Antidepressant Changes and App Usage Improve MDD Outcomes in Study to Implement the Pathway Platform in Primary Care: A Post Hoc Subgroup Analysis

Background: The Pathway Platform was designed to enhance patient-provider engagement and encourage use of outcome measures for major depressive disorder (MDD) to improve adherence to measurement-based care (MBC) in primary care. This post hoc subgroup analysis of the Pathway Platform implementation study examined the effect of antidepressant (AD) changes on outcomes.
Methods: This analysis included all participants from the Pathway cohort. Eligibility criteria entailed age ≥18 years, diagnosis of MDD, and a recent AD start/switch. Data were collected for 6 months via EHR and the Pathway Platform. Subgroups were defined by ≥1 AD change or none. Outcome measures included PHQ-9 utilization, change in PHQ-9 scores, and Pathway app utilization.
Results: The Pathway cohort included 89 participants (80% female; median age: 35 [IQR: 28-46] years); 40 (45%) had ≥1 AD change. The AD change subgroup completed significantly more PHQ-9 assessments in the app compared with the no AD change subgroup (median: 4 [IQR: 2-9] vs 3 [IQR: 2-5]; P=0.0339). Median changes in PHQ-9 scores from baseline to 6 months showed a significantly greater decrease (P=0.0397) in the AD change subgroup (–5.0; P=0.0020; n=12) vs no AD change subgroup (–0.5; P=0.8125; n=8). Over the 6-month study, the AD change subgroup had significantly more days with ≥1 app login (46% [79 days] vs 23% [39 days]; P=0.0110).
Conclusions: This analysis of the AD change subgroup provides evidence for improved MBC and patient engagement along with significantly greater symptom improvement over 6 months vs the no AD change subgroup, suggesting better outcomes.