Design and implementation of the Telemedicine-Enhanced Antidepressant Management Study
ABSTRACT Evidence-based practices designed for large urban clinics are not necessarily transportable into small rural practices. Implementing collaborative care for depression in small rural primary care clinics presents unique challenges because it is typically not feasible to employ on-site mental health specialists. The purpose of the Telemedicine-Enhanced Antidepressant Management (TEAM) study was to evaluate a collaborative care model adapted for small rural clinics using telemedicine technologies. The purpose of this paper is to describe the TEAM study design.
The TEAM study was conducted in small rural Veterans Administration community-based outpatient clinics with interactive video equipment available for mental health, but no on-site psychiatrists/psychologists. The study attempted to enroll all patients whose depression could be appropriately treated in primary care.
The clinical characteristics of the 395 study participants differed significantly from most previous trials of collaborative care. At baseline, 41% were already receiving primary care depression treatment. Study participants averaged 5.5 chronic physical health illnesses and 56.5% had a comorbid anxiety disorder. Over half (57.2%) reported that pain impaired their functioning extremely or quite a bit.
Despite small patient populations in rural clinics, enough patients with depression can be successfully enrolled to evaluate telemedicine-based collaborative care.
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ABSTRACT: Care management-based interventions promoting integrated care by combining primary care with mental health services in a coordinated and colocated manner are increasingly popular; yet, the benefits of specific approaches are not well established. We conducted a systematic review of integrated care trials in US primary care settings to assess whether the level of integration of provider roles or care process affects clinical outcomes. Although most trials showed positive effects, the degree of integration was not significantly related to depression outcomes. Integrated care appears to improve depression management in primary care patients, but questions remain about its specific form and implementation.The Journal of ambulatory care management 01/2011; 34(2):113-25. DOI:10.1097/JAC.0b013e31820ef605
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ABSTRACT: Schizophrenia is a serious and prolonged illness between whose psychosocial treatments one of the most effective is the psychoeducation. This treatment involves the family and succeeds in reducing rates of relapse and improves the course of the illness. The Psychiatry Service of Zamora years ago develops an intervention of this kind. In Zamora, the geographical and transport are obstacles who characterize its territory, and cause of some difficulties in access of families to this important therapy. In view of this circumstances an alternative is develop a distance therapy founded in internet. This work is an approach to test this possibility. This research conducted an exhaustive review of the literature regarding psychoeducation as e-therapy. Analyzed the results of the traditional treatment previously made by the Service of Zamora, and explored the difficulties of access for their users. The results indicate that the intervention traditional in Zamora increases knowledge and requires some improvement; also described the difficulties that families have accessing to the intervention (mainly distance and transportation). Finally, both families and professionals would be prepared to use a therapy at a distance based on Internet. This research has developed a methodology for analysis of the instruments used in the Service of Zamora; has known the outcome of the psychoeducational intervention; have been identified the difficulties in access to interventions and; have been explored the possible acceptances of an e-therapy. These results are the foundation and justification to develop a psychoeducational program called PsicoED that fits the pattern of service to the needs of its population.01/2008, Degree: Salamanca, Supervisor: Franco, M.; Jiménez, F.
- The Cochrane Library