title: Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study.
abstract: OBJECTIVE
  To evaluate an integrated telehealth intervention (Integrated Telehealth Education and Activation of Mood (I-TEAM)) to improve chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression in the home healthcare setting.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Hospital-affiliated home healthcare setting.
  
  
  METHODS
  Medically frail older homebound individuals (N = 102).
  
  
  METHODS
  The 3-month intervention consisted of integrated telehealth chronic illness and depression care, with a telehealth nurse conducting daily telemonitoring of symptoms, body weight, and medication use; providing eight weekly sessions of problem-solving treatment for depression; and providing for communication with participants' primary care physicians, who also prescribed antidepressants. Control participants were allocated to usual care with in-home nursing plus psychoeducation (UC+P).
  
  
  METHODS
  The two groups were compared at baseline and 3 and 6 months after baseline on clinical measures (depression, health, problem-solving) and 12 months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits).
  
  
  RESULTS
  Depression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6 months. Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition. The I-TEAM group had significantly fewer ED visits (P = .01) but did not have significantly fewer days in the hospital at 12 months after baseline.
  
  
  CONCLUSIONS
  Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.
authors.affiliation: Center for Mental Health and Aging, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Zvi D
authors.initials: ZD
authors.lastname: Gellis
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Kenaley
authors.forename: Thomas
authors.initials: T
authors.lastname: Ten Have
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006699:Home Care Services; D018577:Homebound Persons; D006801:Humans; D008297:Male; D011788:Quality of Life; D017216:Telemedicine / Q000379:methods*
keywords: depression; home care; integrated care; randomized trial; telehealth