Torrey W, Cepeda M, Castro S, et al. (2020). Implementing technology-supported care for depression and alcohol use disorder in primary care in Colombia: Preliminary findings. Psychiatric Services. 71(7): 678-683. doi: 10.1176/appi.ps.201900457
A multi-national and multi-disciplinary team of researchers implemented and evaluated implementation outcomes of kiosk-based depression and alcohol screening and tablet-based provider decision support for adult primary care patients in two Colombian clinics (one urban, one rural). Study personnel implemented waiting-room kiosks at which patients could complete screening assessments for depression and unhealthy alcohol use. Kiosks printed screen results for the patient and sent a digital copy to a tablet-based decision support tool that guided the physician through diagnosis and treatment. Clinical providers received training on use of the tablet-based decision support tool. From 2018 to 2019, a total of 2,656 patients completed depression and alcohol use disorder (AUD) screens (rural clinic: 713 patients, urban clinic: 1,943 patients). The percentage of patients diagnosed with depression or AUD increased from almost 0% to 17% and 2%, respectively, in the first year. Clinic physicians appeared to diagnose alcohol use disorder at a lower-than-expected rate: only 38% of patients who screened positive for unhealthy alcohol use were later diagnosed with AUD (whereas 73% of individuals who screened positive for depression were later diagnosed with depression). About 55% of patients diagnosed with depression or AUD chose to join the DIADA study and receive access to Laddr, an evidence-based behavioral therapy mobile app for depression and AUD. Preliminary results indicated that the technology-supported screening model was feasible and led to a significant increase in detection and diagnosis of depression and alcohol use disorder among Colombian primary care patients. This digital care model could inform policy makers and stakeholders who seek to expand mental health care in low- and middle-income primary care settings.