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Deploying eHealth across Europe to face depression


Andrea Gabilondo Cuellar ,

Ana González Pinto,

Adriana García,

Ander Retolaza,

Joaquín Ponte,

Ane Fullaondo,

Joana Mora,

Esteban de Manuel


Introduction: Around 50% of those suffering a depression do not receive treatment and this is due to barriers such as lack of resources for mental health care or stigma related to mental disorders. Research shows that some of these barriers can be successfully overcome with ICT-based solutions among which Computerized Cognitive Behavioral Therapy (cCBT) has proven to be an effective and cost effective treatment for depression. Unfortunately the use of these ICT is still anecdotal in most regions and little is known about the potential health and economic impact of its generalization.

Mastermind project is an EC co-funded project involving 23 partners of 11 European countries. Mastermind pretends to up-scale cCBT based interventions across distinct European regions and study the barriers and facilitators of the implementation process. In addition, a comprehensive evaluation process has been set up to study quantitative and qualitative indicators framed into seven domains: health problem, safety, clinical effectiveness, organizational aspects, economic aspects, patients perspective, socio/legal/ethical aspects.

In the Basque Country 300 patients will participate in the cCBT intervention.

Short description of the intervention: The integrated care based intervention deployed in the Basque Country aims to give a major role to the primary care professionals in the provision of care for patients with depression. The GP and GP practice nurse are responsible for identifying and recruiting patient fulfilling the inclusion criteria defined (>18 years with mild or moderate depression diagnosed by the Patient Health Questionnaire-9).

Once the patient accepts to participate in the project, the primary care team trains him/her in the use of the cCBT programme and provides him/her with the required username and password. During the online therapy, the patient has to fill different health related questionnaires (PHQ-9, BDI, Euroqol and MANSA-2) and go through 8 educational modules. Each module contains three sections: explanatory text, summary presentation and a video. The patient is supposed to read the text, revise the presentation and listen to the video in order to internalize the content of the session. Afterwards, the patient fills some specific exercises that are reviewed by the GP.

During the online therapy, the primary care team are in charge of monitoring the progress of the patient and are supported by the nursing of the eHealth Centre, who work 24x7, in several tasks: phone calls to reinforce the adherence to the treatment, follow-up calls and activation of health resources depending on the final scores of the questionnaires (schedule an appointment in the GP office or specialist, activation of the ambulance).

During the cCBT, the specialists (psychiatrists and psychologists) support the GPs in any decision-making when necessary. To do so, the GP solves clinical doubts via intercolsultations (messages via the EHR) or or via videoconference.

Key findings:

- The cCT programme has been collaboratively developed by the 4 Spanish regions within the project (Aragon, Galicia, Badalona and Basque Country) based on the existing scientific evidence. The programme has been adapted to their local requirements (language, culture and health care characteristics).

- The four Spanish regions are deploying a similar organizational model in order to demonstrate the validity of both the online programme and the integrated care intervention.

- Primary care professionals have to manage patients with mild and moderate depression, limiting the participation of the specialists to the most complex cases and severe depression. By this way, the waiting lists will be reduced in the mental health centers and primary care professionals are provided with a effective tool to improve their decision making.

- Intense dissemination and sensitization efforts have been done to maximize the interest of health professionals and patients in the use of ICT resources as part of depression treatment.

Highlights: (lessons learned)

- Definition of the cCBT programme based on the requirements of both patient and professionals profile.

- Need to reinforce the knowledge of primary care professionals in the clinicnal management of the depression.

- Integration between distinct healthcare professionals (GP, GP practice nurse, specialists and eHealth Centre) is crucial to ensure an integrated care for patients with depression.

- The duration of the online therapy has to be limited (eg. 12 weeks) in order ensure the engagement of the patient and guarantee the effectiveness of the therapy.

Conclusions: The cCBT will be deployed in distinct regions trying to identify barriers and facilitators of the implementation process. The knowledge generated will be of paramount importance for future extensions of this type of care in a safe, efficient and effective way. 

How to Cite: Gabilondo Cuellar A, González Pinto A, García A, Retolaza A, Ponte J, Fullaondo A, et al.. Deploying eHealth across Europe to face depression. International Journal of Integrated Care. 2016;16(6):A218. DOI:
Published on 16 Dec 2016.