Psychotherapy for Depression in Older Veterans Via Telemedicine: Effect on Quality of Life, Satisfaction, Treatment Credibility, and Service Delivery Perception.
OBJECTIVE
To analyze the impact of telepsychology and same-room care on functioning, satisfaction, and perception of care based on a noninferiority trial of psychotherapy delivered via telemedicine or same-room care to elderly patients with depression.


METHODS
241 elderly patients with depression (meeting DSM-IV diagnostic criteria) were randomly assigned to either telemedicine (n = 120) or same-room treatment (n = 121) between April 1, 2007, and July 31, 2011. The primary outcomes included quality of life (36-item Short Form Survey [SF-36]), satisfaction (Charleston Psychiatric Outpatient Satisfaction Scale), treatment credibility, and service delivery perception scores obtained at 4 weeks, 8 weeks, 3 months, and 12 months. Comparisons of intervention means were carried out at each time point using independent sample t tests and SAS Procedure MIANALYZE to combine results across the multiply imputed complete data sets. If significant differences were detected for a given outcome within a domain, a Bonferroni correction was applied to determine if significance was maintained.


RESULTS
None of the SF-36 scores showed a significant difference between the 2 treatment groups by the end of the study period, with little significance shown throughout the intermediate time points. Similarly, over all time points, there was no statistically significant difference in patient satisfaction or treatment credibility.


CONCLUSIONS
This study found that telemedicine is a viable alternative modality for providing evidence-based psychotherapy for elderly patients with depression. Results provide evidence that quality of life and satisfaction with care are not adversely influenced by the decision to use a telehealth modality instead of in-person treatment, and, as a result, resources can be devoted to offering services in patients' homes through telemedicine.


BACKGROUND
ClinicalTrials.gov identifier: NCT00324701.
Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Room 280G, Charleston, SC 29425-0593. egedel@musc.edu.|Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA.|Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.|Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Leonard E
LE
Egede
Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA.|College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA.
Ron
R
Acierno
Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA.|Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Rebecca G
RG
Knapp
Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA.|Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.|Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
Rebekah J
RJ
Walker
Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA.|Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Elizabeth H
EH
Payne
Department of Psychology, University of Hawaii, Hilo, Hawaii, USA.|Department of Psychology, The Menninger Clinic, Houston, Texas, USA.
B Christopher
BC
Frueh
D000368:Aged; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D017216:Telemedicine / Q000379:methods*; D014728:Veterans / Q000523:psychology*