Online cognitive behavioural therapy offers improved outcomes over the traditional treatment for depression

The adoption of digital health technologies is an important challenge for the health sector. Among the barriers preventing the implementation of these solutions is the lack of evidence on their effectiveness and the lack of adequate economic studies on their integration into the system. A UOC study, published in open access, has analysed the impact and cost of primary care implementation of an internet-based cognitive behavioural therapy intervention to treat patients with depression. The results, published in the Journal of Medical Internet Research, show that digital intervention is cost-effective; that is, it would improve the quality of life of patients at an acceptable cost compared to the traditional form of care in a healthcare context such as that of Catalonia.

The work is part of the doctoral thesis of Jordi Piera, a researcher on the doctoral programme in the Information and Knowledge Society and a course instructor in the Faculty of Computer Science, Multimedia and Telecommunications and the Faculty of Information and Communication Sciences. Francisco Lupiáñez-Villanueva, who too is a member of the Faculty of Information and Communication Sciences and a co-supervisor of the thesis, also participated in the research.

"This research shows that the incorporation of digital health into the patient's usual routine is a viable alternative to traditional treatments. The evidence provided by this, and other studies should help us to reflect on a new healthcare model that systematically takes advantage of the opportunities presented by digital transformation technologies in a sector as traditional as medicine," said Jordi Piera.

Digital health, an alternative for patients with depression

Major depressive disorder is a chronic disease. This is the most common mental health condition among the adult population and one of the leading non-fatal causes of disability worldwide for nearly three decades. Cognitive behavioural therapy is a type of psychological treatment that helps modify negative thoughts, feelings, and behaviours and has been shown to be effective against this disease.

Considering the lack and uneven distribution of qualified professionals and delays in the provision of treatments, this online behavioural therapy offers a promising way for more patients to be reached. "The psychology resources that normally exist in the territory are not sufficient to respond to the needs of the system. In fact, the idea behind the project arose from the feeling among primary care professionals that patients with this pathology are under-served as that they do not have sufficient tools to respond to them," underlined Jordi Piera.

Super@ tu depresión, a self-administered intervention

In this context, the researchers analysed Super@ tu depresión, an online behavioural therapy developed within the framework of the European MasterMind project, which has been implemented for the last few years in the primary care system of Badalona, through the Badalona Welfare Services (BSA), a municipal-owned organization that provides comprehensive health and social services to the population of El Barcelonès Nord and El Baix Maresme.

The aim of this therapy is to work on patients' behaviours, thinking and moods in order to improve their overall health. It is about helping them to make use of resources they already have, learn new strategies and introduce small changes that enable them to deal with the emotions better.

Patients are signed up for the therapy by healthcare professionals at BSA, at mental health centres and at the fibromyalgia unit. The Consulta de Prescripció Tecnològica (Technological Prescription Consultation) provides patients with an initial welcome and guidance on use of the program as well as subsequent technical support. In terms of basic support, the patient remains with their usual healthcare professional.

The programme consists of nine modules composed of videos, text content and questionnaires to monitor the progression of symptoms and adherence to the intervention. "The intervention is self-administered, which means that patients mainly interact with the online platform on their own and healthcare professionals are only notified if their clinical condition worsens so that they can take the necessary actions," explained the researcher.

The effectiveness and costs of the intervention were compared with those of the traditional method of care consisting of regular visits with family doctors to primary care clinics combined with drug treatment. This information was collected from data published in previous studies in the same area. "This is a pragmatic study that prioritizes the routine implementation of an intervention that is already evidence-based. In other words, it has already demonstrated its effectiveness in randomized studies. With this study design, what we intend to identify is how the intervention plays out in a real environment, far from the controlled environments that occur in randomized study designs," stated Jordi Piera.

66.7% of patients recovered at the end of the intervention

The study recruited 253 patients, of whom 147 completed the treatment. These were adults diagnosed with mild, moderate or severe major depressive disorder, residing in Badalona and who, according to their GP, had the required technological literacy and internet connection to benefit from the digital therapy. By the end of the intervention, 98 participants, 66.7% of the total, had recovered from the disease.

Subsequently, a cost-analysis tool was developed to control the financial sustainability of this type of health initiative, which considers three types of costs: one-off costs, which represent the total cost incurred only once at the point of implementation – for example, the training of professional personnel or the cost of devices; healthcare costs – that is, the consumption of healthcare resources such as the costs associated with the time that healthcare professionals spend on the provision of services, hospitalizations, medication, etc.; and, finally, social costs, generated by the time spent by patients and informal caregivers, such as the time during which they use the technology or travel to the hospital.

According to the results of this analysis, the Super@ tu depresión programme provided benefits to patients at a cost that would allow its implementation in Spain, where interventions below 30,000 euros per quality-adjusted life-year (QALY) are accepted. This is a measure that relates the impact of a given technology to its effects on health through improvements in quality of life and mortality. In addition, the researchers estimated that a higher number of participants in the programme would also lead to a reduction in the cost per session and, therefore, of its implementation.

The challenge of cultural and organizational change

This research demonstrates the potential impact of this type of digital health tool, but for the UOC researcher, the most important challenge for its future implementation continues to be "the cultural and organizational change" that the roll-out of this type of solution would entail for the healthcare system. "The technologies exist, they’re available and they’ve been proven to be effective. The great challenges are, firstly, the cultural change that healthcare professionals are supposed to take on board and implement, and secondly, the organizational change that rethinking care processes represents so that they also incorporate these models of remote care for patient profiles that can benefit from it," said Jordi Piera.

In this regard, the researcher pointed to the need for more studies to explore "the profile of the patient who can benefit most from the intervention so that general practitioners have more information to properly guide the therapy."

This UOC research supports Sustainable Development Goal (SDG) 3 (Good Health and Well-being).

One of the UOC's academic centers, the eHealth Center, promotes research into digital health at the University and develops activities to boost research and innovation in digital health.

 

UOC R&I

The UOC's research and innovation (R&I) is helping overcome pressing challenges faced by global societies in the 21st century, by studying interactions between technology and human & social sciences with a specific focus on the network society, e-learning and e-health.

Over 500 researchers and 52 research groups work among the University's seven faculties and two research centres: the Internet Interdisciplinary Institute (IN3) and the eHealth Center (eHC).

The University also cultivates online learning innovations at its eLearning Innovation Center (eLinC), as well as UOC community entrepreneurship and knowledge transfer via the Hubbik platform.

The United Nations' 2030 Agenda for Sustainable Development and open knowledge serve as strategic pillars for the UOC's teaching, research and innovation. More information: research.uoc.edu #UOC25years