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

Objectives: 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.

Design: Randomized controlled trial.

Setting: Hospital-affiliated home healthcare setting.

Participants: Medically frail older homebound individuals (N = 102).

Intervention: 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).

Measurements: 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.

Conclusion: Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.

Keywords: depression; home care; integrated care; randomized trial; telehealth.