title: Design and implementation of the telemedicine-enhanced antidepressant management study.
abstract: OBJECTIVE
  Evidence-based practices designed for large urban clinics are not necessarily transportable into small rural practices. Implementing collaborative care for depression in small rural primary care clinics presents unique challenges because it is typically not feasible to employ on-site mental health specialists. The purpose of the Telemedicine-Enhanced Antidepressant Management (TEAM) study was to evaluate a collaborative care model adapted for small rural clinics using telemedicine technologies. The purpose of this paper is to describe the TEAM study design.
  
  
  METHODS
  The TEAM study was conducted in small rural Veterans Administration community-based outpatient clinics with interactive video equipment available for mental health, but no on-site psychiatrists/psychologists. The study attempted to enroll all patients whose depression could be appropriately treated in primary care.
  
  
  RESULTS
  The clinical characteristics of the 395 study participants differed significantly from most previous trials of collaborative care. At baseline, 41% were already receiving primary care depression treatment. Study participants averaged 5.5 chronic physical health illnesses and 56.5% had a comorbid anxiety disorder. Over half (57.2%) reported that pain impaired their functioning extremely or quite a bit.
  
  
  CONCLUSIONS
  Despite small patient populations in rural clinics, enough patients with depression can be successfully enrolled to evaluate telemedicine-based collaborative care.
authors.affiliation: VA Health Services Research and Development, HSR&D, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, 72114, USA. fortneyjohnc@uams.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Pyne
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Edlund
authors.forename: Dean E
authors.initials: DE
authors.lastname: Robinson
authors.forename: Dinesh
authors.initials: D
authors.lastname: Mittal
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Henderson
mesh_terms: D000554:Ambulatory Care Facilities; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods; D012107:Research Design; D019035:Rural Health Services / Q000191:economics; D017216:Telemedicine / Q000191:economics; D014481:United States
chemical_list: D000928:Antidepressive Agents