Pragmatic Clinical Trial of Population Health, Portal-Based Depression Screening: the PORTAL-Depression Study

Abstract

Background: A population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression.

Objective: To determine whether a population health approach to depression screening is more effective than screening during clinic appointments alone for identifying patients with depression.

Design: A pragmatic clinical trial at an adult outpatient internal medicine clinic at an urban, academic, tertiary care center.

Patients: Eligible patients (n = 2713) were adults due for depression screening with active portal accounts. Patients with documented depression or bipolar disorder and those who had been screened in the year prior to the study were excluded.

Intervention: Patients were randomly assigned to usual (n = 1372) or population healthcare (n = 1341). For usual care, patients were screened by medical assistants during clinic appointments. Population healthcare patients were sent letters through the portal inviting them to fill out an online screener regardless of whether they had a scheduled appointment. The same screening tool, the Computerized Adaptive Test for Mental Health (CAT-MH™), was used for clinic- and portal-based screening.

Main measures: The primary outcome was the depression screening rate.

Key results: The depression screening rate in the population healthcare arm was higher than that in the usual care arm (43% (n = 578) vs. 33% (n = 459), p < 0.0001). The rate of positive screens was also higher in the population healthcare arm compared to that in the usual care (10% (n = 58) vs. 4% (n = 17), p < 0.001).

Conclusion: Findings suggest depression screening via a portal as part of a population health approach can increase screening and case identification, compared to usual care.

Trial registration: ClinicalTrials.gov Identifier: NCT03832283.

Keywords: depression; mental health; population health; primary care; screening.

Figure 1

PORTAL-Depression screening trial patient flow diagram. ^aPatients become ineligible before the start of the trial due to a 4-month delay in study launch. ^bPatients requested to be removed from the trial and not receive the screening invitation.