"eHealth can contribute greatly to improving care for sufferers of depression"

 

In Catalonia, three in ten people attended to in primary healthcare centres suffer from a mental illness, most commonly depression. It is a major health problem, as it is widespread, affects sufferers' quality of life and has a significant impact on their well-being and on their family and work environments. Aïna Fuster, researcher at the Research and Innovation Unit of the Catalan Health Institute (ICS) in Central Catalonia, is developing a care model for treating mild or moderate depressive episodes at primary healthcare centres. The aim is to identify eHealth tools that facilitate a comprehensive approach to treating depression in the Catalan primary care system. Fuster is developing this model as part of her doctoral degree in eHealth at the UOC.

In addition, she recently won the first InnoBages award, given by Bages County Council for scientific dissemination through social networks, for a Twitter thread raising awareness of the project.

 

In Catalonia, three in ten people attended to in primary healthcare centres suffer from a mental illness, most commonly depression. It is a major health problem, as it is widespread, affects sufferers' quality of life and has a significant impact on their well-being and on their family and work environments. Aïna Fuster, researcher at the Research and Innovation Unit of the Catalan Health Institute (ICS) in Central Catalonia, is developing a care model for treating mild or moderate depressive episodes at primary healthcare centres. The aim is to identify eHealth tools that facilitate a comprehensive approach to treating depression in the Catalan primary care system. Fuster is developing this model as part of her doctoral degree in eHealth at the UOC.

In addition, she recently won the first InnoBages award, given by Bages County Council for scientific dissemination through social networks, for a Twitter thread raising awareness of the project.

Mental health is a key issue not only for the healthcare system, but also for humankind. This illness is commonly treated within the primary care system, so we analysed depression-related appointments from 2017 to 2022 at primary healthcare centres that are affiliated to the ICS. We found that it has become much more prevalent and the pandemic was a catalyst. In the sample we analysed in 2022, approximately 67% were women, and 33% were men. For my PhD project, I'm developing a care model for mild and moderate depressive episodes in the primary care system, drawing on both eHealth tools and collaborative care.

This illness is commonly treated in the primary healthcare system, so I felt it was important to reinforce care provision using resources such as eHealth, which has the potential to improve public health, providing diagnostic and monitoring tools to improve joint decision-making. And it can used throughout Catalonia.

There are four stages to my project. The first is to analyse the prevalence of the illness and how appointments are handled in primary healthcare centres. The second step involves a survey of primary healthcare professionals from the ICS to understand how they deal with depressive episodes and if they follow any clinical practice guidelines. Thirdly, we'll conduct focus groups with primary healthcare professionals to build this model. Finally, we'll survey professionals and the public to reach a consensus on the recommendations given by the focus groups.

I'm currently working on the second stage and I'm finding that few professionals feel they are following any guideline during clinical practice. This means I'll make some changes to the third target. The focus groups will concentrate on finding out why guidelines aren't used and determining which digital health tools could be important for primary care throughout the patient's treatment process. I'm starting to conduct a systematic review to identify what tools exist around the world, so that we can show the evidence to the groups and have them, as experts, suggest those that fit our primary healthcare system.

eHealth has amazing potential. Currently, primary care is fundamentally based on telemedicine, and we must consider going further: artificial intelligence, mobile health, etc. But we mustn't forget that the Catalan health system is fully immersed in a process of digital transformation, as established in the 2021-2025 health plan, and that great milestones have been reached in recent years, such as the development of the Catalan shared medical records system, La Meva Salut. The ideal solution is to combine face-to-face care and eHealth: the healthcare professional offers experience, expertise, warmth, contact and empathy, while eHealth provides immediacy, constant monitoring, support for decision-making based on clinical data, etc. Each can strengthen the other.

Primary care is the cornerstone of the entire health system and, I believe, key for detecting, managing and monitoring disorders like depression. Its range and universal accessibility make primary healthcare one of the few systems designed for people to use throughout their lives. But I believe it's essential to continuously update primary healthcare, train staff and carry out research so it can continue to improve, and to develop increasingly tailored tools and methods to treat depressive episodes.

Personally, yes, I think we're quite medicalized but I want to point out a few things. Drugs are a scientifically tested resource that help manage depression and I believe they should be used when necessary. However, I believe both professionally and personally that we need to develop more tools and techniques that go beyond pharmacotherapy. Mental health should no longer be taboo. We need to be empowered and normalize the practice of saying that we're okay or that we feel bad, expressing our needs and thoughts. I want to help make that happen.

When I studied pharmacy I already knew that I wanted to work in the field of health and to have the greatest direct impact possible on people's health and quality of life. That's why, when I finished my bachelor's degree, I chose to take the UOC Master's Degree in eHealth. Also, as it was online, it allowed me to combine my studies with my work. Although it wasn't compulsory, I did an internship in the Primary Care Research and Innovation Unit at Central Catalonia's ICS. The unit carried out projects related to eHealth. A few months after finishing there, a researcher post came up, I applied and that's where I am now. My job is to support all the professionals in Central Catalonia who want to do research. We also promote research and participate in different national and European projects, all of them related to eHealth.

As I was sure this is the sector I want to work in, I felt it was necessary to obtain a PhD. I should also mention that the ICS encourages its employees to study and do PhDs. Dr Josep Vidal put me in touch with Dr Carme Carrion, principal investigator at the UOC's eHealth Lab in the Health Sciences department and collaborator group at the UOC’s eHealth Center. I decided that I wanted to set up a brand new project whose keywords had to be primary care, eHealth and depression. After much thought, and with the help of my two supervisors, I decided that I wanted to develop a treatment model for mild or moderate depressive episodes in adults in primary care, based on current primary healthcare roles and the eHealth tools that could be added to the system.

Of course, they're a great tool for scientific dissemination, being open to everyone. Publications in scientific journals are aimed at a specific, very specialized community. I believe that it's essential to bring your research to a wider audience as, in the end, the project affects all members of the public. For me it was a challenge to explain what I'm trying to do with my thesis to non-experts, and I find it very important to be able to do so in a way that people understand. As a member of the public myself, I'm interested in what is going on and, whatever the subject, I like to have it explained in a way I can understand.