Implementing Technology-Supported Care for Depression and Alcohol Use Disorder in Primary Care in Colombia: Preliminary Findings
Torrey W, Cepeda M, Castro S, et al.
The Detection and Integrated Care for Depression and Alcohol Use in Primary Care (DIADA) project seeks to implement and evaluate the impact of kiosk-based depression and alcohol screening, tablet-based decision support, and digital therapeutic care for primary care patients in Colombia.
DIADA psychiatrists trained primary care providers at two Colombian clinics (one rural, one urban) on a technology-supported model of care for depression and alcohol use disorder. Clinics implemented kiosks in waiting rooms where patients could complete screening assessments for depression and unhealthy alcohol use. Kiosks printed screen results for patients and sent a digital copy to a tablet-based decision support tool that guided the physician through diagnosis and treatment. Diagnosed patients had the opportunity to join the DIADA study and receive access to an evidenced-based behavioral therapy mobile app for depression and alcohol use disorder (Laddr).
Between February 12, 2018, and February 11, 2019, two Colombian clinics screened a total of 2,656 individuals for depression and alcohol use disorder (rural clinic: 713 patients screened, urban clinic: 1,943 patients screened).
In the first year, the percentage of patients diagnosed with depression or alcohol use disorder increased from almost 0% to 17% and 2%, respectively.
Primary care physicians found it easier to discuss and diagnose depression than alcohol use disorder (only 38% of patients who screened positive for unhealthy alcohol use were later diagnosed with alcohol use disorder whereas 73% of those who screened positive for depression were diagnosed with depression).
About 55% of patients diagnosed with depression or alcohol use disorder chose to join the DIADA study.
Preliminary results suggest a technology-supported model of care was a feasible and effective approach that led to a significant increase in detection and diagnosis of depression and alcohol use disorder among patients in two Colombian primary care clinics.
The DIADA project model of care could inform policy makers and stakeholders who seek to expand mental health care in low- and middle-income primary care settings across the globe.