Today, researchers from the Center for Technology and Behavioral Health (CTBH) at Dartmouth’s Geisel School of Medicine, Dartmouth-Hitchcock (D-H), and Pontificia Universidad Javeriana in Bogotá, Colombia, received an award—one of that country’s most prestigious in medicine—from Colombia’s National Academy of Medicine for their work implementing a new primary care model for widespread access to diagnosis and treatment of depression and unhealthy alcohol use. This care model harnesses mobile health technology to increase the reach of science-based mental health care.
Depression and alcohol use disorder are among the most common causes of disability and death worldwide. The healthcare workforce in low- to middle-income countries, such as Latin America where the burden of mental health problems is high and services for mental health are low, is significantly insufficient with just one psychiatrist per 200,000 people and even fewer mental health care providers trained in the delivery of psychosocial interventions.
Working together with Colombian community and governmental partners, primary investigators Lisa Marsch, PhD, the Andrew G. Wallace Professor of psychiatry and biomedical data science at Geisel and director of CTBH, Carlos Gómez-Restrepo MD, PhD, Faculty of Medicine Dean at Javeriana, and co-investigator William Torrey, MD, the Raymond Sobel Professor of Psychiatry and interim chair of the Department of Psychiatry at D-H and Geisel, assessed the impact of building a primary care infrastructure to support research capacity, as well as sustainability of the new service delivery model in Colombia.
Scaling Up Science-Based Mental Health Interventions in Latin America, a five-year project, sought ways to leverage technology to screen, evaluate, and treat depression and unhealthy alcohol use. Collaborating with six primary care networks in diverse rural, semi-rural, and urban locations across Colombia, the team created waiting room kiosks to screen primary care patients, decision support tablets to guide clinicians in diagnosis and offering evidence-based treatment, and patient access to digital therapeutics as a treatment option. All study participants were trained how to use the treatment tool by a staff member at the primary care site.
“The goal is to take the learning from these six demonstration sites to inform science-based approaches to scaling up mobile behavioral health technology and launching new models of care to better treat patients with depression and alcohol use disorders in Colombia,” Marsch says.
Torrey has more than a decade of practical experience in building support for mental health and addiction in primary care systems throughout D-H community groups, and is familiar with its challenges, such as how primary care doctors respond, take ownership, and talk to patients about depression and alcohol use. Perceived potential challenges for this project include technology access limitations and literacy challenges in certain communities.
To date, data analyses have underscored the feasibility and acceptability of this model of care. Digital technology is perceived as useful in evaluating, diagnosing, and treating patients with depression and unhealthy alcohol use. Enhanced screening combined with training and technology-supported decision making integrated into the workflow of busy primary care clinics led to dramatically higher rates of diagnoses of these conditions. More than 22,000 people have been screened—10 percent were diagnosed with depression and 1.3 % were diagnosed with unhealthy alcohol use in their primary care appointments compared to zero previously. And depression symptoms and unhealthy alcohol use dramatically decreased among patients after they were exposed to the new service delivery model
“Being part of this process of decreasing that gap and expanding services to people who need them is what I’ve been doing throughout my entire career,” Torrey says. “This intervention had a significant impact on the lives of people in the study. Patients said it is a relief to be able to talk to their doctor about these issues, to get help, and to feel validated. Prior to the study these issues were not discussed.”
“Having impact and learning how to scale up models of care to affect people’s lives—that is the most rewarding part of research,” Marsch says. “This project is such a wonderful example of how to do this. It has been such an honor to work with this group,” she says.
Both Marsch and Torrey agree this model can be implemented in other regions with high needs and low capacity for care and be expanded over time to include other areas of mental health, chronic disease management, and health-promoting interventions based on community needs and priorities. Anywhere with a reasonable primary care system can potentially replicate this model.
This research was supported by the National Institute of Mental Health (NIMH) of the National Institutes of Health (award U19 MH-109988).
About the Center for Technology and Behavioral Health
The Center for Technology and Behavioral Health (CTBH) team shares a goal of harnessing digital technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. CTBH is organized into three primary scientific cores: Treatment Development & Evaluation, Emerging Technologies & Data Analytics, and Dissemination & Implementation Core. Core activities focus on identifying and studying state-of-the-art issues related to digital therapeutic tools targeting behavioral health.
About the Geisel School of Medicine
Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, healthcare policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America’s leading medical schools, Dartmouth’s Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in healthcare.
About Dartmouth-Hitchcock Health
Dartmouth-Hitchcock Health (D-HH), New Hampshire’s only academic health system and the state’s largest private employer, serves a population of 1.9 million across northern New England. D-HH provides access to more than 2,000 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH. D-HH was named again in 2020 as the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in 9 clinical specialties and procedures. Dartmouth-Hitchcock Health also includes the Norris Cotton Cancer Center, one of only 51 NCI-designated Comprehensive Cancer Centers in the nation; the Children's Hospital at Dartmouth-Hitchcock, the state’s only children’s hospital; affiliated member hospitals in Lebanon, Keene, and New London, NH, and Windsor, VT, and Visiting Nurse and Hospice for Vermont and New Hampshire; and 24 Dartmouth-Hitchcock clinics that provide ambulatory services across New Hampshire and Vermont. The D-HH system trains nearly 400 residents and fellows annually, and performs world-class research, in partnership with the Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT.
