TEAM Study to Improve Depression Care in Rural CBOCs

Not Applicable

Completed

• Conditions: Depression
• Interventions: Behavioral: Telemedicine intervention

• Registration Number: NCT00105690
• Lead Sponsor: US Department of Veterans Affairs

Brief Summary

We adapted the collaborative care model using telemedicine (e.g., telephone, interactive video, electronic medical records) to support antidepressant therapy initiated by primary care providers in small rural practices and evaluated the effectiveness and cost-effectiveness of telemedicine-based collaborative care.

Detailed Description

BACKGROUND / RATIONALE: Implementing collaborative care for depression in small rural Primary Care (PC) practices without on-site mental health specialists presents unique challenges. We adapted the collaborative care model using telemedicine (e.g., telephone, interactive video, electronic medical records) to support antidepressant therapy initiated by PC providers in small rural practices. The Telemedicine Enhanced Antidepressant Management (TEAM) collaborative care intervention was implemented by offsite personnel and all intervention components were implemented using telemedicine technologies. OBJECTIVE(S): Specific Aim 1: Determine whether the TEAM intervention improves quality and outcomes compared to usual care. Specific Aim 2: Determine whether the TEAM intervention will be cost-effective in routine practice settings. METHODS: Seven VISN 16 CBOCs participated in the study. CBOCs were included if they 1) treated \>1,000 and \<5,000 unique veterans, 2) had no on-site psychiatrists, and 3) had interactive video equipment. Matched CBOCs were randomized to receive the intervention or usual care. Of the 24,882 clinic patients, 73.6% (n=18,306) were successfully screened and 6.9% screened positive for depression (PHQ9 =12). Of those eligible for the study, 91.3% agreed to participate, and 91.9% of those attended their appointment and were consented. Over an 18-month period, 395 patients were enrolled, and 91.1% (n=360) were followed-up at six months. Telephone research interviews were conducted at baseline, six and twelve months. Effectiveness was tested using an intent-to-treat analysis. Cost-effectiveness analysis was assessed from the perspective of the VA. Costs included intervention costs, encounter costs, and medication costs. Quality Adjusted Life Years (QALYs) were calculated using the Quality of Well Being Scale.

Study Timeline

• Study Start: 2003-04
• Study Completion: 2004-10
• Study First Submitted: 2005-03-16
• Study First Submitted QC: 2005-03-16
• Study First Posted: 2005-03-17
• Status Verified: 2006-09
• Last Update Submitted: 2015-04-06
• Last Update Posted: 2015-04-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 400

Inclusion Criteria

PHQ9 Score > or = to 12

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Exclusion Criteria

A diagnosis of schizophrenia, current suicide ideation, recent bereavement, or receiving specialty mental health treatment

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1	Telemedicine intervention	-

Primary Outcome Measures

Name	Time	Method
1) Antidepressant prescribing, 2) Medication adherence, 3) Treatment response and remission, 4) Health status and health related quality of life

Secondary Outcome Measures

Name	Time	Method
1) Satisfaction with care, 2) service utilization, 3) Cost, 4) Cost-effectiveness

Trial Locations

Locations (3)

G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS; 🇺🇸 Jackson, Mississippi, United States

Overton Brooks VA Medical Center, Shreveport, LA; 🇺🇸 Shreveport, Louisiana, United States

Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR; 🇺🇸 No. Little Rock, Arkansas, United States