Engagement and outcomes of patients selecting providers in a technology-enabled treatment platform

Importance Preliminary evidence is lacking for the engagement and efficacy levels of mental health platforms that enable patients to self-select certain characteristics of their providers. Objective To determine the characteristics, engagement, and clinical outcomes of adult patients who used a technology-enabled platform to access outpatient mental health services and explore associations between type of provider selection and outcomes. Design, Setting, and Participants This real world retrospective study of 304,251 patients 18 or older with a first visit to a provider in 2022-2023 using data routinely collected in the Grow Therapy platform.Main Outcomes and Measures Engagement was defined by the total number of visits with a Grow Therapy provider. Clinical outcomes were derived from changes in repeated self-reported scores on the standardized Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Assessment-7 (GAD-7) surveys administered before the first and most recent treatment visits. Adjusted logistic and linear regression was used for the analyses examining type of provider characteristic selected, engagement, and changes in each clinical outcome.Results This study included Grow Therapy patients (mean age 34.0 years; 69.8% identifying as female). Over a quarter of patients selected a provider specialty (27.1%) and 4.4% selected a provider identity. Patients met with their provider a mean of 9.6 times (67.4% had 3 or more visits) and, among complete case patients with at least 2 PHQ-9 and 2 GAD-7 assessments (n=67,105), a large proportion showed significantly improved symptoms of depression (PHQ-9 improvement=3.5, 60.0% with a minimal clinically important difference [MCID]) and anxiety (GAD-7 improvement=3.5, 66.1% MCID). Patients selecting a provider specialty had fewer visits but had greater declines in depression symptoms, and those selecting a provider identity engaged longer in care than patients not selecting each of these characteristics, respectively.Conclusions and Relevance This real world study demonstrates that a technology-enabled mental health platform that allows patients to self-select their provider is engaging and preliminarily efficacious. Patients may maximize benefits of these platforms by selecting preferred characteristics of their providers.