A randomized trial of telemedicine-based collaborative care for depression
A randomized trial of telemedicine-based collaborative care for depression
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DOI：
10.1007/s11606-007-0201-9
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发表时间：
2007-08-01
影响因子：
5.7
通讯作者：
Henderson, Kathy L.
中科院分区：
文献类型：
--
作者：
Fortney, John C.;Pyne, Jeffrey M.;Henderson, Kathy L.
背景：为大型城市诊所设计的循证实践不一定适用于较小的孤立诊所。在小型初级保健诊所中实施基于实践的抑郁症协作护理面临着独特的挑战，因为聘请现场精神科医生通常是不可行的。目的：远程医疗增强抗抑郁药管理 (TEAM) 研究的目的是评估基于远程医疗的协作护理模式，适用于没有现场精神科医生的小型诊所。设计：匹配的地点被随机分配到干预或常规护理。参与者：小型 VA 社区门诊诊所，没有现场精神科医生。现场精神科医生，但可以联系远程精神科医生。 2003-2004 年，395 名 PHQ9 抑郁症严重程度评分≥12 的初级保健患者被纳入研究，并进行了 12 个月的随访。排除患有严重精神疾病和当前物质依赖的患者。测量：药物依从性、治疗反应、缓解、健康状况、健康相关生活质量和治疗满意度。结果：样本主要由患有严重身体和行为健康合并症的老年人、白人、男性组成。基线时，受试者患有中度抑郁症（霍普金斯症状检查表，SCL-20=1.8），之前有 3.7 次抑郁症发作，67% 的受试者之前接受过抑郁症治疗。多变量分析表明，干预患者在 6 个月（比值比 [OR]=2.1，p=.04）和 12 个月（OR=2.7，p=.01）时更有可能坚持治疗。干预患者更有可能在 6 个月时出现反应（OR=2.0，p=.02），并在 12 个月时缓解（OR=2.4，p=.02）。干预患者的心理健康状况和健康相关的生活质量得到了更大的改善，满意度也更高。结论：协作护理可以成功地应用于初级保健诊所，而无需使用远程医疗技术的现场精神科医生。
Background: Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists.Objective: The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists.Design: Matched sites were randomized to the intervention or usual care.Participants: Small VA Community-based outpatient clinics with no on-site psychiatrists, but access to telepsychiatrists. In 2003-2004, 395 primary care patients with PHQ9 depression severity scores >= 12 were enrolled, and followed for 12 months. Patients with serious mental illness and current substance dependence were excluded.Measures: Medication adherence, treatment response, remission, health status, health-related quality of life, and treatment satisfaction.Results: The sample comprised mostly elderly, white, males with substantial physical and behavioral health comorbidity. At baseline, subjects had moderate depression severity (Hopkins Symptom Checklist, SCL-20=1.8), 3.7 prior depression episodes, and 67% had received prior depression treatment. Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 (odds ratio [OR]=2.1, p=.04) and 12 months (OR=2.7, p=.01). Intervention patients were more likely to respond by 6 months (OR=2.0, p=.02), and remit by 12 months (OR=2.4, p=.02). Intervention patients reported larger gains in mental health status and health-related quality of life, and reported higher satisfaction.Conclusions: Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies.