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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Aug 21, 2017
Open Peer Review Period: Aug 21, 2017 - Oct 16, 2017

NOTE: This is an unreviewed Preprint

Feasibility, Acceptability and Effectiveness of a Remote Collaborative Care Program for Patients with Depression Living in Rural Areas

  • Graciela Rojas; 
  • Viviana Guajardo; 
  • Pablo Martinez; 
  • Ariel Castro; 
  • Rosemarie Fritsch; 
  • Markus Möessner; 
  • Stephanie Bauer

ABSTRACT

Background:

In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients.

Objective:

To test the feasibility, acceptability and effectiveness of a remote collaborative care program for patients with depression living in rural areas.

Methods:

Physicians from fifteen community hospitals located in rural areas recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to a remote collaborative care program (Telepsiquiatría; n=111) or to usual care (UC; n=139). Telepsiquiatría introduced a shared electronic clinical record between primary care teams and a specialized mental health team, telephone monitoring of patients, and remote supervision by a psychiatrist through electronic platform and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after assignment based on a blinded telephone assessment.

Results:

Two hundred and twelve patients (84.8%) completed the assessments to six months. Telepsiquiatría was feasible and acceptable; achieving higher user satisfaction (OR 1.94, 95% CI 1.25 to 3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02 to 3.19) at 6 months, as compared to UC. There were no statically significant differences in depressive symptoms between Telepsiquiatría and UC, although a favorable trend was observed in the intervention arm. Significant differences between groups in favour of Telepsiquiatría were observed at 3 months for mental health-related quality of life (β 3.11, 95% CI 0.19 to 6.02).

Conclusions:

Telepsiquiatría may help reduce depression treatment gap in rural areas, providing an acceptable and highly satisfactory intervention for depressed adults. Future studies must evaluate treatment process outcomes in a more detailed manner.

ClinicalTrial:

Clinicaltrials.gov NCT02200367.