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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 8/2007

01-08-2007 | Original Article

A Randomized Trial of Telemedicine-based Collaborative Care for Depression

Authors: John C. Fortney, PhD, Jeffrey M. Pyne, MD, Mark J. Edlund, MD, PhD, David K. Williams, PhD, Dean E. Robinson, MD, Dinesh Mittal, MD, Kathy L. Henderson, MD

Published in: Journal of General Internal Medicine | Issue 8/2007

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Abstract

Background

Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists.

Objective

The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists.

Design

Matched sites were randomized to the intervention or usual care.

Participants

Small VA Community-based outpatient clinics with no on-site psychiatrists, but access to telepsychiatrists. In 2003–2004, 395 primary care patients with PHQ9 depression severity scores ≥12 were enrolled, and followed for 12 months. Patients with serious mental illness and current substance dependence were excluded.

Measures

Medication adherence, treatment response, remission, health status, health-related quality of life, and treatment satisfaction.

Results

The sample comprised mostly elderly, white, males with substantial physical and behavioral health comorbidity. At baseline, subjects had moderate depression severity (Hopkins Symptom Checklist, SCL-20 = 1.8), 3.7 prior depression episodes, and 67% had received prior depression treatment. Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 (odds ratio [OR] = 2.1, p = .04) and 12 months (OR = 2.7, p = .01). Intervention patients were more likely to respond by 6 months (OR = 2.0, p = .02), and remit by 12 months (OR = 2.4, p = .02). Intervention patients reported larger gains in mental health status and health-related quality of life, and reported higher satisfaction.

Conclusions

Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies.
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Metadata
Title
A Randomized Trial of Telemedicine-based Collaborative Care for Depression
Authors
John C. Fortney, PhD
Jeffrey M. Pyne, MD
Mark J. Edlund, MD, PhD
David K. Williams, PhD
Dean E. Robinson, MD
Dinesh Mittal, MD
Kathy L. Henderson, MD
Publication date
01-08-2007
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 8/2007
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-007-0201-9

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