Med underdose 
                 Why? 
                 1 - go to 142 
                   
                 MedUnderDose[MedNum] 
               
               
                   
                 prompt 
                   
                 2 - go to 143 
                   
                 (IX) 
               
               
                   
                   
                   
                 3 - go to 144 
               
               
                   
                   
                   
                 4 - go to 145 
               
               
                   
                   
                   
                 5 - go to 146 
               
               
                   
                   
                   
                 6 - go to 120 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 142 
                 Med ran out 
                 Info 
                 Go to 148 
               
               
                   
                 message 
               
               
                 143 
                 Med forgot 
                 Info 
                 Go to 148 
               
               
                   
                 message 
               
               
                 144 
                 Med think correct 
                 Info 
                 Go to 148 
               
               
                   
                 message 
               
               
                 145 
                 Med reduce side 
                 Info 
                 If Lithium true - go 
                 Lithium (EF) 
               
               
                   
                 effects message 
                   
                 to 147 
               
               
                   
                   
                   
                 Else, go to 148 
               
               
                 146 
                 Med used to feel 
                 Info 
                 If Lithium true - go 
                 Lithium (EF) 
               
               
                   
                 message 
                   
                 to 147 
               
               
                   
                   
                   
                 Else, go to 148 
               
               
                 147 
                 Med lithium extra 
                 Info 
                 Go to 148 
               
               
                 148 
                 Med zero check 
                 Placeholder 
                 If MedCount = 0, 
                   
                 MedZero[MedNum] (IX) 
               
               
                   
                   
                   
                 set the MedZero 
               
               
                   
                   
                   
                 flag 
               
               
                   
                   
                   
                 Go to 160 
               
               
                 150 
                 Alt Med 
                 Why? 
                 1 - go to 142 
                   
                 MedUnderDose[MedNum] 
               
               
                   
                 underdose 
                   
                 2 - go to 143 
                   
                 (IX) 
               
               
                   
                 prompt 
                   
                 3 - go to 144 
               
               
                   
                   
                   
                 4 - go to 145 
               
               
                   
                   
                   
                 5 - go to 146 
               
               
                   
                   
                   
                 6 - go to 120 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 151 
                 Alt Med 
                 Info 
                 Go to 148 
               
               
                   
                 underdose 
               
               
                   
                 message 
               
               
                 160 
                 Med overdose 
                 You overdosed. 
                 Set MedOverdose 
                   
                 MedOverdose[MedNum] 
               
               
                   
                 prompt 
                   
                 AND 
                   
                 (IX) 
               
               
                   
                   
                   
                 1 - go to 160 
               
               
                   
                   
                   
                 2 - end call 
               
               
                   
                   
                   
                 3 - go to 180 
               
               
                   
                   
                   
                 4 - go to 120 
               
               
                   
                   
                   
                 5 - go to 180 
               
               
                   
                   
                   
                 Other entries? 
               
               
                 180 
                 Med section 
                 Placeholder 
                 Increment 
                 MedsTotal (EF) 
               
               
                   
                 loop 
                   
                 MedNumber 
                 MedNum (IS) 
               
               
                   
                   
                   
                 If MedNumber 
               
               
                   
                   
                   
                 greater than 
               
               
                   
                   
                   
                 MedsTotal - go to 
               
               
                   
                   
                   
                 200 
               
               
                   
                   
                   
                 Else, go to 100 
               
             
          
           
               
                 MOOD (200-299) 
               
             
          
           
               
                 200 
                 Mood review 
                 Placeholder 
                 If first contact, go 
                 FirstTime (EF) 
                   
               
               
                   
                   
                   
                 to 210 
               
               
                   
                   
                   
                 Else, go to 201 
               
               
                 201 
                 Mood review 
                 Review your 
                 Go to 202 
               
               
                   
                 introduction 
                 mood. 
               
               
                   
                 message 
               
               
                 202 
                 Mood review 
                 Placeholder 
                 If MoodMissLong 
                 MoodMissLong (EF) 
               
               
                   
                 logic 
                   
                 is true, go to 205 
                 MoodYesterday (EF) 
               
               
                   
                   
                   
                 If MoodYesterday 
                 MoodLastSplit (EF) 
               
               
                   
                   
                   
                 is false, go to 203 
               
               
                   
                   
                   
                 If MoodLastSplit 
               
               
                   
                   
                   
                 is true, go to 204 
               
               
                   
                   
                   
                 Else, go to 206 
               
               
                 203 
                 Mood review 
                 Need every 
                 Go to 210 
                 DoctorName (EX) 
               
               
                   
                 option 1 
                 day. 
               
               
                   
                 message 
               
               
                 204 
                 Mood review 
                 Last time split. 
                 Go to 210 
                 MoodCycleOne (EF) 
               
               
                   
                 option 2 
                   
                   
                 MoodCycleTwo (EF) 
               
               
                   
                 message 
               
               
                 205 
                 Mood review 
                 No rating for 
                 Go to 210 
                 DoctorName (EX) 
               
               
                   
                 option 3 
                 days. 
               
               
                   
                 message 
               
               
                 206 
                 Mood review 
                 Last time you 
                 Go to 210 
                 MoodRatingPrev (EF) 
               
               
                   
                 option 4 
                 rated. 
               
               
                   
                 message 
               
               
                 210 
                 Split mood 
                 Switching 
                 1 - go to 230 
                   
                 MoodSplit (IF) 
               
               
                   
                 check 
                 moods? 
                 2 - go to 220 
               
               
                   
                 prompt 
                   
                 9 - go to 215 
               
               
                   
                   
                   
                 Other - go to 219 
               
               
                 215 
                 Mood cycle 
                 Split examples. 
                 Go to 210 
               
               
                   
                 examples 
               
               
                   
                 message 
               
               
                 219 
                 Split mood 
                 Problem with 
                 Go to 210 
               
               
                   
                 check error 
                 entry. 
               
               
                   
                 message 
               
               
                 220 
                 Mood input 
                 Now you will 
                 Go to 221 
               
               
                   
                 introduction 
                 rate. 
               
               
                   
                 message 
               
               
                 221 
                 Mood input 
                 On a scale of 
                 Go to 222 
               
               
                   
                 message 
                 . . . 
               
               
                 222 
                 Mood input 
                 How did you 
                 0 to 100 - go to 
                   
                 MoodRating (IF) 
               
               
                   
                 prompt 
                 feel today? 
                 300 
               
               
                   
                   
                   
                 999 - go to 225 
               
               
                   
                   
                   
                 Other entry - go to 
               
               
                   
                   
                   
                 229 
               
               
                 225 
                 Mood input 
                 Examples. 
                 Go to 222 
               
               
                   
                 examples 
               
               
                   
                 message 
               
               
                 229 
                 Mood input 
                 Entry problem. 
                 Go to 222 
               
               
                   
                 error 
               
               
                   
                 message 
               
               
                 230 
                 Mood cycle 
                 Please note 
                 Go to 231 
               
               
                   
                 check 
                 that . . . 
               
               
                   
                 message 
               
               
                 231 
                 Mood cycle 
                 Continue with 
                 1 - go to 240 
               
               
                   
                 check prompt 
                 cycle? 
                 2 - go to 210 
               
               
                   
                   
                   
                 Other entry - go to 
               
               
                   
                   
                   
                 239 
               
               
                 239 
                 Mood cycle 
                 Entry problem. 
                 Go to 231 
               
               
                   
                 check error 
               
               
                   
                 message 
               
               
                 240 
                 Mood cycle 
                 Highest mood 
                 0 to 100 - go to 
                   
                 MoodCycleval1 (IF) 
               
               
                   
                 one prompt 
                 today? 
                 250 
               
               
                   
                   
                   
                 Other entry - go to 
               
               
                   
                   
                   
                 249 
               
               
                 249 
                 Mood cycle 
                 Entry problem. 
                 Go to 240 
               
               
                   
                 one error 
               
               
                   
                 message 
               
               
                 250 
                 Mood cycle 
                 Lowest mood 
                 0 to 100 - go to 
                   
                 MoodCycleVal2 (IF) 
               
               
                   
                 two prompt 
                 today? 
                 260 
               
               
                   
                   
                   
                 Other entry - go to 
               
               
                   
                   
                   
                 259 
               
               
                 259 
                 Mood cycle 
                 Entry problem. 
                 Go to 250 
               
               
                   
                 two error 
               
               
                   
                 message 
               
               
                 260 
                 Mood cycle 
                 Number of 
                 0 to 100 - go to 
                   
                 MoodCycleCount (IX) 
               
               
                   
                 count 
                 cycles? 
                 300 
               
               
                   
                 prompt 
                   
                 Other entry - go to 
               
               
                   
                   
                   
                 269 
               
               
                 269 
                 Mood cycle 
                 Entry problem. 
                 Go to 260 
               
               
                   
                 count error 
               
               
                   
                 message 
               
             
          
           
               
                 SEVERITY (300-399) 
               
             
          
           
               
                 300 
                 Severity 
                 Placeholder 
                 If first contact, go to 
                 FirstTime (EF) 
                   
               
               
                   
                 review 
                   
                 310 
               
               
                   
                   
                   
                 Else, go to 301 
               
               
                 301 
                 Severity review 
                 Review 
                 Go to 302 
               
               
                   
                 introduction 
                 severity. 
               
               
                   
                 message 
               
               
                 302 
                 Severity review 
                 Placeholder 
                 If MoodLastSplit is 
                 MoodLastSplit (EF) 
               
               
                   
                 logic 
                   
                 true, go to 303 
                 SeverityLast (EF) 
               
               
                   
                   
                   
                 If SeverityLast is false, 
                 SeverityNoCnt (EF) 
               
               
                   
                   
                   
                 go to 304 
               
               
                   
                   
                   
                 If SeverityNoCnt is 
               
               
                   
                   
                   
                 more than 6, go to 305 
               
               
                   
                   
                   
                 Else, go to 306 
               
               
                 303 
                 Severity review 
                 Last time 
                 Go to 310 
                 ImpairRate1 (EX) 
               
               
                   
                 option 1 
                 split. 
                   
                 ImpairRate2 (EX) 
               
               
                   
                 message 
               
               
                 304 
                 Severity review 
                 Last time 
                 Go to 310 
                 DoctorName (EX) 
               
               
                   
                 option 2 
                 none. 
               
               
                   
                 message 
               
               
                 305 
                 Severity review 
                 None past 7 
                 Go to 310 
                 DoctorName (EX) 
               
               
                   
                 option 3 
                 days. 
               
               
                   
                 message 
               
               
                 306 
                 Severity review 
                 Last time 
                 Go to 310 
                 SeverRate (EX) 
               
               
                   
                 option 4 
                 entered. 
               
               
                   
                 message 
               
               
                 310 
                 Severity input 
                 Placeholder 
                 If MoodSplit is true, go 
                 MoodSplit (IF) 
               
               
                   
                 check 
                   
                 to 330 
               
               
                   
                   
                   
                 Else, go to 311 
               
               
                 311 
                 Severity input 
                 Now rate 
                 If MoodRating 0 to 49, 
                 MoodRating (IF) 
               
               
                   
                 introduction 
                 mood. 
                 go to 312 
               
               
                   
                 message 
                   
                 If MoodRating 51 to 
               
               
                   
                   
                   
                 100, go to 313 
               
               
                   
                   
                   
                 If MoodRating is 50, 
               
               
                   
                   
                   
                 go to 314 
               
               
                 312 
                 Severity input 
                 Mood 
                 Go to 315 
               
               
                   
                 low message 
                 appears 
               
               
                   
                   
                 down 
               
               
                 313 
                 Severity input 
                 Mood 
                 Go to 316 
               
               
                   
                 high message 
                 appears up. 
               
               
                 314 
                 Severity input 
                 Mood 
                 Go to 317 
               
               
                   
                 mid message 
                 appears 
               
               
                   
                   
                 norm 
               
               
                 315 
                 Severity input 
                 Enter impair 
                 0 - go to 500 
                   
                 ImpairRate (IF) 
               
               
                   
                 low prompt 
                 level? 
                 1 to 4 - go to 321 
                   
                 ImpairType (IF) 
               
               
                   
                   
                   
                 9 - go to 380 
                   
                 (depressed) 
               
               
                   
                   
                   
                 Other entry - go to 319 
                   
                 ExplainReturn (IS) 
               
               
                   
                   
                   
                   
                   
                 (315) 
               
               
                 316 
                 Severity input 
                 Enter impair 
                 0 - go to 500 
                   
                 ImpairRate (IF) 
               
               
                   
                 high prompt 
                 level? 
                 1 to 4 - go to 318 
                   
                 ImpairType (IF) 
               
               
                   
                   
                   
                 9 - go to 380 
                   
                 (manic) 
               
               
                   
                   
                   
                 Other entry - go to 319 
                   
                 ExplainReturn (IS) 
               
               
                   
                   
                   
                   
                   
                 (316) 
               
               
                 317 
                 Severity input 
                 Enter impair 
                 0 - go to 500 
                   
                 ImpairRate (IF) 
               
               
                   
                 mid prompt 
                 level? 
                 1 - go to 316 
                   
                 ImpairType (IF) 
               
               
                   
                   
                   
                 2 - go to 315 
                   
                 (normal) 
               
               
                   
                   
                   
                 Other entry - go to 319 
               
               
                 318 
                 Dysphoric 
                 Unhappy? 
                 1 (yes) - go to 321 
                   
                 DysphoricFlag (IX) 
               
               
                   
                 check prompt 
                   
                 2 (no) - go to 321 
               
               
                   
                   
                   
                 Other entry (go to 
               
               
                   
                   
                   
                 320)? 
               
               
                 319 
                 Severity input 
                 Entry 
                 Go to 311 
               
               
                   
                 error message 
                 problem. 
               
               
                 320 
                 Dysphoric 
                 Entry 
                 Go to 318 
               
               
                   
                 check error 
                 Problem 
               
               
                   
                 (if needed) 
               
               
                 321 
                 Severity flags 
                 Placeholder 
                 If ImpairType is manic 
                 ImpairRate (IF) 
               
               
                   
                   
                   
                 AND ImpairRate is 3, 
                 ImpairType (IF) 
               
               
                   
                   
                   
                 go to 322 
               
               
                   
                   
                   
                 If ImpairType is manic 
               
               
                   
                   
                   
                 AND ImpairRate is 4, 
               
               
                   
                   
                   
                 go to 323 
               
               
                   
                   
                   
                 If ImpairType is 
               
               
                   
                   
                   
                 depressed AND 
               
               
                   
                   
                   
                 ImpairRate is 3, go to 
               
               
                   
                   
                   
                 324 
               
               
                   
                   
                   
                 If ImpairType is 
               
               
                   
                   
                   
                 depressed AND 
               
               
                   
                   
                   
                 ImpairRate is 4, go to 
               
               
                   
                   
                   
                 325 
               
               
                   
                   
                   
                 Else, go to 500 
               
               
                 322 
                 Severity flags 
                 High mania. 
                 Go to 326 
               
               
                   
                 high mania 
               
               
                   
                 message 
               
               
                 323 
                 Severity flags 
                 Severe 
                 Go to 326 
               
               
                   
                 severe mania 
                 mania. 
               
               
                   
                 message 
               
               
                 324 
                 Severity flags 
                 High 
                 Go to 327 
               
               
                   
                 high 
                 depression. 
               
               
                   
                 depression 
               
               
                   
                 message 
               
               
                 325 
                 Severity flags 
                 Severe 
                 Go to 327 
               
               
                   
                 severe 
                 depression. 
               
               
                   
                 depression 
               
               
                   
                 message 
               
               
                 326 
                 Severity flags 
                 Severe 
                 Go to 328 
               
               
                   
                 mania message 
                 mania. 
               
               
                 327 
                 Severity flags 
                 Severe 
                 Go to 328 
               
               
                   
                 depression 
                 depression. 
               
               
                   
                 message 
               
               
                 328 
                 Severity flags 
                 Continue? 
                 1 - go to 321 
                   
                 ExtremeImpair (IX) 
               
               
                   
                 prompt 
                   
                 2 - end call 
               
               
                   
                   
                   
                 3 - 500 
               
               
                   
                   
                   
                 Other entry? 
               
               
                 330 
                 Severity input 
                 Rate both 
                 Go to 340 
               
               
                   
                 split message 
                 moods. 
               
               
                 340 
                 Split one 
                 Placeholder 
                 If MoodCycleVal1 is 0 
                 MoodCycleVal1 (IF) 
               
               
                   
                 severity input 
                   
                 to 49, go to 341 
               
               
                   
                   
                   
                 If MoodCycleVal1 is 51 
               
               
                   
                   
                   
                 to 100, go to 342 
               
               
                   
                   
                   
                 If MoodCycleVal1 is 
               
               
                   
                   
                   
                 50, go to 343 
               
               
                 341 
                 Split one 
                 Mood 
                 Go to 344 
               
               
                   
                 severity input 
                 appears 
               
               
                   
                 low message 
                 down 
               
               
                 342 
                 Split one 
                 Mood 
                 Go to 345 
               
               
                   
                 severity input 
                 appears up. 
               
               
                   
                 high message 
               
               
                 343 
                 Split one 
                 Mood 
                 Go to 346 
               
               
                   
                 severity input 
                 appears 
               
               
                   
                 mid message 
                 norm 
               
               
                 344 
                 Split one 
                 Enter impair 
                 0 - go to 360 
                   
                 ImpairRate1 (IF) 
               
               
                   
                 severity input 
                 level? 
                 1 to 4 - go to 350 
                   
                 ImpairType1 (IF) 
               
               
                   
                 low prompt 
                   
                 9 - go to 380 
                   
                 (depressed) 
               
               
                   
                   
                   
                 Other entry - go to 349 
                   
                 ExplainReturn (IS) 
               
               
                   
                   
                   
                   
                   
                 (344) 
               
               
                 345 
                 Split one 
                 Enter impair 
                 0 - go to 360 
                   
                 ImpairRate1 (IF) 
               
               
                   
                 severity input 
                 level? 
                 1 to 4 - go to 347 
                   
                 ImpairType1 (IF) 
               
               
                   
                 high prompt 
                   
                 9 - go to 380 
                   
                 (manic) 
               
               
                   
                   
                   
                 Other entry - go to 349 
                   
                 ExplainReturn (IS) 
               
               
                   
                   
                   
                   
                   
                 (345) 
               
               
                 346 
                 Split one 
                 Enter impair 
                 0 - go to 360 
                   
                 ImpairRate1 (IF) 
               
               
                   
                 severity input 
                 level? 
                 1 - go to 345 
                   
                 ImpairType1 (IF) 
               
               
                   
                 mid prompt 
                   
                 2 - go to 344 
                   
                 (normal) 
               
               
                   
                   
                   
                 Other entry - go to 349 
               
               
                 347 
                 Split one 
                 Unhappy? 
                 1 (yes) - go to 350 
                   
                 DysphoricFlag1 (IX) 
               
               
                   
                 dysphoric 
                   
                 2 (no) - go to 350 
               
               
                   
                 check prompt 
                   
                 Other entry? (go to 
               
               
                   
                   
                   
                 348?) 
               
               
                 348 
                 Split one 
                 Entry 
                 Go to 347 
               
               
                   
                 dysphoric 
                 problem. 
               
               
                   
                 check error (if 
               
               
                   
                 needed) 
               
               
                 349 
                 Split one 
                 Entry 
                 Go to 340 
               
               
                   
                 severity input 
                 problem. 
               
               
                   
                 error message 
               
               
                 350 
                 Split one 
                 Placeholder 
                 If ImpairType1 is 
                 ImpairRate1 (IF) 
               
               
                   
                 severity flags 
                   
                 manic AND 
                 ImpairType1 (IF) 
               
               
                   
                   
                   
                 ImpairRate1 is 3, go to 
               
               
                   
                   
                   
                 351 
               
               
                   
                   
                   
                 If ImpairType1 is 
               
               
                   
                   
                   
                 manic AND 
               
               
                   
                   
                   
                 ImpairRate1 is 4, go to 
               
               
                   
                   
                   
                 352 
               
               
                   
                   
                   
                 If ImpairType1 is 
               
               
                   
                   
                   
                 depressed AND 
               
               
                   
                   
                   
                 ImpairRate1 is 3, go to 
               
               
                   
                   
                   
                 353 
               
               
                   
                   
                   
                 If ImpairType1 is 
               
               
                   
                   
                   
                 depressed AND 
               
               
                   
                   
                   
                 ImpairRate1 is 4, go to 
               
               
                   
                   
                   
                 354 
               
               
                   
                   
                   
                 Else, go to 360 
               
               
                 351 
                 Split one 
                 High mania. 
                 Go to 355 
               
               
                   
                 severity flags 
               
               
                   
                 high mania 
               
               
                   
                 message 
               
               
                 352 
                 Split one 
                 Severe 
                 Go to 355 
               
               
                   
                 severity flags 
                 mania. 
               
               
                   
                 severe mania 
               
               
                   
                 message 
               
               
                 353 
                 Split one 
                 High 
                 Go to 356 
               
               
                   
                 severity flags 
                 depression. 
               
               
                   
                 high depression 
               
               
                   
                 message 
               
               
                 354 
                 Split one 
                 Severe 
                 Go to 356 
               
               
                   
                 severity flags 
                 depression. 
               
               
                   
                 severe 
               
               
                   
                 depression 
               
               
                   
                 message 
               
               
                 355 
                 Split one 
                 Severe 
                 Go to 357 
               
               
                   
                 severity flags 
                 mania. 
               
               
                   
                 mania message 
               
               
                 356 
                 Split one 
                 Severe 
                 Go to 357 
               
               
                   
                 severity flags 
                 depression. 
               
               
                   
                 depression 
               
               
                   
                 message 
               
               
                 357 
                 Split one 
                 Continue? 
                 1 - go to 350 
                   
                 ExtremeImpair1 (IX) 
               
               
                   
                 severity flags 
                   
                 2 - end call 
               
               
                   
                 prompt 
                   
                 3 - 360 
               
               
                   
                   
                   
                 Other entry? 
               
               
                 360 
                 Split two 
                 Placeholder 
                 If MoodCycleVal2 is 0 
                 MoodCycleVal2 (IF) 
               
               
                   
                 severity input 
                   
                 to 49, go to 361 
               
               
                   
                   
                   
                 If MoodCycleVal2 is 51 
               
               
                   
                   
                   
                 to 100, go to 362 
               
               
                   
                   
                   
                 If MoodCycleVal2 is 
               
               
                   
                   
                   
                 50, go to 363 
               
               
                 361 
                 Split two 
                 Mood 
                 Go to 364 
               
               
                   
                 severity input 
                 appears 
               
               
                   
                 low message 
                 down 
               
               
                 362 
                 Split two 
                 Mood 
                 Go to 365 
               
               
                   
                 severity input 
                 appears up. 
               
               
                   
                 high message 
               
               
                 363 
                 Split two 
                 Mood 
                 Go to 366 
               
               
                   
                 severity input 
                 appears 
               
               
                   
                 mid message 
                 norm 
               
               
                 364 
                 Split two 
                 Enter impair 
                 0 - go to 500 
                   
                 ImpairRate2 (IF) 
               
               
                   
                 severity input 
                 level? 
                 1 to 4 - go to 370 
                   
                 ImpairType2 (IF) 
               
               
                   
                 low prompt 
                   
                 9 - go to 380 
                   
                 (depressed) 
               
               
                   
                   
                   
                 Other entry - go to 369 
                   
                 ExplainReturn (IS) 
               
               
                   
                   
                   
                   
                   
                 (364) 
               
               
                 365 
                 Split two 
                 Enter impair 
                 0 - go to 500 
                   
                 ImpairRate2 (IF) 
               
               
                   
                 severity input 
                 level? 
                 1 to 4 - go to 367 
                   
                 ImpairType2 (IF) 
               
               
                   
                 high prompt 
                   
                 9 - go to 380 
                   
                 (manic) 
               
               
                   
                   
                   
                 Other entry - go to 369 
                   
                 ExplainReturn (IS) 
               
               
                   
                   
                   
                   
                   
                 (365) 
               
               
                 366 
                 Split two 
                 Enter impair 
                 0 - go to 500 
                   
                 ImpairRate2 (IF) 
               
               
                   
                 severity input 
                 level? 
                 1 - go to 365 
                   
                 ImpairType2 (IF) 
               
               
                   
                 mid prompt 
                   
                 2 - go to 364 
                   
                 (normal) 
               
               
                   
                   
                   
                 Other entry - go to 369 
               
               
                 367 
                 Split two 
                 Unhappy? 
                 1 (yes) - go to 370 
                   
                 DysphoricFlag2 (IX) 
               
               
                   
                 dysphoric 
                   
                 2 (no) - go to 370 
               
               
                   
                 check prompt 
                   
                 Other entry? (go to 
               
               
                   
                   
                   
                 368?) 
               
               
                 368 
                 Split two 
                 Entry 
                 Go to 367 
               
               
                   
                 dysphoric 
                 problem. 
               
               
                   
                 check error 
               
               
                 369 
                 Split two 
                 Entry 
                 Go to 360 
               
               
                   
                 severity input 
                 problem. 
               
               
                   
                 error message 
               
               
                 370 
                 Split two 
                 Placeholder 
                 If ImpairType2 is 
                 ImpairRate2 (IF) 
               
               
                   
                 severity flags 
                   
                 manic AND 
                 ImpairType2 (IF) 
               
               
                   
                   
                   
                 ImpairRate2 is 3, go to 
               
               
                   
                   
                   
                 371 
               
               
                   
                   
                   
                 If ImpairType2 is 
               
               
                   
                   
                   
                 manic AND 
               
               
                   
                   
                   
                 ImpairRate2 is 4, go to 
               
               
                   
                   
                   
                 372 
               
               
                   
                   
                   
                 If ImpairType2 is 
               
               
                   
                   
                   
                 depressed AND 
               
               
                   
                   
                   
                 ImpairRate2 is 3, go to 
               
               
                   
                   
                   
                 373 
               
               
                   
                   
                   
                 If ImpairType2 is 
               
               
                   
                   
                   
                 depressed AND 
               
               
                   
                   
                   
                 ImpairRate2 is 4, go to 
               
               
                   
                   
                   
                 374 
               
               
                   
                   
                   
                 Else, go to 500 
               
               
                 371 
                 Split one 
                 High mania. 
                 Go to 375 
               
               
                   
                 severity flags 
               
               
                   
                 high mania 
               
               
                   
                 message 
               
               
                 372 
                 Split one 
                 Severe 
                 Go to 375 
               
               
                   
                 severity flags 
                 mania. 
               
               
                   
                 severe mania 
               
               
                   
                 message 
               
               
                 373 
                 Split one 
                 High 
                 Go to 376 
               
               
                   
                 severity flags 
                 depression. 
               
               
                   
                 high depression 
               
               
                   
                 message 
               
               
                 374 
                 Split one 
                 Severe 
                 Go to 376 
               
               
                   
                 severity flags 
                 depression. 
               
               
                   
                 severe 
               
               
                   
                 depression 
               
               
                   
                 message 
               
               
                 375 
                 Split two 
                 Severe 
                 Go to 377 
               
               
                   
                 severity flags 
                 mania. 
               
               
                   
                 mania message 
               
               
                 376 
                 Split two 
                 Severe 
                 Go to 377 
               
               
                   
                 severity flags 
                 depression. 
               
               
                   
                 depression 
               
               
                   
                 message 
               
               
                 377 
                 Split two 
                 Continue? 
                 1 - go to 370 
                   
                 ExtremeImpair2 (IX) 
               
               
                   
                 severity flags 
                   
                 2 - end call 
               
               
                   
                 prompt 
                   
                 3 - 500 
               
               
                   
                   
                   
                 Other entry? 
               
               
                 380 
                 Severity 
                 Placeholder 
                 If ImpairType is 
                 ImpairType (IF) 
               
               
                   
                 explain 
                   
                 depressed, go to 381 
                 ImpairType1 (IF) 
               
               
                   
                   
                   
                 Else, go to 382 
                 ImpairType2 (IF) 
               
               
                 381 
                 Severity explain 
                 Explain 
                 1 - go to 391 
                 ExplainReturn (IS) 
               
               
                   
                 depression 
                 depression 
                 2 - go to 392 
               
               
                   
                 prompt 
                   
                 3 - go to 393 
               
               
                   
                   
                   
                 4 - go to 394 
               
               
                   
                   
                   
                 9 - go to 
               
               
                   
                   
                   
                 ExplainReturn 
               
               
                   
                   
                   
                 Other entry - go to 389 
               
               
                 382 
                 Severity explain 
                 Explain 
                 1 - go to 395 
                 ExplainReturn (IS) 
               
               
                   
                 mania prompt 
                 mania 
                 2 - go to 396 
               
               
                   
                   
                   
                 3 - go to 397 
               
               
                   
                   
                   
                 4 - go to 398 
               
               
                   
                   
                   
                 9 - go to 
               
               
                   
                   
                   
                 ExplainReturn 
               
               
                   
                   
                   
                 Other entry - go to 389 
               
               
                 389 
                 Severity explain 
                 Entry 
                 Go to 380 
               
               
                   
                 error 
                 problem. 
               
               
                 391 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 depression 1 
                 depress 1 
               
               
                   
                 message 
               
               
                 392 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 depression 2 
                 depress 2 
               
               
                   
                 message 
               
               
                 393 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 depression 3 
                 depress 3 
               
               
                   
                 message 
               
               
                 394 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 depression 4 
                 depress 4 
               
               
                   
                 message 
               
               
                 395 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 mania 1 
                 mania 1 
               
               
                   
                 message 
               
               
                 396 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 mania 2 
                 mania 2 
               
               
                   
                 message 
               
               
                 397 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 mania 3 
                 mania 3 
               
               
                   
                 message 
               
               
                 398 
                 Severity explain 
                 Explain 
                 Go to 380 
               
               
                   
                 mania 4 
                 mania 4 
               
               
                   
                 message 
               
             
          
           
               
                 SLEEP (500-599) 
               
             
          
           
               
                 500 
                 Sleep review 
                 Placeholder 
                 If first contact, go to 
                 FirstTime (EF) 
                   
               
               
                   
                   
                   
                 505 
                 NoSleepHours (EF) 
               
               
                   
                   
                   
                 If NoSleepHours is 
               
               
                   
                   
                   
                 true, go to 502 
               
               
                   
                   
                   
                 Else, go to 501 
               
               
                 501 
                 Sleep review 
                 Yesterday&#39;s hours. 
                 Go to 505 
                 SleepHours (EX) 
               
               
                   
                 message 
               
               
                 502 
                 Sleep review no 
                 Nothing from 
                 Go to 505 
               
               
                   
                 yesterday message 
                 yesterday. 
               
               
                 505 
                 Sleep review input 
                 How many hours 
                 0 to 24 - go to 600 
                   
                 SleepHours (IX) 
               
               
                   
                 prompt 
                 sleep? 
                 Other entry - go to 
               
               
                   
                   
                   
                 509 
               
               
                 509 
                 Sleep review input 
                 Entry problem. 
                 Go to 505 
               
               
                   
                 error message 
               
             
          
           
               
                 CONCLUSION (600-699) 
               
             
          
           
               
                 600 
                 Conclusion message 
                 Thanks &amp; goodbye. 
                 End call 
                 DoctorName (EX) 
               
               
                   
               
             
          
         
       
     
         [0338]    
       
         
               
             
               
               
               
               
               
               
             
           
               
                 TABLE VIII 
               
             
             
               
                   
               
               
                   
               
               
                 Variable definitions 
               
               
                 Variables: 
               
               
                 varName (EF) - external flag variable for condition tests, provided via csv file. 
               
               
                 varName (EX) - external string variable used within text scripts, provided via csv file. 
               
               
                 varName (IF) - internal flag variable that needs persistance, captured locally. 
               
               
                 varName (IX) - internal variable to be returned, captured locally and returned via csv file. 
               
               
                 varName (IS) - internal flag variable used internally at runtime, not captured. 
               
               
                 PAR3 variables are shaded. 
               
             
          
           
               
                 Name 
                 Description 
                 Type 
                 Who 
                 Needed 
                 Collected 
               
               
                   
               
               
                 PatientName (EX) 
                 Name of patient. Used in message. 
                 Text 
                 Redmon 
                 10, 20 
                   
               
               
                 StudyTitle (EX) 
                 Name of study. Used in message. 
                 Text 
                 Redmon 
                  10 
               
               
                 CallBack (IX) 
                 Identifies a patient that will call back 
                 Boolean 
                 PAR3 
                   
                  25 
               
               
                   
                 at a later time. 
               
               
                 BadCall (IX) 
                 Identifies a bad call such as a wrong 
                 Boolean 
                 PAR3 
                   
                  29 
               
               
                   
                 number. 
               
               
                 PatientID (EF) 
                 Patient identifier used to check for 
                 Text 
                 Redmon 
                  30 
               
               
                   
                 correct call. 
               
               
                 PatientID (IX) 
                 Patient identifier collected to identify 
                 Text 
                 PAR3 
                   
                  35 
               
               
                   
                 the patient that is calling back. 
               
               
                 DoctorName (EX) 
                 Name of patient&#39;s doctor. Used in 
                 Text 
                 Redmon 
                 40, 203, 
               
               
                   
                 message. 
                   
                   
                 205, 304, 
               
               
                   
                   
                   
                   
                 305, 600 
               
               
                 Suicide (IX) 
                 Indicates suicide plan. 
                 Boolean 
                 PAR3 
                   
                  55 
               
               
                   
                 This flag should alert an 
               
               
                   
                 administrator. 
               
               
                 EdOp (IF) 
                 Indicates the education option 
                 Integer 
                 PAR3 
                  70 
                 61, 62, 63 
               
               
                   
                 played. 
               
               
                 Lithium (EF) 
                 Indicates that the patient is on 
                 Boolean 
                 Redmon 
                 70, 145, 
               
               
                   
                 Lithium. Obtain from patient data. 
                   
                   
                 146 
               
               
                 MedNum (IS) 
                 This is a special counter that 
                 Integer 
                 PAR3 
                 140, 180 
               
               
                   
                 identifies which medicine is being 
               
               
                   
                 questioned. It is used to identify 
               
               
                   
                 many of the following variables. 
               
               
                   
                 This is a special variable that is 
               
               
                   
                 only used during the telephone 
               
               
                   
                 call. 
               
               
                 MedNameStatus[MedNum] (EF) 
                 Indicates the status of the current 
                 Integer 
                 Redmon 
                 100 
               
               
                   
                 medicine being questioned. On 
               
               
                   
                 hold, released with error corrected, 
               
               
                   
                 released with no error or normal. 
               
               
                   
                 This value is collected by PAR3 and 
               
               
                   
                 can be changed by administrators 
               
               
                   
                 before being returned to PAR3 in a 
               
               
                   
                 future session. 
               
               
                 MedNameStatus[MedNum] (IX) 
                 Same variable as above. Indicates 
                 Integer 
                 PAR3 
                   
                 105 
               
               
                   
                 the status of the current medicine 
               
               
                   
                 being questioned. Set to ‘On hold’ if 
               
               
                   
                 this item is used. 
               
               
                 MedName[MedNum] (EX) 
                 Name of the medicine used in the 
                 Text 
                 Redmon 
                 101, 102, 
               
               
                   
                 message. 
                   
                   
                 103, 110, 
               
               
                   
                   
                   
                   
                 121, 122, 
               
               
                   
                   
                   
                   
                 123 
               
               
                 MedMissDose[MedNum] (IX) 
                 Indicates that the patient missed this 
                 Boolean 
                 PAR3 
                   
                 110 
               
               
                   
                 medication yesterday. 
               
               
                 MedCountStatus[MedNum] (EF) 
                 Indicates the status of the count of 
                 Integer 
                 Redmon 
                 120 
               
               
                   
                 the current medicine being 
               
               
                   
                 questioned. On hold, released with 
               
               
                   
                 error corrected, released with no 
               
               
                   
                 error or normal. This value is 
               
               
                   
                 collected by PAR3 and can be 
               
               
                   
                 changed by administrators before 
               
               
                   
                 being returned to PAR3 in a future 
               
               
                   
                 session. 
               
               
                 MedCountStatus[MedNum] (IX) 
                 Same variable as above. Indicates 
                 Integer 
                 PAR3 
                   
                 127 
               
               
                   
                 the status of the count of the current 
               
               
                   
                 medicine being questioned. Set to 
               
               
                   
                 ‘On hold’ if this item is used. 
               
               
                 MedCount[MedNum] (IF) 
                 Patient&#39;s response to the number of 
                 Integer 
                 PAR3 
                 124, 128 
                 121, 122, 
               
               
                   
                 pills taken for this medication. 
                   
                   
                   
                 123 
               
               
                 MedDoseCount[MedNum] (EX) 
                 Dosage for this medication for this 
                 Text 
                 Redmon 
                 122, 123 
               
               
                   
                 patient on file. 
               
               
                   
                 This value is used in the message 
               
               
                   
                 as opposed to a comparison. 
               
               
                   
                 Should this be a different variable 
               
               
                   
                 than the one below? 
               
               
                 MedDoseCount[MedNum] (EF) 
                 Dosage for this medication for this 
                 Integer 
                 Redmon 
                 124, 128 
               
               
                   
                 patient on file. This is the same 
               
               
                   
                 variable as the one above, but used 
               
               
                   
                 in a different context. 
               
               
                   
                 See above. 
               
               
                 DoseChange[MedNum] (IX) 
                 Is this a valid dose change? Set to 
                 Boolean 
                 PAR3 
                   
                 126 
               
               
                   
                 true is the patient thinks their doctor 
               
               
                   
                 changed their dose for this 
               
               
                   
                 medication. Redmon will need to 
               
               
                   
                 flag the administrator of this 
               
               
                   
                 condition. 
               
               
                 MedUnderDose[MedNum] (IX) 
                 Indicates that the patient did not take 
                 Boolean 
                 PAR3 
                   
                 141, 150 
               
               
                   
                 enough of this medication yesterday. 
               
               
                 MedZero[MedNum] (IX) 
                 Indicates that the patient did not take 
                 Boolean 
                 PAR3 
                   
                 148 
               
               
                   
                 any of this medication yesterday. 
               
               
                 MedOverdose[MedNum] (IX) 
                 Indicates that the patient took too 
                 Boolean 
                 PAR3 
                   
                 160 
               
               
                   
                 much of this medication yesterday. 
               
               
                 MedsTotal (EF) 
                 Indicates the total number of 
                 Integer 
                 Redmon 
                 180 
               
               
                   
                 medicines being tracked. 
               
               
                 FirstTime (EF) 
                 Indicates that this the first time that 
                 Boolean 
                 Redmon 
                 200, 300, 
               
               
                   
                 the patient is using this system. 
                   
                   
                 500 
               
               
                 MoodMissLong (EF) 
                 Indicates that the patient has not 
                 Boolean 
                 Redmon 
                 202 
               
               
                   
                 given a mood scale for 7 days. 
               
               
                 MoodYesterday (EF) 
                 Indicates if the patient entered mood 
                 Boolean 
                 Redmon 
                 202 
               
               
                   
                 information yesterday. 
               
               
                 MoodLastSplit (EF) 
                 Indicates that the last mood rating 
                 Boolean 
                 Redmon 
                 202, 302 
               
               
                   
                 was a split mood. 
               
               
                 MoodCycleOne (EF) 
                 Yesterday&#39;s mood cycle one rating 
                 Integer 
                 Redmon 
                 204 
               
               
                   
                 (collected from MoodCycleVal1 
               
               
                   
                 yesterday). 
               
               
                 MoodCycleTwo (EF) 
                 Yesterday&#39;s mood cycle two rating 
                 Integer 
                 Redmon 
                 204 
               
               
                   
                 (collected from MoodCycleVal2 
               
               
                   
                 yesterday). 
               
               
                 MoodRatingPrev (EF) 
                 Yesterday&#39;s mood rating for a non- 
                 Integer 
                 Redmon 
                 206 
               
               
                   
                 split cycle (collected from 
               
               
                   
                 MoodRating yesterday). 
               
               
                 MoodSplit (IF) 
                 Indicates if the patient had split 
                 Boolean 
                 PAR3 
                 310 
                 210 
               
               
                   
                 moods. 
               
               
                 MoodRating (IF) 
                 Mood rating by the patient for a non- 
                 Integer 
                 PAR3 
                 311 
                 222 
               
               
                   
                 split cycle. Value of 0 to 100. 
               
               
                 MoodCycleVal1 (IF) 
                 Highest mood for the patient in a 
                 Integer 
                 PAR3 
                 340 
                 240 
               
               
                   
                 split cycle. Value of 0 to 100. 
               
               
                 MoodCycleVal2 (IF) 
                 Lowest mood for the patient in a split 
                 Integer 
                 PAR3 
                 360 
                 250 
               
               
                   
                 cycle. Value of 0 to 100. 
               
               
                 MoodCycleCount (IX) 
                 Number of cycles for the patient in a 
                 Integer 
                 PAR3 
                   
                 260 
               
               
                   
                 split cycle. Value of 0 to 100. 
               
               
                 SeverityLast (EF) 
                 Indicates if the patient made a 
                 Boolean 
                 Redmon 
                 302 
               
               
                   
                 severity rating during the last 
               
               
                   
                 session. 
               
               
                 SeverityNoCnt (EF) 
                 Count of consecutive days without a 
                 Integer 
                 Redmon 
                 302 
               
               
                   
                 severity rating for this patient. 
               
               
                 ImpairRate1 (EX) 
                 The collected imparement rate 
                 Integer 
                 Redmon 
                 303 
               
               
                   
                 (ImpairRate1) from yesterday&#39;s data. 
               
               
                   
                 Used in the message. 
               
               
                 ImpairRate2 (EX) 
                 The collected imparement rate 
                 Integer 
                 Redmon 
                 303 
               
               
                   
                 (ImpairRate2) from yesterday&#39;s data. 
               
               
                   
                 Used in the message. 
               
               
                 SeverRate (EX) 
                 The collected severity rate 
                 Integer 
                 Redmon 
                 306 
               
               
                   
                 (SeverRate) from yesterday&#39;s data. 
               
               
                   
                 Used in the message. 
               
               
                 ImpairRate (IF) 
                 The level of impairment (1 to 4). 
                 Integer 
                 PAR3 
                 321 
                 315, 316, 
               
               
                   
                 This will combine with the imparity 
                   
                   
                   
                 317 
               
               
                   
                 type to determine the actual impairity 
               
               
                   
                 level. 
               
               
                 ImpairType (IF) 
                 The type of impairment, depressed, 
                 Integer 
                 PAR3 
                 321, 380 
                 315, 316, 
               
               
                   
                 manic or normal. 
                   
                   
                   
                 317 
               
               
                 ExplainReturn (IS) 
                 This is an item identifier to mark the 
                 Integer 
                 PAR3 
                 381, 382 
                 315, 316, 
               
               
                   
                 return point from another section of 
                   
                   
                   
                 317, 344, 
               
               
                   
                 the call (the examples). 
                   
                   
                   
                 345, 364, 
               
               
                   
                 This is another special variable 
                   
                   
                   
                 365 
               
               
                   
                 that is only used during the 
               
               
                   
                 telephone call. 
               
               
                 DysphoricFlag (IX) 
                 This is a flag that is captured to 
                 Boolean 
                 PAR3 
                   
                 318 
               
               
                   
                 indicate the the patient was feeling 
               
               
                   
                 unhappy. 
               
               
                 ExtremeImpair (IX) 
                 Indicates that this patient is 
                 Boolean 
                 PAR3 
                   
                 328 
               
               
                   
                 experiencing extreme impairment. 
               
               
                   
                 This flag should alert an 
               
               
                   
                 administrator. 
               
               
                 ImpairRate1 (IF) 
                 The level of impairment (1 to 4) for 
                 Integer 
                 PAR3 
                 350 
                 344, 345 
               
               
                   
                 the first split mood. This will 
                   
                   
                   
                 346 
               
               
                   
                 combine with the imparity type for 
               
               
                   
                 the first split mood to determine the 
               
               
                   
                 actual impairity level for the first split 
               
               
                   
                 mood. 
               
               
                 ImpairType1 (IF) 
                 The type of impairment for the first 
                 Integer 
                 PAR3 
                 350, 380 
                 344, 345, 
               
               
                   
                 split mood, depressed, manic or 
                   
                   
                   
                 346 
               
               
                   
                 normal. 
               
               
                 DysphoricFlag1 (IX) 
                 This is a flag that is captured to 
                 Boolean 
                 PAR3 
                   
                 347 
               
               
                   
                 indicate the the patient was feeling 
               
               
                   
                 unhappy for the first split mood. 
               
               
                 ExtremeImpair1 (IX) 
                 Indicates that this patient is 
                 Boolean 
                 PAR3 
                   
                 357 
               
               
                   
                 experiencing extreme impairment for 
               
               
                   
                 the first split mood. 
               
               
                   
                 This flag should alert an 
               
               
                   
                 administrator. 
               
               
                 ImpairRate2 (IF) 
                 The level of impairment (1 to 4) for 
                 Integer 
                 PAR3 
                 370 
                 364, 365, 
               
               
                   
                 the second split mood. This will 
                   
                   
                   
                 366 
               
               
                   
                 combine with the imparity type for 
               
               
                   
                 the second split mood to determine 
               
               
                   
                 the actual impairity level for the 
               
               
                   
                 second split mood. 
               
               
                 ImpairType2 (IF) 
                 The type of impairment for the 
                 Integer 
                 PAR3 
                 370, 380 
                 364, 365, 
               
               
                   
                 second split mood, depressed, 
                   
                   
                   
                 366 
               
               
                   
                 manic or normal. 
               
               
                 DysphoricFlag2 (IX) 
                 This is a flag that is captured to 
                 Boolean 
                 PAR3 
                   
                 367 
               
               
                   
                 indicate the the patient was feeling 
               
               
                   
                 unhappy for the second split mood. 
               
               
                 ExtremeImpair2 (IX) 
                 Indicates that this patient is 
                 Boolean 
                 PAR3 
                   
                 377 
               
               
                   
                 experiencing extreme impairment for 
               
               
                   
                 the second split mood. 
               
               
                   
                 This flag should alert an 
               
               
                   
                 administrator. 
               
               
                 NoSleepHours (EF) 
                 Indicates if the patient responded to 
                 Boolean 
                 Redmon 
                 500 
               
               
                   
                 the sleep hours question yesterday. 
               
               
                 SleepHoursPrev (EX) 
                 The number of sleep hours that the 
                 Integer 
                 Redmon 
                 501 
               
               
                   
                 patient indicated yesterday. Used in 
               
               
                   
                 the message. 
               
               
                 SleepHours (IX) 
                 The number of sleep hours that the 
                 Integer 
                 PAR3 
                   
                 505 
               
               
                   
                 patient received last night. 
               
               
                   
               
             
          
         
       
     
         [0339]    
       
         
               
             
               
             
               
             
               
             
               
               
               
               
             
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
               
               
               
             
               
             
               
             
               
             
               
             
               
             
               
             
               
             
               
             
           
               
                 TABLE IX 
               
               
                   
               
               
                   
               
             
             
               
                 USiP Bipolar Database Definition Document 
               
             
          
           
               
                 Database Overview 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Entire database overview with major relationships (enforced through code only) 
               
             
          
           
               
                 USiP Bipolar Table Definitions 
               
               
                 Attributes 
               
               
                 This table holds the attributes for the studies. An attribute is a variable collected from PAR3 through their telephone 
               
               
                 survey system or a variable sent back to PAR3. Each study will have its own set of attributes. The attribute key value is 
               
               
                 used to identify these values in the responses and data_sent tables. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_attribute_id 
                 int 
                 4 
                 Key for this table of attributes. 
               
               
                 at_study_id 
                 int 
                 4 
                 Identifies the study that this attribute is used for. 
               
               
                 at_name 
                 varchar 
                 100 
                 This is the name of the attribute, also known as the variable name. 
               
               
                 at_description 
                 text 
                 16 
                 Description of the attribute. 
               
               
                 at_type 
                 smallint 
                 2 
                 Type of attribute. 0 for outgoing (sent from USIP), 1 for incomming (sent to USIP), 
               
               
                 at_order 
                 int 
                 4 
                 Order that the attributes should display in the PAR3 file headers. 
               
               
                 at_is_active 
                 bit 
                 1 
                 Is this attribute currently active within the system? 
               
               
                   
               
             
          
           
               
                 USip Bipolar Project - DRAFT 
               
             
          
           
               
                 ChangeTrack 
               
               
                 This table holds a record of all of the administrative changes to users within the system. The current information is stored 
               
               
                 in the main tables while all changes are logged to this table. An administrative change history is contained in this table 
               
               
                 along with the time and date that the changes occurred. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_chg_id 
                 int 
                 4 
                 Key for this table that tracks changes made within the system. 
               
               
                 chg_study_id 
                 int 
                 4 
                 Study identifier for this change. 
               
               
                 chg_per_id 
                 int 
                 4 
                 Person identifier that is making this change. 
               
               
                 chg_admin_per_id 
                 int 
                 4 
                 Person identifier for the administrator makin this change. 
               
               
                 chg_med_id 
                 int 
                 4 
                 Medication id, used if this change is associated with a medication. 
               
               
                 chg_date 
                 datetime 
                 8 
                 Date and time that the change was made. 
               
               
                 chg_data_element 
                 varchar 
                 100 
                 Name of the data element (database field) that changed. 
               
               
                 chg_old_value 
                 varchar 
                 250 
                 Old value before the change occurred. 
               
               
                 chg_new_value 
                 varchar 
                 250 
                 New value after the change occurred. 
               
               
                 chg_old_text 
                 text 
                 16 
                 Old value before the change occurred. This is used for text fields such as notes. 
               
               
                 chg_new_text 
                 text 
                 16 
                 New value after the change occurred. This is used for text fields such as notes. 
               
               
                   
               
             
          
           
               
                 Data_sent 
               
               
                 This is an archive table that holds all of the data that is passed to PAR3 in data files to drive the telephone questionnaires. 
               
               
                 Even though the data files will serve as the primary backup of transmitted information, this data will provide an easy 
               
               
                 means of looking up specific data if necessary. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_data_sent_id 
                 int 
                 4 
                 Key for this table of data sent to PAR3. 
               
               
                 ds_study_id 
                 int 
                 4 
                 Study identifier for this record. 
               
               
                 ds_person_id 
                 int 
                 4 
                 Person identifier for this record. 
               
               
                 ds_attribute_id 
                 int 
                 4 
                 Identifies the attribute for this record. 
               
               
                 ds_value 
                 varchar 
                 100 
                 Value of this attribute for this person for this study. 
               
               
                 ds_date 
                 datetime 
                 8 
                 Date to which this record applies. 
               
               
                 ds_timestamp 
                 datetime 
                 8 
                 Time that this record was added to the database. 
               
               
                   
               
             
          
           
               
                 Doctor 
               
               
                 This table holds additional doctor specific information in addition to the information held in the person table. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_doc_id 
                 int 
                 4 
                 Key for this table of doctor specific information. 
               
               
                 doc_per_id 
                 int 
                 4 
                 Person identifier. 
               
               
                 doc_assist_first_name 
                 varchar 
                 250 
                 Assistant first name. 
               
               
                 doc_assist_middle_name 
                 varchar 
                 250 
                 Assistant middle name. 
               
               
                 doc_assist_last_name 
                 varchar 
                 250 
                 Assistant last name. 
               
               
                 doc_assist_phone 
                 varchar 
                 50 
                 Assistant phone number. 
               
               
                 doc_assist_fax 
                 varchar 
                 50 
                 Assistant FAX number. 
               
               
                 doc_assist_email 
                 varchar 
                 250 
                 Assistant email address. 
               
               
                 doc_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 doc_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 DoctorChangeRequest 
               
               
                 This table holds a log of requests from doctors to change patient information. The doctors can request changes through 
               
               
                 the interface and the requests are logged here. This table will be used to build the change approval form used by the 
               
               
                 researchers and administrators to make the actual changes to the person, patient or medications tables. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_dcr_id 
                 int 
                 4 
                 Key for this table logging patient change requests from doctors. 
               
               
                 dcr_study_id 
                 int 
                 4 
                 Study identifier for this change request. 
               
               
                 dcr_psy_id 
                 int 
                 4 
                 Doctor identifier. 
               
               
                 dcr_pat_id 
                 int 
                 4 
                 Patient identifier. 
               
               
                 dcr_med_id 
                 int 
                 4 
                 Medication identifier used if this change refers to a medication for this patient. 
               
               
                 dcr_data_element 
                 varchar 
                 100 
                 Name of the data element (database field) for this change request. 
               
               
                 dcr_new_value 
                 varchar 
                 250 
                 New value requested. 
               
               
                 dcr_new_text 
                 text 
                 16 
                 New value requested. This is used if this is for the notes field. 
               
               
                 dcr_status 
                 int 
                 4 
                 Status of the request (0-requested, 1-accepted, 2-rejected). 
               
               
                 dcr_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 dcr_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 DoctorReportRequest 
               
               
                 This table holds a log of requests from doctors to obtain reports. The doctors can request reports through the interface 
               
               
                 and the requests are logged here. This table will be used to build the report generation and printing form used by the 
               
               
                 researchers and administrators to print the forms so that they can be faxed to the doctors. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_drr_id 
                 int 
                 4 
                 Key for this table that logs doctors report requests. 
               
               
                 drr_doc_id 
                 int 
                 4 
                 Doctor identifier. 
               
               
                 drr_rpt_id 
                 int 
                 4 
                 Report identifier. 
               
               
                 drr_pat_id 
                 int 
                 4 
                 Patient identifier (not needed for all reports, −1 if unused). 
               
               
                 drr_status 
                 int 
                 4 
                 Status of the request (0-requested, 1-printed). 
               
               
                 drr_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 drr_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 Medications 
               
               
                 This table holds all of the patient medication information such as name and dosage. A patient can have many 
               
               
                 medications. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_med_id 
                 int 
                 4 
                 Key for this table of medication used by patients. 
               
               
                 med_pat_id 
                 int 
                 4 
                 Patient identifier for these medications. 
               
               
                 med_name 
                 int 
                 4 
                 Name of this medication. 
               
               
                 med_dose 
                 varchar 
                 250 
                 Daily dosage for this medication for this patient. 
               
               
                 med_create_date 
                 datetime 
                 8 
                 Date that this record was created. 
               
               
                 med_dolp 
                 datetime 
                 8 
                 Date of last post. 
               
               
                   
               
             
          
           
               
                 Password 
               
               
                 This table contains the userid and password information for all users. This table is checked during login for valid entries. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_pw_id 
                 int 
                 4 
                 Key for this table of user names and passwords. 
               
               
                 pw_study_id 
                 int 
                 4 
                 Study identifier. 
               
               
                 pw_er_id 
                 int 
                 4 
                 Person identifier. 
               
               
                 pw_userid 
                 varchar 
                 100 
                 Username. 
               
               
                 pw_password 
                 varchar 
                 100 
                 Password. 
               
               
                 pw_create_date 
                 datetime 
                 8 
                 Date that this record was created. 
               
               
                 pw_dolp 
                 datetime 
                 8 
                 Date of last post. 
               
               
                   
               
             
          
           
               
                 Patient 
               
               
                 This table contains patient specific information and contact preferences. This is in addition to the person information for 
               
               
                 all users. This table will use an insert trigger to return the key id for inserted records. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_pat_id 
                 int 
                 4 
                 Key for this table of patient preference information. 
               
               
                 pat_per_id 
                 int 
                 4 
                 Person identifier for this patient. 
               
               
                 pat_contact_sunday 
                 bit 
                 1 
                 Contact this patient on Sunday? 
               
               
                 pat_contact_monday 
                 bit 
                 1 
                 Contact this patient on Monday? 
               
               
                 pat_contact_tuesday 
                 bit 
                 1 
                 Contact this patient on Tuesday? 
               
               
                 pat_contact_wednesday 
                 bit 
                 1 
                 Contact this patient on Wednesday? 
               
               
                 pat_contact_thursday 
                 bit 
                 1 
                 Contact this patient on Thursday? 
               
               
                 pat_contact_friday 
                 bit 
                 1 
                 Contact this patient on Friday? 
               
               
                 pat_contact_saturday 
                 bit 
                 1 
                 Contact this patient on Saturday? 
               
               
                 pat_contact_holiday 
                 bit 
                 1 
                 Contact this patient on holidays? 
               
               
                 pat_contact_time_code 
                 int 
                 4 
                 Time block to contact this patient. 1-morning, 2-afternoon, 3-evening 
               
               
                 pat_is_female 
                 bit 
                 1 
                 Is this patient female? 
               
               
                 pat_is_post_meno 
                 bit 
                 1 
                 Is this patient post menopausal? 
               
               
                 pat_is_lithium 
                 bit 
                 1 
                 Is this patient taking Lithium? 
               
               
                 pat_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 pat_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 PatientGroup 
               
               
                 This table groups the patients to the doctors for a given study. This data would be used to identify a patient&#39;s doctor or to 
               
               
                 identify the patients under a specific doctor. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Descnption 
               
               
                   
               
               
                 key_pgp_id 
                 int 
                 4 
                 Key for this table that groups patients to doctors and studies. 
               
               
                 pgp_study_id 
                 int 
                 4 
                 Study identifier for this patient. 
               
               
                 pgp_doc_id 
                 int 
                 4 
                 Doctor for this patient in this study. 
               
               
                 pgp_pat_id 
                 int 
                 4 
                 Patient person identifier. 
               
               
                 pgp_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 pgp_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 Person 
               
               
                 This table contains the base information for all users within the system. This table will use an insert trigger to return the key id for inserted records. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_per_id 
                 int 
                 4 
                 Key for this table of all persons. 
               
               
                 per_phone_primary 
                 varchar 
                 50 
                 Main phone number. 
               
               
                 per_phone_alt1 
                 varchar 
                 50 
                 Alternate phone number. 
               
               
                 per_fax 
                 varchar 
                 50 
                 FAX number. 
               
               
                 per_title_prefix 
                 Varchar 
                 10 
                 Prefix for ther name (Mr., Ms., Dr., etc.) 
               
               
                 per_name_first 
                 varchar 
                 250 
                 First name. 
               
               
                 per_name_middle 
                 varchar 
                 250 
                 Middle name. 
               
               
                 per_name_last 
                 varchar 
                 250 
                 Last name. 
               
               
                 per_address1 
                 varchar 
                 250 
                 Address line 1. 
               
               
                 per_address2 
                 varchar 
                 250 
                 Address line 2. 
               
               
                 per_city 
                 varchar 
                 250 
                 City 
               
               
                 per_state 
                 varchar 
                 250 
                 State 
               
               
                 per_zip 
                 varchar 
                 20 
                 Zip code 
               
               
                 per_email 
                 varchar 
                 250 
                 Email address for this person. 
               
               
                 per_role_id 
                 int 
                 4 
                 Role identifier that will identify this person&#39;s role in this study. 
               
               
                 per_notes 
                 text 
                 16 
                 Administrative notes about this person. 
               
               
                 per_is_active 
                 bit 
                 1 
                 Is this person currently active? 
               
               
                 per_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 per_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 Report 
               
               
                 This table hold the report information for specific reports within the studies. This data is used to provide listings for report 
               
               
                 selections within the interface. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_rpt_id 
                 int 
                 4 
                 Key for this table of reports. 
               
               
                 rpt_name_long 
                 varchar 
                 250 
                 Long name for this report. Used for complete identification of this report within displays. 
               
               
                 rpt_name_short 
                 varchar 
                 100 
                 Short name for this report. 
               
               
                 rpt_is_patient_ok 
                 bit 
                 1 
                 Is this report available to the patient? 
               
               
                 rpt_is_doctor_ok 
                 bit 
                 1 
                 Is this report available to the doctor? 
               
               
                 rpt_is_client_ok 
                 bit 
                 1 
                 Is this report available to the client? 
               
               
                 rpt_study_id 
                 int 
                 4 
                 Study identifier for this report. 
               
               
                 rpt_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 rpt_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 Responses 
               
               
                 This table holds the patient responses to the PAR3 telephone query system. This data will be used to build reports and to 
               
               
                 help in building some of the data transmitted to PAR3. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_resp_id 
                 int 
                 4 
                 Key for this table. 
               
               
                 resp_study_id 
                 int 
                 4 
                 Study identifier for this response. 
               
               
                 resp_per_id 
                 int 
                 4 
                 Person identifier for this response. 
               
               
                 resp_attribute_id 
                 int 
                 4 
                 Attribute identifier for this response. 
               
               
                 resp_input_value 
                 varchar 
                 100 
                 Response value. Only boolean and integers are collected. Boolean can be 1/0 for T/F. 
               
               
                 resp_date 
                 datetime 
                 8 
                 Date that this response was made. Note: this may be different from the recorded date. 
               
               
                 resp_timestamp 
                 datetime 
                 8 
                 Date and time that this response was recorded. This is the time that the data is processed from PAR3. 
               
               
                   
               
             
          
           
               
                 Role 
               
               
                 This table identifies the roles of the various users within the system. It also identifies any crossover between roles, such 
               
               
                 as admins may also have researcher privileges. This strategy could be used to create special customized roles. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_role_id 
                 int 
                 4 
                 Key for this table of person roles within the studies. 
               
               
                 role_study_id 
                 int 
                 4 
                 Study identifier where this role will be used. 
               
               
                 role_name 
                 varchar 
                 100 
                 Name of this role for listings. 
               
               
                 role_is_sys_admin 
                 bit 
                 1 
                 Does this role have systems administrator privileges? 
               
               
                 role_is_admin 
                 bit 
                 1 
                 Does this role have administrator privileges? 
               
               
                 role_is_researcher 
                 bit 
                 1 
                 Does this role have researcher privileges? 
               
               
                 role_is_client 
                 bit 
                 1 
                 Does this role have client privileges? 
               
               
                 role_is_doctor 
                 bit 
                 1 
                 Does this role have doctor privileges? 
               
               
                 role_is_patient 
                 bit 
                 1 
                 Does this role have patient privileges? 
               
               
                 role_is_active 
                 bit 
                 1 
                 Is this a currently active role for this study. 
               
               
                 role_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 role_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 Study 
               
               
                 This table contains the study specific information. There should be one record per study. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_study_id 
                 int 
                 4 
                 Key for this table of studies. 
               
               
                 stdy_name_long 
                 varchar 
                 250 
                 Long name for this study. Formal name. 
               
               
                 stdy_name_short 
                 varchar 
                 100 
                 Short name for this study. 
               
               
                 stdy_sftp_userid 
                 varchar 
                 100 
                 Secure FTP transfer user name. 
               
               
                 stdy_sftp_password 
                 varchar 
                 100 
                 Secure FTP transfer password. 
               
               
                 stdy_par3_file_send 
                 varchar 
                 250 
                 Name of file to send to PAR3. 
               
               
                 stdy_par3_file_get 
                 varchar 
                 250 
                 Name of file to retreive from PAR3. 
               
               
                 stdy_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 stdy_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 Study_roles 
               
               
                 This table identifies the user&#39;s roles in the context of a study. A person may have different roles in different studies. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_study_role_id 
                 int 
                 4 
                 Key for this table of roles for this study. 
               
               
                 sr_study_id 
                 int 
                 4 
                 Study identifier for this role. 
               
               
                 sr_per_id 
                 int 
                 4 
                 Person for this role for this study. 
               
               
                 sr_role_id 
                 int 
                 4 
                 Role identifier. 
               
               
                 sr_create_date 
                 datetime 
                 8 
                 Date this record was created. 
               
               
                 sr_dolp 
                 datetime 
                 8 
                 Date this record was last changed. 
               
               
                   
               
             
          
           
               
                 User_log 
               
               
                 This table tracks all users logging into the system. If users use the logout button, then we can also track the user logouts. 
               
             
          
           
               
                 Name 
                 Type 
                 Size 
                 Description 
               
               
                   
               
               
                 key_user_log_id 
                 int 
                 4 
                 Key for this table of user logins. 
               
               
                 ul_study_id 
                 int 
                 4 
                 Study identifier for this login. 
               
               
                 ul_per_id 
                 int 
                 4 
                 Person for this login. 
               
               
                 ul_login_date 
                 datetime 
                 8 
                 Date and time this user logged in. 
               
               
                 ul_logout_date 
                 datetime 
                 8 
                 Date and time this user logged out (may not be available. 
               
               
                   
               
             
          
           
               
                 Major Table Relationships 
               
               
                 Login authenticate, get user name and password: 
               
               
                 The entered username and password are checked against the password table records for the specific study. A 
               
               
                 successful match can will identify the person and role for this study. Successful logins will be logged to the user_log table. 
               
               
                   
               
             
          
           
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Patient information: 
               
               
                 Using the person id, this will obtain all of the patient information, including the doctor&#39;s name. This will probably be 
               
               
                 created as a view to join the person, patient, patient_group, doctor and medications information into a single view. These 
               
               
                 relationships can also be used to get the patient preferences. 
               
               
                   
               
             
          
           
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 User information: 
               
               
                 These relationships can be used to gather information about any of the system users. A person can be identified by role 
               
               
                 for a given study. A list of patients for a given doctor or a list of doctors for a given study can be obtained. These 
               
               
                 relationships will also handle the doctor&#39;s patient information change requests and administrative processing of the requests. 
               
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
           
               
                 Telephone Interactions and reporting: 
               
               
                 These relationships will allow the telephone data file interactions to be stored and recalled for use in building reports. The 
               
               
                 transfer passwords and file names are also available here. 
               
             
          
           
               
                   
               
               
                 
                   
                             
                     
                         
                         
                     
                   
                 
               
               
                   
               
             
          
         
       
     
         [0340]    
       
         
               
             
               
               
             
           
               
                 TABLE X 
               
             
             
               
                   
               
               
                   
               
               
                 Bipolar Bidirectional Messaging Algorithm 
               
             
          
           
               
                 No.: Seq. Name 
                   
               
               
                   
               
               
                 10: INTRO 
                 Prompt: 
               
               
                 MESSAGE 
                 Hi, &lt;first name&gt;, this is your C.L.E.A.R program survey. If you have time 
               
               
                   
                 to participate now, press 1, if not or you are not the right person, press 2. 
               
               
                   
                 Actions: 
               
               
                   
                 On 1: Go to 30: Enter ID 
               
               
                   
                 On any other keypress: Go to 20: 3 RD  PARTY INTRO PROMPT 
               
               
                   
                 On No Entry: Go to 15: ANSWERING MACHINE MESSAGE 
               
               
                 15: ANSWERING 
                 Message: 
               
               
                 MACHINE 
                 This is your C.L.E.A.R program survey for &lt;FirstName&gt;&lt;LastName&gt;. 
               
               
                 MESSAGE 
                 Please contact us toll free at 1 866-818-9853 by &lt;date&gt; and enter PIN 
               
               
                   
                 Number &lt;PIN - will be static for each participant&gt; when prompted. Thank 
               
               
                   
                 you Goodbye. 
               
               
                   
                 Action: 
               
               
                   
                 Disconnect 
               
               
                 20: 3 rd  PARTY 
                 Prompt: 
               
               
                 INTRO PROMPT 
                 To tell us that you&#39;ll call us back later, press 1 
               
               
                   
                 If your mood prevents you from participating today, press 2 
               
               
                   
                 To have us call you back in an hour, press 3 
               
               
                   
                 If you&#39;d like us to hold for &lt;first name&gt;, press 4 
               
               
                   
                 If you&#39;d like to take a message, press 5 
               
               
                   
                 If you&#39;re ready now, press 6 
               
               
                   
                 To repeat these options, press star. 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 25: CALL BACK INSTRUCTIONS 
               
               
                   
                 On 2 go to 25: CALL BACK INSTRUCTIONS (Note should we do a hope 
               
               
                   
                 message instead?) 
               
               
                   
                 On 3 go to 22: CALL LATER 
               
               
                   
                 On 4 go to 930: HOLD ROUTINE 
               
               
                   
                 On 5 go to 29: 3 rd  PARTY MESSAGE 
               
               
                   
                 On 6 go to 30: ENTER ID 
               
               
                   
                 On Start go to 920: PRESS STAR 
               
               
                 22: CALL LATER 
                 Prompt: 
               
               
                   
                 Thank you, we will try you again in an hour.. 
               
               
                   
                 Actions: 
               
               
                   
                 End call 
               
               
                 25: CALL BACK 
                 Message: 
               
               
                 INSTRUCTIONS 
                 Thank you, when you&#39;re ready, please contact us at 866-818-9853 and enter 
               
               
                   
                 Patient access code &lt;PIN.&gt; when prompted. 
               
               
                   
                 To repeat this information, press star 
               
               
                   
                 If you need time to get a pen, press 1 
               
               
                   
                 To return to the previous menu, press #, 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 Go to 930: HOLD ROUTINE 
               
               
                 29: 3 rd  PARTY 
                 Message: 
               
               
                 MESSAGE 
                 Please have &lt;FirstName&gt; contact us at 866-818-9853 and enter access code 
               
               
                   
                 &lt;PIN.&gt; when prompted. 
               
               
                   
                 To repeat this information, press star 
               
               
                   
                 If you need time to get a pen, press 1 
               
               
                   
                 To return to the previous menu, press #, 
               
               
                   
                 Thank you Goodbye. 
               
               
                   
                 Actions: 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 Go to 930: HOLD ROUTINE 
               
               
                 30: ENTER ID 
                 Prompt: 
               
               
                   
                 In order for us to protect your privacy please enter your patient ID now. 
               
               
                   
                 To return to the previous menu, press #. 
               
               
                   
                 Actions: 
               
               
                   
                 On success/validation go to 40: WELCOME 
               
               
                   
                 On fail/invalid go to 39: INVALID ID 
               
               
                 35: INBOUND 
                 Prompt: 
               
               
                 CALL BACK 
                 Welcome to your C.L.E.A.R program message retrieval center. 
               
               
                   
                 Please enter your Patient ID number followed by the pound sign. 
               
               
                   
                 Actions: 
               
               
                   
                 On success/validation go to 30: ENTERID 
               
               
                   
                 On fail/invalid go to 39: INVALID ID 
               
               
                   
                 Note: This will be used whether calling back from 15: ANSWERING 
               
               
                   
                 MACHINE MESSAGE from Option 1 in 20 above. 
               
               
                 39: INVALID ID 
                 Message: 
               
               
                   
                 The number entered does not match our records. Please re-enter your patient 
               
               
                   
                 ID number 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 30: EnterID 
               
               
                 40: WELCOME 
                 Message: 
               
               
                   
                 “Welcome. Thanks for taking the time to participate. [skip begins here if 
               
               
                   
                 press*] Tracking your mood every day can easily be completed together 
               
               
                   
                 with taking your medications. It will help you and [doctor name] track how 
               
               
                   
                 well your treatment works. In the future, you may press *[NP1] to skip this 
               
               
                   
                 introduction.” 
               
               
                   
                 Actions: 
               
               
                   
                 On * at any time go to 50: SUICIDE SCREEN 
               
               
                   
                 Go to 50: SUICIDE SCREEN 
               
               
                 50: SUICIDE 
                 Message: 
               
               
                 DISCLAIMER 
                 “This is not a crisis hotline and is not a substitute for medical care. If you 
               
               
                   
                 are thinking about suicide or harming yourself, please hang up and call your 
               
               
                   
                 doctor immediately. You can reach [Dr. name] at [doctor phone number]. If 
               
               
                   
                 you cannot reach your doctor, call 911 or go to the nearest emergency 
               
               
                   
                 room.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 60: GENERAL EDUCATION 
               
               
                 60: GENERAL 
                 Logic: 
               
               
                 EDUCATION 
                 [different message each day of the month - repeat every 30 days] 
               
               
                   
                 Message: 
               
               
                   
                 [insert messages of hope (potential different voice than voice talent), 
               
               
                   
                 factoids, and other general messages here - we will have enough to have a 
               
               
                   
                 different one each day of the month - repeat every 30 days] 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 100: MED NAME CHECK 
               
               
                 MEDICINE 
               
               
                 100: MED NAME 
                 Logic: 
               
               
                 CHECK (Logic) 
                 If 100: MED NAME CHECK on hold due to discrepancy, 
               
               
                   
                 go to 104: COMPLIANCE LOGIC; 
               
               
                   
                 If 100: MED NAME CHECK hold released and we corrected error, 
               
               
                   
                 go to 102: MED NAME CHECK UPDATE, 
               
               
                   
                 If 100: MED NAME CHECK hold released and there was no error, 
               
               
                   
                 go to 103: MED NAME CHECK UPDATE WRONG, 
               
               
                   
                 Else go to 101. 
               
               
                 101: MED NAME 
                 Message: “Now we are going to discuss how you have been taking your 
               
               
                 CHECK PROMPT 
                 medication.” 
               
               
                   
                 Prompt: 
               
               
                   
                 “According to our records, you are taking [data field: medication 1], [data 
               
               
                   
                 field: medication 2], [data field: medication 3], [data field: medication 4], 
               
               
                   
                 [data field: medication 5], and [data field: medication X]. Is this correct? 
               
               
                   
                 Press 1 for yes or 2 for no.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 120: MED DOSE COUNT 
               
               
                   
                 On 2 go to 105: MED NAME CHECK DISCREPANCY 
               
               
                   
                 Any other entry go to 107: MED NAME CHECK PROMPT ERROR 
               
               
                 102: MED NAME 
                 Prompt: 
               
               
                 CHECK UPDATE 
                 “We checked with [Dr. name]. We show you are taking [data field: 
               
               
                   
                 medication 1], [data field: medication 2], [data field: medication 3], [data 
               
               
                   
                 field: medication 4], [data field: medication 5], and [data field: medication 
               
               
                   
                 X]. Is this correct? Press 1 for yes or 2 for no.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 120: MED DOSE COUNT 
               
               
                   
                 On 2 go to 105: MED NAME CHECK DISCREPANCY 
               
               
                   
                 Any other entry go to 108: MED NAME CHECK UPDATE ERROR 
               
               
                 103: MED NAME 
                 Prompt: 
               
               
                 CHECK UPDATE 
                 “We checked with [Dr. name]. [Dr. name] said that you are taking [data 
               
               
                 WRONG 
                 field: medication 1], [data field: medication 2], [data field: medication 3], 
               
               
                   
                 [data field: medication 4], [data field: medication 5], [data field: medication 
               
               
                   
                 X]. You might know a medication by its brand name or its generic name. 
               
               
                   
                 Please check the name on the bottle. Are all of these names correct? Press 1 
               
               
                   
                 for yes or 2 for no.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 120: MED DOSE COUNT 
               
               
                   
                 On 2 go to 105: MED NAME CHECK DISCREPANCY 
               
               
                   
                 Any other entry go to 109: MED NAME CHECK UPDATE WRONG 
               
               
                   
                 ERROR 
               
               
                 104: MED NAME 
                 Message: “We are checking with [Dr. name] about [data field: hold 
               
               
                 CHECK PROMPT 
                 medication 1], [data field: hold medication 2], . . . ” 
               
               
                 HOLD VERSION 
                 Prompt: “Are you still taking [list remaining medications]? Press 1 for yes 
               
               
                   
                 or 2 for no.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 120: MED DOSE COUNT 
               
               
                   
                 On 2 go to 105: MED NAME CHECK DISCREPANCY 
               
               
                   
                 Any other entry go to ERROR 
               
               
                 105: MED NAME 
                 Message: 
               
               
                 CHECK 
                 “Our records don&#39;t match something. Are you not taking one of these 
               
               
                 DISCREPANCY 
                 medications or are you taking something else that is not on this list? Press 1 
               
               
                   
                 if you&#39;re not taking one of these, or press 2 if you&#39;re taking something 
               
               
                   
                 else. 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 106: MED NAME CHECK DISCREPANCY PROMPT 
               
               
                   
                 On 2 go to 105.1: DISCREPANCY - TAKING SOMETHING ELSE 
               
               
                 105.1 
                 Prompt: 
               
               
                 DISCREPANCY -  
                 “We&#39;ll check with [Dr. name]. If you have any questions, you may contact 
               
               
                 TAKING 
                 your doctor. Are you still taking [data field: medication 1], [data field: 
               
               
                 SOMETHING ELSE 
                 medication 2], [data field: medication 3], [data field: medication 4], [data 
               
               
                   
                 field: medication 5], [data field: medication X]? Press 1 for yes or 2 for no.” 
               
               
                   
                 On 1 go to 120: MED DOSE COUNT 
               
               
                   
                 On 2 go to 105: MED NAME CHECK DISCREPANCY 
               
               
                   
                 Any other entry go to ERROR 
               
               
                 106: MED NAME 
                 Prompt: 
               
               
                 CHECK 
                 “Which pills aren&#39;t you taking anymore? Press 1 if you aren&#39;t taking [data 
               
               
                 DISCREPANCY 
                 field: medication 1], press 2 if you aren&#39;t taking [data field: medication 2], 
               
               
                 PROMPT 
                 press 3 if you aren&#39;t taking [data field: medication 3], press 4 if you aren&#39;t 
               
               
                   
                 taking [data field: medication 4], press 5 if you aren&#39;t taking [data field: 
               
               
                   
                 medication 5], press X if you aren&#39;t taking [data field: medication X]. If you 
               
               
                   
                 aren&#39;t taking more than one of these, select one, then we&#39;ll ask you again 
               
               
                   
                 about the others.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1: place hold on 100: MED NAME CHECK for [data field: medication 
               
               
                   
                 1] until records are updated, and go to 106.1: MED DOSE COMPLIANCE 
               
               
                   
                 PROMPT 
               
               
                   
                 On 2: place hold on 100: MED NAME CHECK for [data field: medication 
               
               
                   
                 2] until records are updated, and go to 106.1: MED DOSE COMPLIANCE 
               
               
                   
                 PROMPT 
               
               
                   
                 On 3: place hold on 100: MED NAME CHECK for [data field: medication 
               
               
                   
                 3] until records are updated, and go to 106.1: MED DOSE COMPLIANCE 
               
               
                   
                 PROMPT 
               
               
                   
                 On 4: place hold on 100: MED NAME CHECK for [data field: medication 
               
               
                   
                 4] until records are updated, and go to 106.1: MED DOSE COMPLIANCE 
               
               
                   
                 PROMPT 
               
               
                   
                 On 5: place hold on 100: MED NAME CHECK for [data field: medication 
               
               
                   
                 5] until records are updated, and go to 106.1: MED DOSE COMPLIANCE 
               
               
                   
                 PROMPT 
               
               
                   
                 On X: place hold on 100: MED NAME CHECK for [data field: medication 
               
               
                   
                 X] until records are updated, and go to 106.1: MED DOSE COMPLIANCE 
               
               
                   
                 PROMPT 
               
               
                   
                 On any other entry go to 106.1 MED NAME CHECK DISCREPANCY 
               
               
                   
                 PROMPT ERROR 
               
               
                   
                 Special: 
               
               
                   
                 If any put on hold, fax doc saying, “On [data field: date], your patient, [data 
               
               
                   
                 field: patient name], reported that they are no longer taking [data field: 
               
               
                   
                 medication put on hold]. This information conflicts with what we have on 
               
               
                   
                 file. Please fax back this form with an updated regimen or indicating that the 
               
               
                   
                 medication has not changed. If you believe the patient is mistaken should be 
               
               
                   
                 taking this [data field: medication put on hold], please contact them to 
               
               
                   
                 resolve the issue.” 
               
               
                 106.1 MED NAME 
                 Message: 
               
               
                 CHECK 
                 “There seemed to be a problem with your entry.” 
               
               
                 DISCREPANCY 
                 Actions: 
               
               
                 PROMPT ERROR 
                 Go to 106: MED NAME CHECK DISCREPANCY PROMPT 
               
               
                 106.2 MED NAME 
                 Prompt: 
               
               
                 CHECK PROMPT 2 
                 “We&#39;ll check with [Dr. name] about [data field: medication that was selected 
               
               
                   
                 above]. If you have any questions, you may contact your doctor. Are you 
               
               
                   
                 still taking [list remaining medications]? Press 1 for yes or 2 for no.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 120: MED DOSE COUNT 
               
               
                   
                 On 2 go to 106.4: MED NAME CHECK DISCREPANCY 2 
               
               
                   
                 Any other entry go to 106.3 MED NAME CHECK DISCREPANCY 
               
               
                   
                 PROMPT 2 ERROR 
               
               
                 106.3 MED NAME 
                 Message: 
               
               
                 CHECK 
                 “There seemed to be a problem with your entry.” 
               
               
                 DISCREPANCY 
                 Actions: 
               
               
                 PROMPT 2 ERROR 
                 Go to 106.2: MED NAME CHECK DISCREPANCY PROMPT 
               
               
                 106.4 MED NAME 
                 Need a loop here that deals with the possibility that someone is not taking 
               
               
                 CHECK 
                 more than one of their meds. It should loop them back through 106 to 106.2 
               
               
                 DISCREPANCY 2 
                 until we&#39;ve captured all the meds from our list that they are NOT taking. 
               
               
                   
                 The loop ends when they kick out to 120. 
               
               
                 107: MED NAME 
                 Message: 
               
               
                 CHECK PROMPT 
                 “There seemed to be a problem with your entry.” 
               
               
                 ERROR 
                 Actions: 
               
               
                   
                 Go to 101: MED NAME CHECK PROMPT 
               
               
                 108: MED NAME 
                 Message: 
               
               
                 CHECK UPDATE 
                 “There seemed to be a problem with your entry.” 
               
               
                 ERROR 
                 Actions: 
               
               
                   
                 Go to 102: MED NAME CHECK UPDATE 
               
               
                 109: MED NAME 
                 Message: 
               
               
                 CHECK UPDATE 
                 “There seemed to be a problem with your entry.” 
               
               
                 WRONG ERROR 
                 Actions: 
               
               
                   
                 Go to 103: MED NAME CHECK UPDATE WRONG 
               
               
                 120: MED DOSE 
                 Note: At this point, the focus shifts to individual drugs. Thus, the logic 
               
               
                 COUNT 
                 below refers to each drug taken by the patient. 
               
               
                 (logic) 
                 Logic: 
               
               
                   
                 If 120: MED DOSE COUNT on hold due to discrepancy, 
               
               
                   
                 go to 180: COMPLIANCE LOGIC; 
               
               
                   
                 If 120: MED DOSE COUNT hold released and we corrected error, 
               
               
                   
                 go to 122: MED DOSE COUNT UPDATE, 
               
               
                   
                 If 120: MED DOSE COUNT hold released and there was no error, 
               
               
                   
                 go to 123: MED DOSE COUNT UPDATE WRONG, 
               
               
                   
                 Else go to 121. 
               
               
                 121: MED DOSE 
                 Prompt: 
               
               
                 COUNT PROMPT 
                 “How many [data field: medication 1] [data field: pill type (half or whole)] 
               
               
                 Important 
                 pills did you take yesterday? Please enter the number followed by the # 
               
               
                   
                 sign. Enter zero # if you did not take any. Enter 99 if you have are now 
               
               
                   
                 taking [data field: opposite pill type (whole or half)] pills of [data field: 
               
               
                   
                 medication 1]?” 
               
               
                   
                 Actions: 
               
               
                   
                 On 99, go to 123.1: PILL TYPE DISCREPANCY 
               
               
                   
                 Else, go to 124: MED DOSE COUNT CHECK 
               
               
                 122: MED DOSE 
                 Message: 
               
               
                 COUNT UPDATE 
                 “We have corrected our records and now show that you are taking [data 
               
               
                   
                 field: # of pills on file for medication 1] [data field: pill type (half or whole)] 
               
               
                   
                 pills of [data field: medication 1].” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 121: MED DOSE COUNT PROMPT 
               
               
                 123: MED DOSE 
                 Message: 
               
               
                 COUNT UPDATE 
                 “We checked with your doctor, who said you are taking [data field: # of pills 
               
               
                 WRONG 
                 on file for medication 1] [data field: pill type (half or whole)] pills of [data 
               
               
                   
                 field: medication 1]. Please check the amount of your dose on the pill 
               
               
                   
                 bottle.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 121: MED DOSE COUNT PROMPT 
               
               
                 123.1 PILL TYPE 
                 Prompt: 
               
               
                 DISCREPANCY 
                 Our records don&#39;t show that you are taking [data field: opposite pill type 
               
               
                   
                 (whole or half)] pills of [data field: medication]. Did your physician change 
               
               
                   
                 your dose? Press 1 for yes or 2 for no. 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 123.2: PILL TYPE DISCREPANCY VALID 
               
               
                   
                 On 2 go to 123.3 PILL TYPE DISCREPANCY INVALID 
               
               
                   
                 Any other entry go to 123.4 PILL TYPE DISCREPANCY ERROR 
               
               
                 123.2 PILL TYPE 
                 Message: 
               
               
                 DISCREPANCY 
                 “We&#39;re going to check with your doctor about changes made to your 
               
               
                 VALID 
                 medications. If you have any questions, you may contact your doctor. We&#39;ll 
               
               
                   
                 let you know when we&#39;ve got things straight. Thanks.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 180: MED SECTION LOOP 
               
               
                   
                 Special: 
               
               
                   
                 fax doc saying, “Your patient, [data field: patient name], reported taking 
               
               
                   
                 [data field: opposite pill type (whole or half)] pills of [data field: medication] 
               
               
                   
                 on [data field: date]. We had [data field: pill type (whole or half)] pills of 
               
               
                   
                 [data field: medication] on record. Your patient indicated that you have 
               
               
                   
                 changed the dose. Please fax back this form with an updated regimen or 
               
               
                   
                 indicating that the dose has not changed. If you believe the patient is 
               
               
                   
                 mistaken and should not be taking [data field: opposite pill type (whole or 
               
               
                   
                 half)] pills of [data field: medication], please contact them to resolve the 
               
               
                   
                 issue.” 
               
               
                 123.3 PILL TYPE 
                 Message: 
               
               
                 DISCREPANCY 
                 “We&#39;re going to check with your doctor about changes made to your 
               
               
                 INVALID 
                 medications. If you have any questions, you may contact your doctor. We&#39;ll 
               
               
                   
                 let you know when we&#39;ve got things straight. Thanks.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 180: MED SECTION LOOP 
               
               
                   
                 Special: 
               
               
                   
                 fax doc saying, “Your patient, [data field: patient name], reported taking 
               
               
                   
                 [data field: opposite pill type (whole or half)] pills of [data field: medication] 
               
               
                   
                 on [data field: date]. We had [data field: pill type (whole or half)] pills of 
               
               
                   
                 [data field: medication] on record. Your patient indicated that you have not 
               
               
                   
                 changed the dose. [data field: patient name] thinks they are taking the 
               
               
                   
                 correct dose. Please contact the patient to resolve the issue.” 
               
               
                 123.4 PILL TYPE 
                 Message: 
               
               
                 DISCREPANCY 
                 “There seemed to be a problem with your entry.” 
               
               
                 ERROR 
                 Actions: 
               
               
                   
                 Go to 123.1 PILL TYPE DISCREPANCY 
               
               
                 124: MED DOSE 
                 Logic: 
               
               
                 COUNT CHECK 
                 If 121: is 0 or [MED COUNT] NOT = [number of pills on file], 
               
               
                 (logic) 
                 go to 126: COMPLIANCE LOGIC; 
               
               
                   
                 Else go to 125. 
               
               
                 125: MED DOSE 
                 Message: 
               
               
                 COUNT CORRECT 
                 “It&#39;s terrific that you&#39;re taking all of your medication. Keep up the good 
               
               
                   
                 work.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 180: MED SECTION LOOP 
               
               
                 126: MED DOSE 
                 Prompt: 
               
               
                 COUNT CONFIRM 
                 “Our records don&#39;t match the number of pills you are taking. Did your 
               
               
                   
                 physician change your dose? Press 1 for yes or 2 for no.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 127: VALID MED DOSE CHANGE 
               
               
                   
                 On 2 go to 128: INVALID MED DOSE CHANGE 
               
               
                   
                 Any other entry go to 129: MED DOSE COUNT CONFIRM ERROR 
               
               
                 127: VALID MED 
                 Message: 
               
               
                 DOSE CHANGE 
                 “We&#39;re going to check with your doctor about changes made to your 
               
               
                   
                 medications. If you have any questions, you may contact your doctor. We&#39;ll 
               
               
                   
                 let you know when we&#39;ve got things straight. Thanks.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 180: MED SECTION LOOP 
               
               
                   
                 Special: 
               
               
                   
                 fax doc saying, “Your patient, [data field: patient name], reported taking 
               
               
                   
                 [data field: med count] [data field: medication 1] pills on [data field: date]. 
               
               
                   
                 This dose conflicts with the dose we have on file, however the patient 
               
               
                   
                 indicates that you have changed the dose. Please fax back this form with 
               
               
                   
                 an updated regimen or indicating that the dose has not changed. If you 
               
               
                   
                 believe the patient is mistaken and should not be taking this quantity of pills, 
               
               
                   
                 please contact them to resolve the issue.” 
               
               
                 128: INVALID MED 
                 Logic: 
               
               
                 DOSE CHANGE 
                 If 121: is 0 or [MED COUNT] less than [number of pills on file], 
               
               
                 (logic) 
                 go to 140: MED UNDERDOSE 
               
               
                   
                 Else go to 160: MED OVERDOSE. 
               
               
                   
                 Special: 
               
               
                   
                 fax doc saying, “Your patient, [data field: patient name], reported taking 
               
               
                   
                 [data field: med count] [data field: medication 1] pills on [data field: date]. 
               
               
                   
                 This dose conflicts with the dose we have on file, and the patient indicates 
               
               
                   
                 that you have not changed the dose. [data field: patient name] thinks they 
               
               
                   
                 are taking the correct dose. Please contact the patient to resolve the issue.” 
               
               
                 129: MED DOSE 
                 Message: 
               
               
                 COUNT CONFIRM 
                 “There seemed to be a problem with your entry.” 
               
               
                 ERROR 
                 Actions: 
               
               
                   
                 Go to 126: MED DOSE COUNT CONFIRM 
               
               
                 140: MED NUMBER 
                 Logic: 
               
               
                 CHECK 
                 If this is the primary medication ([MED NUMBER] = 1), 
               
               
                 (logic) 
                 go to 141: MED UNDERDOSE 
               
               
                   
                 Else go to 150: ALT MED UNDERDOSE. 
               
               
                 141: MED 
                 Prompt: 
               
               
                 UNDERDOSE 
                 “It looks like you took fewer pills than the doctor prescribed.. Press 1 if you 
               
               
                   
                 ran out of medication. Press 2 if you forgot. Press 3 if you think you took 
               
               
                   
                 the correct number of pills. Press 4 if you&#39;re trying to reduce your side 
               
               
                   
                 effects. Press 5 if you&#39;re feeling better and don&#39;t think you need to take it. 
               
               
                   
                 Press 6 if you made a mistake when you entered the number of pills you 
               
               
                   
                 took.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 142: MED RAN OUT 
               
               
                   
                 On 2 go to 143: MED FORGOT 
               
               
                   
                 On 3 go to 144: MED THINK CORRECT 
               
               
                   
                 On 4 go to 145: MED REDUCE SIDE EFFECTS 
               
               
                   
                 On 5 go to 146: USED TO FEEL 
               
               
                   
                 On 6 go to 120: MED DOSE COUNT 
               
               
                   
                 Any other entry go to 149: MED UNDERDOSE ERROR 
               
               
                 142: MED RAN OUT 
                 Message: 
               
               
                   
                 “Always order a refill about 5 days before you run out because it can take a 
               
               
                   
                 couple of days to get a refill. If you have trouble remembering, many 
               
               
                   
                 pharmacies now offer a reminder service or you can ask a friend or family 
               
               
                   
                 member to help you.” 
               
               
                   
                 Custom Messages: (based on med type, can push extra cautions here) 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 148: MED ZERO CHECK 
               
               
                 143: MED FORGOT 
                 Message: 
               
               
                   
                 “Here&#39;s a tip for remembering to take your medication - make it part of your 
               
               
                   
                 daily routine. For example, put your pills right next to your toothpaste so 
               
               
                   
                 you remember to take them when you brush your teeth in the morning or at 
               
               
                   
                 night.” 
               
               
                   
                 Custom Messages: (based on med type, can push extra cautions here) 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 148: MED ZERO CHECK 
               
               
                 144: MED THINK 
                 Message: 
               
               
                 CORRECT 
                 “The number of pills you reported taking doesn&#39;t match the information we 
               
               
                   
                 have on file. You may not be taking the correct number. We&#39;ll check with 
               
               
                   
                 your doctor and get back to you.” 
               
               
                   
                 Custom Messages: (based on med type, can push extra cautions here) 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 148: MED ZERO CHECK 
               
               
                 145: MED REDUCE 
                 Message: 
               
               
                 SIDE EFFECTS 
                 “Side effects can be hard to deal with. However, it&#39;s important not to take 
               
               
                   
                 less of your medication or stop taking it completely without first talking to 
               
               
                   
                 your doctor. Call your doctor as soon as you can to talk about this.” 
               
               
                   
                 Custom Messages: (based on med type, can push extra cautions here) 
               
               
                   
                 Actions: 
               
               
                   
                 If LITHIUM is true, go to 147: MED LITHIUM EXTRA 
               
               
                   
                 Else, go to 148: MED ZERO CHECK 
               
               
                 146: USED TO FEEL 
                 Message: 
               
               
                   
                 “Never stop taking your medication because you feel better unless you talk 
               
               
                   
                 to your doctor first. If you stop without your doctor&#39;s permission there&#39;s a 
               
               
                   
                 real good chance you will begin feeling bad again.” 
               
               
                   
                 Custom Messages: (based on med type, can push extra cautions here) 
               
               
                   
                 Actions: 
               
               
                   
                 If LITHIUM is true, go to 147: MED LITHIUM EXTRA 
               
               
                   
                 Else, go to 148: MED ZERO CHECK 
               
               
                 147: MED LITHIUM 
                 Message: 
               
               
                 EXTRA 
                 “As we said before, if you&#39;re taking Lithium, it&#39;s important to not stop 
               
               
                   
                 without your doctor&#39;s permission because your risk of suicide might 
               
               
                   
                 increase. If you feel you have to stop taking your Lithium, never do so on 
               
               
                   
                 your own. Call your doctor right away.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 148: MED ZERO CHECK 
               
               
                 148: MED ZERO 
                 Logic: 
               
               
                 CHECK 
                 If MED COUNT = 0, set the MEDZERO flag. 
               
               
                 (logic) 
                 Go to 180: MED SECTION LOOP 
               
               
                 Important 
                 Special: 
               
               
                   
                 If user has multiple recent count of zero meds, {≧2 days in a row or ≧2 
               
               
                   
                 days out of past 7 days}: 
               
               
                   
                 send PRIORITY REPORT to doc (“Your patient, [data field: patient name], 
               
               
                   
                 has not taken their [data field: medication] for two out of the past 7 days. 
               
               
                   
                 This message is dated [data field: date].”) 
               
               
                 149: MED 
                 Message: 
               
               
                 UNDERDOSE 
                 “There seemed to be a problem with your entry.” 
               
               
                 ERROR 
                 Actions: 
               
               
                   
                 Go to 141: MED UNDERDOSE 
               
               
                 150: ALT MED 
                 Prompt: 
               
               
                 UNDERDOSE 
                 “It looks like you took fewer pills than the doctor prescribed.. Press 1 if you 
               
               
                 PROMPT 
                 ran out of medication. Press 2 if you forgot. Press 3 if you think you took 
               
               
                   
                 the correct number of pills. Press 4 if you&#39;re trying to reduce your side 
               
               
                   
                 effects. Press 5 if you&#39;re feeling better and don&#39;t think you need to take it. 
               
               
                   
                 Press 6 if you made a mistake when you entered the number of pills you 
               
               
                   
                 took.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 151: ALT MED UNDERDOSE MESSAGE 
               
               
                   
                 On 2 go to 151: ALT MED UNDERDOSE MESSAGE 
               
               
                   
                 On 3 go to 151: ALT MED UNDERDOSE MESSAGE 
               
               
                   
                 On 4 go to 151: ALT MED UNDERDOSE MESSAGE 
               
               
                   
                 On 5 go to 151: ALT MED UNDERDOSE MESSAGE 
               
               
                   
                 On 6 go to 120: MED DOSE COUNT 
               
               
                   
                 Any other entry go to 159: ALT MED UNDERDOSE PROMPT ERROR 
               
               
                 151: ALT MED 
                 Message: 
               
               
                 UNDERDOSE 
                 “It looks like you&#39;ve missed taking your medication as prescribed more than 
               
               
                 MESSAGE 
                 once. It&#39;s important you always take it. If this is too difficult for you, you 
               
               
                   
                 should call your doctor right away.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 148: MED ZERO CHECK 
               
               
                 159: ALT MED 
                 Message: 
               
               
                 UNDERDOSE 
                 “There seemed to be a problem with your entry.” 
               
               
                 PROMPT ERROR 
                 Actions: 
               
               
                   
                 Go to 150: ALT MED UNDERDOSE PROMPT 
               
               
                 160: MED 
                 Prompt: 
               
               
                 OVERDOSE 
                 “From what you report, you may be taking more medication than your 
               
               
                 Important 
                 doctor prescribed. This can cause some serious side effects. Never change 
               
               
                   
                 how you take your medication without first talking with your doctor. If 
               
               
                   
                 you&#39;re not sure if you&#39;ve taken too much medication, call your doctor right 
               
               
                   
                 away. If you can&#39;t get in touch with [Dr. name], call 911 or go to the nearest 
               
               
                   
                 emergency room right away.” 
               
               
                   
                 Press 1 to hear these instructions again, press 2 to end this call so you can 
               
               
                   
                 contact someone, press 3 if you believe you have taken the correct number 
               
               
                   
                 of pills and have received this message in error, press 4 if you incorrectly 
               
               
                   
                 entered the number of pills you took”, press 5 to continue.” 
               
               
                   
                 Custom Messages: (based on med type, can push extra cautions here) 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 160: MED OVERDOSE 
               
               
                   
                 On 2 (or hang up) END CALL 
               
               
                   
                 On 3 go to 180: MED SECTION LOOP 
               
               
                   
                 On 4 go to 120: MED DOSE COUNT 
               
               
                   
                 On 5 go to 180: MED SECTION LOOP 
               
               
                   
                 Any other entry go to 169: MED OVERDOSE ERROR 
               
               
                 169: MED 
                 Message: 
               
               
                 OVERDOSE ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 160: MED OVERDOSE 
               
               
                 180: MED SECTION 
                 Logic: 
               
               
                 LOOP 
                 Increment med number. 
               
               
                 (logic) 
                 If med number is greater than total meds for this patient, 
               
               
                   
                 go to 200: MOOD REVIEW 
               
               
                   
                 Else, go to 120: MED DOSE COUNT 
               
               
                 MOOD 
               
               
                 200: MOOD 
                 Logic: 
               
               
                 REVIEW 
                 If first contact with this patient, 
               
               
                 (logic) 
                 go to 210: SPLIT MOOD CHECK 
               
               
                 Important 
                 Else, go to 201: MOOD REVIEW MESSAGE 
               
               
                 201: MOOD REVIEW 
                 Message: 
               
               
                 INTRO 
                 “Now we are going to review your mood rating from last time.” 
               
               
                 Important 
                 Actions: 
               
               
                   
                 Go to 202: MOOD REVIEW LOGIC 
               
               
                 202: MOOD 
                 Logic: 
               
               
                 REVIEW LOGIC 
                 If no mood scale for past 7 days: 
               
               
                 Important 
                 go to 205: MOOD REVIEW OPTION 3 
               
               
                   
                 Else if no mood scale was received yesterday (note this could only occur if 
               
               
                   
                 patient hung up midway or did not answer): 
               
               
                   
                 go to 203: MOOD REVIEW OPTION 1 
               
               
                   
                 Else if last mood rating was a split mood: 
               
               
                   
                 go to 204: MOOD REVIEW OPTION 2 
               
               
                   
                 Else (default): 
               
               
                   
                 go to 206: MOOD REVIEW OPTION 4 
               
               
                 203: MOOD 
                 Message: 
               
               
                 REVIEW OPTION 1 
                 “When we called last time, you didn&#39;t rate your mood. It&#39;s important you do 
               
               
                 Important 
                 this every day. This information is really useful for [Dr. name] to see how 
               
               
                   
                 well your treatment is working.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 210: SPLIT MOOD CHECK 
               
               
                 204: MOOD 
                 Message: 
               
               
                 REVIEW OPTION 2 
                 “Last time you rated your mood as split, with your highest rating a [Data 
               
               
                 Important 
                 Entry from 111: MOOD CYCLE ONE from most recent rating] and your 
               
               
                   
                 lowest a [Data Entry from 112: MOOD CYCLE TWO from most recent 
               
               
                   
                 rating]” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 210: SPLIT MOOD CHECK 
               
               
                 205: MOOD 
                 Message: 
               
               
                 REVIEW OPTION 3 
                 “You have not made a mood rating for the past 7 days. It&#39;s important you do 
               
               
                 Important 
                 this every day. This information is really useful for [Dr. name] to see how 
               
               
                   
                 well your treatment is working.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 210: SPLIT MOOD CHECK 
               
               
                 206: MOOD 
                 Message: 
               
               
                 REVIEW OPTION 4 
                 “Last time, you rated your mood a [data field: mood rating from most recent 
               
               
                 Important 
                 rating].” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 210: SPLIT MOOD CHECK 
               
               
                 210: SPLIT MOOD 
                 Prompt: 
               
               
                 CHECK 
                 “When thinking about your mood yesterday, did you experience switching 
               
               
                   
                 mood states? Press 1 for yes, 2 for no, or 9 to hear examples of switching 
               
               
                   
                 mood states.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 230: MOOD CYCLE CHECK 
               
               
                   
                 On 2 go to 220: MOOD INPUT INTRODUCTION 
               
               
                   
                 On 9 go to 215: MOOD CYCLE EXAMPLES 
               
               
                   
                 Any other entry, go to 219: SPLIT MOOD CHECK ERROR 
               
               
                 215: MOOD CYCLE 
                 Message: 
               
               
                 EXAMPLES 
                 “Examples of switching within a day include: sudden, distinct, and large 
               
               
                   
                 mood changes between depression and mania within a single day.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 210: SPLIT MOOD CHECK 
               
               
                 219: SPLIT MOOD 
                 Message: 
               
               
                 CHECK ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                 Essential 
                 Actions: 
               
               
                   
                 Go to 210: SPLIT MOOD CHECK 
               
               
                 220: MOOD INPUT 
                 Message: 
               
               
                 INTRODUCTION 
                 “Now we are going to ask you to rate how you felt yesterday.” 
               
               
                 Essential 
                 Actions: 
               
               
                   
                 Go to 221: MOOD INPUT MESSAGE 
               
               
                 221: MOOD INPUT 
                 Message: 
               
               
                 MESSAGE 
                 “On a scale of 0 to 100, where 0 is the most depressed you could imagine 
               
               
                 Essential 
                 being, 50 is a balanced or level mood, and 100 is the most energetic, 
               
               
                   
                 activated, or manic you could ever be, how would you rate your mood 
               
               
                   
                 yesterday?” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 222: MOOD INPUT MESSAGE 
               
               
                 222: MOOD INPUT 
                 Prompt: 
               
               
                 PROMPT 
                 “Please enter a number between 0 and 100, followed by the # key. If you 
               
               
                 Essential 
                 would like to hear some example ratings on the 0 to 100 scale, press 999 
               
               
                   
                 followed by the # key.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 51 to 100 go to 300: DYSPHORIC CHECK 
               
               
                   
                 On 0-50 go to 400: CUSTOM EDUCATION LOGIC 
               
               
                   
                 On 999 go to 225: MOOD INPUT EXAMPLES 
               
               
                   
                 Any other entry, go to 229: MOOD INPUT ERROR 
               
               
                 225: MOOD INPUT 
                 Message: 
               
               
                 EXAMPLES 
                 “Example ratings. If yesterday you felt moderately depressed, you might 
               
               
                 Essential 
                 rate your mood as 32 or 35, or if you felt a little manic, you might rate your 
               
               
                   
                 mood as 54 or 57.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 222: MOOD INPUT MESSAGE 
               
               
                 229: MOOD INPUT 
                 Message: 
               
               
                 ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                 Essential 
                 Actions: 
               
               
                   
                 Go to 222: MOOD INPUT MESSAGE 
               
               
                 230: MOOD CYCLE 
                 Message: 
               
               
                 CHECK MESSAGE 
                 “Please note that feeling worse in the morning and a very gradual 
               
               
                 Essential 
                 improvement during the day (or better in the morning with a gradual 
               
               
                   
                 worsening as the day goes on) should not be counted as a mood switch.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 231: MOOD CYCLE CHECK PROMPT 
               
               
                 231: MOOD CYCLE 
                 Prompt: 
               
               
                 CHECK PROMPT 
                 “Press 1 to continue and rate two mood levels, or press 2 to return to rate a 
               
               
                 Essential 
                 single mood.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 240: MOOD CYCLE ONE 
               
               
                   
                 On 2 go to 221: MOOD INPUT MESSAGE 
               
               
                   
                 On any other entry: go to 239: MOOD CYCLE CHECK ERROR 
               
               
                 239: MOOD CYCLE 
                 Message: 
               
               
                 CHECK ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 231: MOOD CYCLE CHECK PROMPT 
               
               
                 240: MOOD CYCLE 
                 Prompt: 
               
               
                 ONE 
                 “Please enter the highest or most energized mood you experienced 
               
               
                 Essential 
                 yesterday. Please enter a number between 0 and 100, followed by #. If you 
               
               
                   
                 would like to hear some example ratings on the 0 to 100 scale, press 999 
               
               
                   
                 followed by the # key.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 0 to 100 go to 250: MOOD CYCLE TWO 
               
               
                   
                 On 999 go to 225: MOOD INPUT EXAMPLES 
               
               
                   
                 Any other entry, go to 249: MOOD CYCLE ONE ERROR 
               
               
                 249: MOOD CYCLE 
                 Message: 
               
               
                 ONE ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                 Essential 
                 Actions: 
               
               
                   
                 Go to 240: MOOD CYCLE ONE 
               
               
                 250: MOOD CYCLE 
                 Prompt: 
               
               
                 TWO 
                 “Please enter the lowest mood you experienced yesterday. Please enter a 
               
               
                 Essential 
                 number between 0 and 100, followed by #. If you would like to hear some 
               
               
                   
                 example ratings on the 0 to 100 scale, press 999 followed by the # key.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 0 to 100 go to 260: MOOD CYCLE COUNT 
               
               
                   
                 On 999 go to 225: MOOD INPUT EXAMPLES 
               
               
                   
                 $$ Any other entry, go to 259: MOOD CYCLE TWO ERROR 
               
               
                 259: MOOD CYCLE 
                 Message: 
               
               
                 TWO ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                 Essential 
                 Actions: 
               
               
                   
                 Go to 250: MOOD CYCLE TWO 
               
               
                 260: MOOD CYCLE 
                 Prompt: 
               
               
                 COUNT 
                 “Please enter the number of times you switched between a higher and a 
               
               
                 Essential 
                 lower state yesterday, followed by #. One switch would mean that you 
               
               
                   
                 experienced two mood states.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 0# to 100# 
               
               
                   
                 go to 300: DYSPHORIC CHECK 
               
               
                   
                 On any other input go to 269: MOOD CYCLE COUNT ERROR 
               
               
                   
                 Special: 
               
               
                   
                 On 0# to 100# 
               
               
                   
                 set SPLIT_FLAG to TRUE 
               
               
                 269: MOOD CYCLE 
                 Message: 
               
               
                 COUNT ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                 Essential 
                 Actions: 
               
               
                   
                 Go to 260: MOOD CYCLE COUNT 
               
               
                 SEVERITY 
               
               
                 300: DYSPHORIC 
                 Prompt: 
               
               
                 CHECK 
                 “When you felt energized or manic, did you experience unhappiness, 
               
               
                 Important 
                 irritability, or anxious uneasiness? Press 1 for Yes or 2 for No” 
               
               
                   
                 Actions: 
               
               
                   
                 On 1 go to 400: CUSTOM EDUCATION LOGIC 
               
               
                   
                 On 2 go to 400: CUSTOM EDUCATION LOGIC 
               
               
                   
                 Any other entry: go to 309 
               
               
                   
                 Special: 
               
               
                   
                 Set the Dysphoric Flag. 
               
               
                 309: DYSPHORIC 
                 Message: 
               
               
                 CHECK ERROR 
                 “There seemed to be a problem with your entry.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 300: DYSPHORIC CHECK 
               
               
                 EDUCATION 
               
               
                 400: CUSTOM 
                 Logic: 
               
               
                 EDUCATION 
                 If 222 &lt; 40 go to 410: GENERAL DEPRESSION EDUCATION 
               
               
                 LOGIC 
                 If 222 &gt; 60 go to 420: GENERAL MANIA EDUCATION 
               
               
                   
                 If 222 &gt; 60 and 300 (DYSPHORIC CHECK) = 1 go to 430: DYSPHORIC 
               
               
                   
                 MANIA EDUCATION 
               
               
                   
                 If 231 (MOOD CYCLE CHECK PROMPT) = 1 and 300 (DYSPHORIC 
               
               
                   
                 CHECK) = 2 go to 440: SPLIT MOOD NO DYSPHORIA EDUCATION 
               
               
                   
                 If 231 (MOOD CYCLE CHECK PROMPT) = 1 and 300 (DYSPHORIC 
               
               
                   
                 CHECK) = 1 go to 450: SPLIT MOOD WITH DYSPHORIA EDUCATION 
               
               
                 410: GENERAL 
                 Add education 
               
               
                 DEPRESSION 
                 Go to 500: SLEEP REVIEW 
               
               
                 EDUCATION 
               
               
                 420: GENERAL 
                 Add education 
               
               
                 MANIA 
                 Go to 500: SLEEP REVIEW 
               
               
                 EDUCATION 
               
               
                 430: DYSPHORIC 
                 Add education 
               
               
                 MANIA 
                 Go to 500: SLEEP REVIEW 
               
               
                 EDUCATION 
               
               
                 440: SPLIT MOOD 
                 Add education 
               
               
                 NO DYSPHORIA 
                 Go to 500: SLEEP REVIEW 
               
               
                 EDUCATION 
               
               
                 450: SPLIT MOOD 
                 Add education 
               
               
                 WITH DYSPHORIA 
                 Go to 500: SLEEP REVIEW 
               
               
                 EDUCATION 
               
               
                 SLEEP 
               
               
                 500: SLEEP 
                 Logic: 
               
               
                 REVIEW 
                 If first contact with the patient, 
               
               
                 (logic) 
                 go to 505: SLEEP REVIEW INPUT 
               
               
                 Marginal 
                 Else if patient did not respond yesterday, 
               
               
                   
                 go to 502: SLEEP REVIEW NO YESTERDAY 
               
               
                   
                 Else, 
               
               
                   
                 go to 501: SLEEP REVIEW MESSAGE 
               
               
                 501: SLEEP 
                 Message: 
               
               
                 REVIEW MESSAGE 
                 “Yesterday, you said that you slept [data field: sleep rating from previous 
               
               
                 Marginal 
                 day] hours.” 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 505: SLEEP REVIEW INPUT 
               
               
                 502: SLEEP 
                 Message: 
               
               
                 REVIEW NO 
                 “Yesterday, you did not make a sleep rating. It&#39;s important you do this 
               
               
                 YESTERDAY 
                 every day.” 
               
               
                 Marginal 
                 Actions: 
               
               
                   
                 Go to 505: SLEEP REVIEW INPUT 
               
               
                 505: SLEEP INPUT 
                 Prompt: 
               
               
                 Important/Marginal 
                 “Please enter the number of hours of sleep you slept last night. If you slept 
               
               
                   
                 part of an hour, round up. For example, 4 hours and 15 minutes or 4-and-a- 
               
               
                   
                 half hours counts as 5. Please count only your main sleep time and do not 
               
               
                   
                 include naps you might have taken several hours after you got up. Please 
               
               
                   
                 enter a number of hours of sleep now, followed by the # sign.” 
               
               
                   
                 Actions: 
               
               
                   
                 On 0 to 24 go to 700: CONCLUSION 
               
               
                   
                 Any other entry, go to 509: SLEEP REVIEW INPUT ERROR 
               
               
                 509: SLEEP 
                 Message: 
               
               
                 REVIEW INPUT 
                 “There seemed to be a problem with your entry.” 
               
               
                 ERROR 
                 Actions: 
               
               
                 Important/Marginal 
                 Go to 505: SLEEP REVIEW INPUT 
               
               
                 SUPPLEMENTARY 
               
               
                 QUESTIONS 
               
               
                 600: 
                 Logic: 
               
               
                 SUPPLEMENTARY 
                 These questions will be pushed to patients once every 7 days, beginning on 
               
               
                 QUESTION LOGIC 
                 the 7 th  day after their first contact. 
               
               
                   
                 Actions: 
               
               
                   
                 Go to 610: MAJOR LIFE EVENT 
               
               
                 610: MAJOR LIFE 
                 Message: “We&#39;d now like to ask you a few extra questions about things that 
               
               
                 EVENT 
                 happened last week. We&#39;ll only ask you these questions once a week.” 
               
               
                   
                 Prompt: 
               
               
                   
                 “Did you have a major life event last week such as starting a new job, 
               
               
                   
                 moving, an argument with a friend or loved one, or anything else that really 
               
               
                   
                 affected you? Press 1 for yes or 2 for no. 
               
               
                   
                 Action: 
               
               
                   
                 On 1 go to 620: MENSTRUATION LOGIC 
               
               
                   
                 On 2 go to 620: MENSTRUATION LOGIC 
               
               
                 620: 
                 Logic: 
               
               
                 MENSTRUATION 
                 If [gender from enrollment form] = female, go to 630: MENSTRUATION 
               
               
                 LOGIC 
                 Else go to 640: ALCOHOL AND DRUGS 
               
               
                 630: 
                 Prompt: 
               
               
                 MENSTRUATION 
                 “Did you have your period last week? Press 1 for yes or 2 for no.” 
               
               
                   
                 Action: 
               
               
                   
                 On 1 go to 640: ALCOHOL AND DRUGS 
               
               
                   
                 On 2 go to 640: ALCOHOL AND DRUGS 
               
               
                 640: ALCOHOL 
                 Prompt: 
               
               
                 AND DRUGS 
                 “Did you binge on alcohol or takes drugs last week? Press 1 for yes or 2 for 
               
               
                   
                 no.” 
               
               
                   
                 Action: 
               
               
                   
                 On 1 go to 700: CONCLUSION 
               
               
                   
                 On 2 go to 700: CONCLUSION 
               
               
                 CONCLUSION 
               
               
                 700: CONCLUSION 
                 Message: 
               
               
                 Essential 
                 “Thank you for tracking your medications and completing your mood chart. 
               
               
                   
                 This makes it easier for you and [doctor name] to track how your treatment 
               
               
                   
                 is going.” 
               
               
                   
                 Actions: 
               
               
                   
                 END CALL 
               
               
                 STANDARD 
               
               
                 OPTIONS 
               
               
                 900: NO ENTRY 
                 Message: 
               
               
                   
                 “I&#39;m sorry, I did not get a response” 
               
               
                   
                 Action: 
               
               
                   
                 Replay message and prompt 
               
               
                 910: INVALID 
                 Message: 
               
               
                 ENTRY 
                 “I&#39;m sorry, that was not a valid response” 
               
               
                   
                 Action: 
               
               
                   
                 Replay message and prompt 
               
               
                 920: PRESS STAR 
                 Action: 
               
               
                   
                 Repeat message and menu 
               
               
                 930: HOLD 
                 Message: 
               
               
                 ROUTINE 
                 “&lt;Music&gt; This is the CLEAR Program study holding for &lt;First Name&gt;. 
               
               
                   
                 Press any key to continue. (repeat for 1 minute)” 
               
               
                   
                 Action: 
               
               
                   
                 ANY KEPYPRESS or TIMOUT: Replay message and Prompt