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. 2007 Feb;4(2):58-65.

A randomized, controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care

Donald M Hilty  1 , Shayna Marks, Jacob Wegelin, Edward J Callahan, Thomas S Nesbitt
Affiliations

A randomized, controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care

Donald M Hilty et al. Psychiatry (Edgmont). 2007 Feb.

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.

Keywords: depression; primary care; rural; telemedicine.

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Figures

Figure 1
Figure 1
BDI-13 Scores over time
Figure 2
Figure 2
SCL-90-R depression subscores over time
Figure 3
Figure 3
Study retention per group over time
Figures 4a–c
Figures 4a–c
Study retention over time for a) quartile age; b) age less or above 46; and c) DMM vs. DMM plus telepsychiatry vs. IDDM.
Figures 4a–c
Figures 4a–c
Study retention over time for a) quartile age; b) age less or above 46; and c) DMM vs. DMM plus telepsychiatry vs. IDDM.
Figures 4a–c
Figures 4a–c
Study retention over time for a) quartile age; b) age less or above 46; and c) DMM vs. DMM plus telepsychiatry vs. IDDM.
See this image and copyright information in PMC

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