Design and implementation of the telemedicine-enhanced antidepressant management study.
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.
Fortney
John C
JC
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
Pyne
Jeff M
JM
Edlund
Mark J
MJ
Robinson
Dean E
DE
Mittal
Dinesh
D
Henderson
Kathy L
KL
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
D000928:Antidepressive Agents