Integrated Telehealth Care for Chronic Illness and Depression in Geriatric Home Care Patients: The Integrated Telehealth Education and Activation of Mood (I-TEAM) Study
Integrated Telehealth Care for Chronic Illness and Depression in Geriatric Home Care Patients: The Integrated Telehealth Education and Activation of Mood (I-TEAM) Study
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DOI：
10.1111/jgs.12776
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发表时间：
2014-05-01
影响因子：
6.3
通讯作者：
Ten Have, Thomas
中科院分区：
文献类型：
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作者：
Gellis, Zvi D.;Kenaley, Bonnie L.;Ten Have, Thomas
目的评价一种综合性远程健康干预方法（综合远距健康教育及活化情绪（I-TEAM））改善慢性病（充血性心力衰竭，慢性阻塞性肺疾病）和共病抑郁症在家庭医疗保健设置。设计随机对照试验。设置医院附属的家庭医疗保健设置。残疾人医学虚弱的老年人在家的人（N=102）。干预3-一个月的干预包括综合远程保健慢性病和抑郁症护理，远程保健护士每天进行症状，体重和药物使用的远程监测;提供每周八次的抑郁症问题解决治疗;并提供与参与者的初级保健医生的沟通，他们也开了抗抑郁药。对照组采用家庭护理加心理健康教育（UC+P）的常规护理，比较两组在基线时、基线后3个月和6个月的临床指标（抑郁、健康、解决问题）和基线后12个月的健康利用（再入院，护理事件，结果I-TEAM组抑郁评分在3个月和6个月时比UC+P组低50%。那些接受I-TEAM干预的人显着提高了他们解决问题的能力和管理医疗状况的自我效能。I-TEAM组有显着减少艾德访问（P=.01），但没有显着减少在医院的日子在12个月后baseline.ConclusionIntegrated远程医疗保健老年人慢性疾病和共病抑郁症可以减少症状和出院后艾德使用在家庭健康环境。
ObjectivesTo 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.DesignRandomized controlled trial.SettingHospital-affiliated home healthcare setting.ParticipantsMedically frail older homebound individuals (N=102).InterventionThe 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).MeasurementsThe two groups were compared at baseline and 3 and 6months after baseline on clinical measures (depression, health, problem-solving) and 12months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits).ResultsDepression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6months. 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 12months after baseline.ConclusionIntegrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.