Abstract Body (Do not enter title and authors here): Introduction
Nearly 1 in 5 coronary heart disease (CHD) patients experience depression, an independent risk factor for major adverse cardiovascular events. Yet, depression remains undertreated in CHD patients, and few existing implementation strategies address gaps in AHA depression treatment guidelines. Although digital health interventions may help provide patient preference-driven treatment and support, provider perceptions of these tools are poorly understood.
Methods
From 2019 to 2024, we randomized 12 Columbia University Medical Center affiliated primary care and cardiology clinics to timing of a multi-level intervention, which includes problem-solving meetings for mental health social workers (MHSW), cardiologist/PCP (provider) education, and integration of a psychoeducation, activation, and treatment digital selection tool (“iHeart”). We previously found pre-post improvements in provider referral/prescribing rates (25 vs. 40%). Informed by the Consolidated Framework for Implementation Research 2.0, we conducted 1:1 interviews on treatment barriers and iHeart tool/digital health acceptability with 2-3 providers/MHSW/administrators per clinic in the post-implementation phase. We conducted thematic analyses, incorporating a data-driven inductive approach.
Results
To date, 10 clinics completed the post implementation phase, and 20 clinicians consented to interviews. Key themes included 1. dissatisfaction with current depression screening and referral practices 2. Poor integration of digital therapeutics into existing clinic resource hubs, 3. Competing time and priorities and 4. Digital literacy in older, non-English speaking, or low-income patients limits uptake. For specific iHeart feedback, barriers included needing integration into the pre-visit screening workflow and confidentiality concerns. However, providers felt it would streamline the burdensome referral process and improve overall patient communication on mental health issues. For future stages, providers recommended clarifying tool integration infrastructure (e.g. for individual providers or entire clinic), engaging patient family members, and incorporating a navigation team component to orient patients with technological or literacy barriers.
Conclusion
A multi-level digital health implementation strategy may help address existing clinician barriers to depression treatment in individuals with CHD. Future studies will examine impact on patient symptoms, management patterns, and treatment uptake.