Currently submitted to: Journal of Medical Internet Research
Date Submitted: Aug 21, 2017
Open Peer Review Period: Aug 21, 2017 - Oct 16, 2017
Feasibility, Acceptability and Effectiveness of a Remote Collaborative Care Program for Patients with Depression Living in Rural Areas
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.
To test the feasibility, acceptability and effectiveness of a remote collaborative care program for patients with depression living in rural areas.
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 (TelepsiquiatrÃa; n=111) or to usual care (UC; n=139). TelepsiquiatrÃa 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.
Two hundred and twelve patients (84.8%) completed the assessments to six months. TelepsiquiatrÃa 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 TelepsiquiatrÃa and UC, although a favorable trend was observed in the intervention arm. Significant differences between groups in favour of TelepsiquiatrÃa were observed at 3 months for mental health-related quality of life (Î² 3.11, 95% CI 0.19 to 6.02).
TelepsiquiatrÃa 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.