Design and implementation of the Telemedicine-Enhanced Antidepressant Management Study
Louisiana State University in Shreveport, Shreveport, Louisiana, United States General Hospital Psychiatry
(Impact Factor: 2.61).
02/2006; 28(1):18-26. DOI: 10.1016/j.genhosppsych.2005.07.001
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.
Available from: Roger G Kathol
- ", 2001 , 2003 , 2004 ; Simon et al . , 2004 ; Un - utzer et al . , 2001 ) . Twelve trials had the pri - mary care clinician principally responsible for care , with the assistance of care management and specialty mental health clinicians as sup - port ( Adler et al . , 2004 ; Boudreau et al . , 2002 ; Bruce & Pearson , 1999 ; Datto et al . , 2003 ; Fortney et al . , 2006 ; Hunkeler et al . , 2000 ; Katzelnick et al . , 2000 ; Oxman et al . , 2002 ; Rost et al . , 2000 ; Simon et al . , 2000 ; Tutty et al . , 2000 ; Wells , 1999 ) . Only 4 trials reported consensus decision making between medical and mental health clinicians ( Hedrick et al . , 2003 ; Katon et al . , 1995 , 1999 ; Swindle et al . , 2003 "
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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.
Available from: Katherine Easton
- "Richardson and Richards (2006) "
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ABSTRACT: Remote psychotherapy services such as telephone-administered cognitive behavioural therapy (T-CBT) have the potential to provide effective psychological treatment whilst simultaneously maximising efficiency, lowering costs and improving access to care. However, a lack of research examining the acceptability of non face-to-face psychotherapy means that little is known about users' perceptions of these delivery models. This paper reports data from two qualitative evaluations of T-CBT delivered in the voluntary and occupational health sectors in the UK. It explores users' acceptance of T-CBT, contrasting initial socially-construed expectations with more positive regard derived from experiential norms. User satisfaction with T-CBT was mixed. However, the relative ease with which most participants adapted to telephone-based care was suggestive of a shared construct of mental health service provision that prioritised the accessibility and availability of services over the social, professional and medico-legal perspectives that conventionally promote the co-location of practitioner and client.
Available from: Jolanda Antonia Cornelia Meeuwissen
- "In this study, we did not distinguish consultation as a separate step as in other studies , assuming it can be supporting all interventions in the stepped care algorithm [36, 37]. As regards the actual sequence of evidence-based interventions, deviating from other studies [38, 39], we position pharmacotherapy either in the same step or after brief psychotherapy such as cognitive or cognitive behavioural therapy or interpersonal therapy. This is in line with the Dutch evidence-based multidisciplinary guideline for depression. "
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ABSTRACT: Stepped care strategies are potentially effective to organise integrated care but unknown is whether they function well in practice. This paper evaluates the implementation of a stepped care programme for depression in primary care and secondary care. THEORY AND METHODS: We developed a stepped care algorithm for diagnostics and treatment of depression, supported by a liaison-consultation function. In a 2(1/2) year study with pre-post design in a pilot region, adherence to the protocol was assessed by interviewing 28 caregivers of 235 patients with mild, moderate, or severe major depression. Consultation and referral patterns between primary and secondary care were analysed.
Adherence of general practitioners and consultant caregivers to the stepped care protocol proved to be 96%. The percentage of patients referred for depression to secondary care decreased significantly from 26% to 21% (p=0.0180). In the post-period more patients received treatment in primary care and requests for consultation became more concordant with the stepped care protocol.
Implementation of a stepped care programme is feasible in a primary and secondary care setting and is associated with less referrals.
Further research on all subsequent treatment steps in a standardised stepped care protocol is needed.
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