A randomized, controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care.
Introduction. Disease management modules (DMM), including education, tracking, support, and medical care, have improved health for patients with asthma and diabetes. For rural patients, novel ways of delivery are needed to access clinical expertise from urban or academic specialists. Telemedicine (telephone and televideo) could be instrumental in this process, though no randomized, controlled trials have assessed their effectiveness.Methods. Self-report and structured psychiatric interviews were used to screen potential depressed subjects. Subjects were randomized to: 1) usual care with a DMM using telephone and self-report questionnaires; or 2) a DMM using telephone, questionnaires, and monthly televideo psychiatric consultation emphasizing primary care physician (PCP) skill development. Subjects' depressive symptoms, health status, and satisfaction with care were tabulated at three, six, and 12 months after study entry.Results. There was significant clinical improvement for depression in both groups, with a trend toward significance in the more intensive module. Satisfaction and retention was superior in the more intensive group. There was no overall change in health functioning in either group.Conclusions. Intensive modules using telepsychiatric educational interventions toward PCPs may be superior, but the most critical ingredient may be administrative tracking of patients, prompted intervention by PCPs, and (when necessary) new ideas by a specialist.
Hilty
Donald M
DM
Dr. Hilty is Associate Professor of Clinical Psychiatry.
Marks
Shayna
S
Wegelin
Jacob
J
Callahan
Edward J
EJ
Nesbitt
Thomas S
TS
J Rural Health. 1996 Winter;12(1):45-53
10172606
Am J Health Syst Pharm. 2003 Oct 1;60(19):1976-81
14531243
Biometrics. 1982 Dec;38(4):963-74
7168798
Gen Hosp Psychiatry. 1987 Mar;9(2):95-101
3569892
N Engl J Med. 2005 Jun 16;352(24):2515-23
15958807
J Rural Health. 2007 Spring;23(2):163-5
17397373
Telemed J E Health. 2004 Winter;10(4):413-21
15689644
Psychosom Med. 1998 Mar-Apr;60(2):143-9
9560861
J Rural Health. 1999 Summer;15(3):326-34
11942565
J Pers Disord. 2000 Winter;14(4):291-9
11213787
Telemed J E Health. 2005 Feb;11(1):36-43
15785219
Gen Hosp Psychiatry. 1991 Jan;13(1):9-18
1993523
Can J Psychiatry. 2004 Jan;49(1):12-23
14763673
Psychosomatics. 2006 Mar-Apr;47(2):152-7
16508028
JAMA. 2001 Sep 19;286(11):1325-30
11560537
Comput Methods Programs Biomed. 1990 Jul-Aug;32(3-4):179-88
2249417
Gen Hosp Psychiatry. 2003 Jul-Aug;25(4):222-9
12850653
Jt Comm J Qual Saf. 2003 Sep;29(9):443-51
14513667
J Clin Psychiatry. 1997;58 Suppl 1:20-3
9054905
West J Med. 2000 Sep;173(3):169-74
10986176
JAMA. 1989 Dec 15;262(23):3298-302
2585674
Arch Gen Psychiatry. 1996 Oct;53(10):913-9
8857868
Med Inform (Lond). 1992 Apr-Jun;17(2):105-23
1405831
J Psychiatr Res. 1988;22(3):207-20
3225790