title: A randomized, controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care.
abstract: 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.
authors.affiliation: Dr. Hilty is Associate Professor of Clinical Psychiatry.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Hilty
authors.forename: Shayna
authors.initials: S
authors.lastname: Marks
authors.forename: Jacob
authors.initials: J
authors.lastname: Wegelin
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Callahan
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
references.citation: J Rural Health. 1996 Winter;12(1):45-53
references.pmid: 10172606
references.citation: Am J Health Syst Pharm. 2003 Oct 1;60(19):1976-81
references.pmid: 14531243
references.citation: Biometrics. 1982 Dec;38(4):963-74
references.pmid: 7168798
references.citation: Gen Hosp Psychiatry. 1987 Mar;9(2):95-101
references.pmid: 3569892
references.citation: N Engl J Med. 2005 Jun 16;352(24):2515-23
references.pmid: 15958807
references.citation: J Rural Health. 2007 Spring;23(2):163-5
references.pmid: 17397373
references.citation: Telemed J E Health. 2004 Winter;10(4):413-21
references.pmid: 15689644
references.citation: Psychosom Med. 1998 Mar-Apr;60(2):143-9
references.pmid: 9560861
references.citation: J Rural Health. 1999 Summer;15(3):326-34
references.pmid: 11942565
references.citation: J Pers Disord. 2000 Winter;14(4):291-9
references.pmid: 11213787
references.citation: Telemed J E Health. 2005 Feb;11(1):36-43
references.pmid: 15785219
references.citation: Gen Hosp Psychiatry. 1991 Jan;13(1):9-18
references.pmid: 1993523
references.citation: Can J Psychiatry. 2004 Jan;49(1):12-23
references.pmid: 14763673
references.citation: Psychosomatics. 2006 Mar-Apr;47(2):152-7
references.pmid: 16508028
references.citation: JAMA. 2001 Sep 19;286(11):1325-30
references.pmid: 11560537
references.citation: Comput Methods Programs Biomed. 1990 Jul-Aug;32(3-4):179-88
references.pmid: 2249417
references.citation: Gen Hosp Psychiatry. 2003 Jul-Aug;25(4):222-9
references.pmid: 12850653
references.citation: Jt Comm J Qual Saf. 2003 Sep;29(9):443-51
references.pmid: 14513667
references.citation: J Clin Psychiatry. 1997;58 Suppl 1:20-3
references.pmid: 9054905
references.citation: West J Med. 2000 Sep;173(3):169-74
references.pmid: 10986176
references.citation: JAMA. 1989 Dec 15;262(23):3298-302
references.pmid: 2585674
references.citation: Arch Gen Psychiatry. 1996 Oct;53(10):913-9
references.pmid: 8857868
references.citation: Med Inform (Lond). 1992 Apr-Jun;17(2):105-23
references.pmid: 1405831
references.citation: J Psychiatr Res. 1988;22(3):207-20
references.pmid: 3225790