Pilot Study of Annie Text Messaging for Depression Treatment Adherence
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Patients and providers need effective tools to help promote adherence to newly prescribed
      medications for depression and to determine if this medication is improving depressed mood.
      This study will test an intervention that uses 1) VA's text messaging program called Annie to
      help patient's engage in self-management when starting a new medication for depression and 2)
      My HealtheVet, VA's patient portal, for education and communication with their VA health care
      team. The goals of this intervention are to improve adherence to depression medication and
      depressive symptoms in Veterans.
    

Detailed description: 
      Background: There are several known challenges to starting a medication for depression, such
      as side effects and needing four to six weeks before the effects of the medication may be
      noticed. This pilot randomized controlled trial will compare usual care to an intervention
      which aims to improve antidepressant adherence and depression outcomes in Veterans initiating
      medication to treat depression by using Annie, VA's short messaging services (SMS)
      application and My HealtheVet, VA's patient portal.

      Method: Veterans will be eligible if they are initiating a new antidepressant medication as
      part of their care at the Iowa City VA primary care or mental health. Veterans will be
      randomized to one of three groups, usual care or 1 of 2 interventional groups (Annie or Annie
      plus). Veterans in the intervention groups will 1) receive education about depression and the
      importance of taking medications as prescribed and 2) receive text messages from "Annie" with
      information and questions for response. For example, are Veterans taking their medication, is
      their medication working, and how would they rate their mood. They will also receive weekly
      reports about their responses to Annie through My HealtheVet, VA's patient portal. In
      addition, Veterans assigned to Annie Plus will receive a weekly phone call to review progress
      and to answer any questions. Prior to a participant's scheduled follow-up appointment, a
      summary of information collected to date via Annie will be made available to the clinical
      team in the medical record. At the end of the study, participants will be invited to complete
      a recorded interview about their experiences using the Annie text messaging program and to
      provide any recommendations for changes. VA providers will also be invited to complete a
      recorded phone interview about their experience with patients using Annie.

      For Veterans randomized to the control condition, research staff will provide education about
      depression and the importance of taking medications as prescribed. Staff will contact
      participants in this arm by phone just prior to scheduled follow up visits to discuss any
      concerns the patient may be experiencing. A sample of Veterans will be asked to complete a
      recorded interview about their medication management at the end of the study.
    

Intervention name(s): AIMS; AIMS plus
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants randomized to the AIMS arm be enrolled in VA's Annie text messaging program and receive the study protocol. Annie text messages will ask the participate to provide feedback about specific domains related to their depression treatment and goals. The Veteran participant will receive a weekly report about their Annie responses through My HealtheVet, VA's patient portal, and instructed to share information with their care team at their next scheduled appointment. In addition, a summary of response will be provided to the participant's clinician prior to their appointment(s) during the studies 12 week time frame.; Participants randomized to the AIMS Plus arm will receive a weekly phone call in addition to being enrolled in VA's Annie text messaging program/study protocol. Annie text messages will ask the participate to provide feedback about specific domains related to their depression treatment and goals. The Veteran participant will receive a weekly report about their Annie responses through My HealtheVet, VA's patient portal, and instructed to share information with their care team at their next scheduled appointment. In addition, a summary of response will be provided to the participant's clinician prior to their appointment(s) during the studies 12 week time frame.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study will test an intervention designed to improve antidepressant adherence and depression outcomes in Veterans initiating or changing antidepressant medication to treat depression. Veterans will be assigned to 1) use Annie, VA's short message service (SMS) in combination with My HealtheVet, VA's online patient portal, 2) use Annie plus receive a weekly phone call, or 3) to the control group who will not be enrolled in Annie.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Depression; Patient Participation; Text messaging; Patient Portals