Telemedicine-Based Collaborative Care to Reduce Rural Disparities

NCT00439452 | Completed

• 1 other identifier: 61251
• Study Type: interventional
• Target: 500
• Locations: 1 country
• Sites: 1

Brief Summary

Across the country, Community Health Centers are participating in the Health Disparities Collaboratives sponsored by the Health Services Resources and Services Administration (HRSA). The Health Disparities Collaboratives integrate three complementary conceptual frameworks: 1) the Institute for Healthcare Improvement's (IHI) Breakthrough Series Model; 2) the Improvement Model (i.e., Plan-Do-Study-Act cycles); and 3) Wagner's Chronic Care Model. The Chronic Care model uses patient self-management, delivery system re-design, decision support, and clinical information systems to maximize the effectiveness of interactions between prepared proactive care teams and informed activated patients with chronic illnesses such as diabetes, asthma, and depression. The Chronic Care model for depression, also known as Collaborative Care, involves primary care providers working with a depression care team comprising non-physicians (e.g., nurses, pharmacists) and mental health specialists (e.g., psychiatrists). Practice-based collaborative care involves primary care providers working with an on-site depression care team. In contrast, telemedicine-based collaborative care involves primary care providers working with an off-site depression care team using telemedicine technologies. The purpose of this research project is to compare the effectiveness and cost effectiveness of practice-based and telemedicine-based collaborative care in Community Health Centers (without on-site mental health specialists) implementing the Health Disparities Collaborative for depression.

Conditions

Depression

Outcome Measures

Primary Outcomes (1)

• To compare processes and outcomes between CHC patients receiving practice-based collaborative care to CHC patients receiving telemedicine-based collaborative care (OUTREACH intervention).

  6, 12, 18 months after baseline

Study Arms (2)

Telemedicine-Based Collaborative Care

ACTIVE COMPARATOR

Telemedicine-Based Collaborative Care - Off-site depression care team (telephone nurse care manager, telephone pharmacist, tele-psychologist and tele-psychiatrist) works collaboratively with on-site primary care providers. Telephone nurse care manager activities include promoting patient activation and self management, assessing symptoms and comorbidities, and monitoring adherence, side-effects and treatment response. Telephone pharmacist activities include documenting medication histories and conducting medication management. Tele-psychologist activities include providing cognitive behavioral therapy via interactive video. Tele-psychiatrist activities include conducting patient consultation via interactive video.

Other: Telemedicine-Based Collaborative Care

Practice Based Collaborative Care

ACTIVE COMPARATOR

One-site nurse care manager works collaboratively with on-site primary care providers. Nurse care manager activities include promoting patient activation and self management, assessing symptoms and comorbidities, and monitoring adherence, side-effects and treatment response.

Other: Practice Based Collaborative Care

Interventions

Telemedicine-Based Collaborative Care OTHER

Off-site depression care team (telephone nurse care manager, telephone pharmacist, tele-psychologist and tele-psychiatrist) works collaboratively with on-site primary care providers. Telephone nurse care manager activities include promoting patient activation and self management, assessing symptoms and comorbidities, and monitoring adherence, side-effects and treatment response. Telephone pharmacist activities include documenting medication histories and conducting medication management. Tele-psychologist activities include providing cognitive behavioral therapy via interactive video. Tele-psychiatrist activities include conducting patient consultation via interactive video.

Telemedicine-Based Collaborative Care

Practice Based Collaborative Care OTHER

One-site nurse care manager works collaboratively with on-site primary care providers. Nurse care manager activities include promoting patient activation and self management, assessing symptoms and comorbidities, and monitoring adherence, side-effects and treatment response.

Practice Based Collaborative Care

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Clinically Significant Depression

You may not qualify if:

• Sub-threshold Depression,
• Non-english speaking,
• Patients not having telephone access,
• Bereaved,
• Suicidal,
• Currently being treated by a mental health specialist,
• Bipolar disorder,
• Psychotic disorders,
• Drug or alcohol dependence,
• Cognitively impaired,
• Terminal illness,
• Having a court appointed guardian, or
• Pregnant (if applicable)

Sponsors & Collaborators

• University of Arkansas: lead

Study Sites (1)

University of Arkansas for Medical Science

Little Rock, Arkansas, 72205, United States

Location

Related Publications (5)

• Mittal D, Chekuri L, Lu L, Fortney JC. Demographic, Economic, and Clinical Correlates of Depression Treatment Response in an Underserved Primary Care Population. J Clin Psychiatry. 2014 Aug 26;75(8):848-854. doi: 10.4088/JCP.13m08954.

  PMID: 29676557 DERIVED

• Grubbs KM, Fortney JC, Pyne J, Mittal D, Ray J, Hudson TJ. A Comparison of Collaborative Care Outcomes in Two Health Care Systems: VA Clinics and Federally Qualified Health Centers. Psychiatr Serv. 2018 Apr 1;69(4):431-437. doi: 10.1176/appi.ps.201700067. Epub 2018 Jan 16.

  PMID: 29334874 DERIVED

• Pyne JM, Fortney JC, Mouden S, Lu L, Hudson TJ, Mittal D. Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs. Psychiatr Serv. 2015 May 1;66(5):491-9. doi: 10.1176/appi.ps.201400186. Epub 2015 Feb 17.

  PMID: 25686811 DERIVED

• Fortney JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, Williams DK, Bynum CA, Mattox R, Rost KM. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013 Apr;170(4):414-25. doi: 10.1176/appi.ajp.2012.12050696.

  PMID: 23429924 DERIVED

• Deen TL, Fortney JC, Schroeder G. Patient acceptance of and initiation and engagement in telepsychotherapy in primary care. Psychiatr Serv. 2013 Apr 1;64(4):380-4. doi: 10.1176/appi.ps.201200198.

  PMID: 23370530 DERIVED

MeSH Terms

Conditions

Depression

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior

Study Officials

• John C Fortney, PhD

  University of Arkansas

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 22, 2007
• First Posted: February 23, 2007
• Study Start: May 1, 2007
• Primary Completion: December 1, 2010
• Study Completion: December 1, 2010
• Last Updated: September 2, 2011

Record last verified: 2011-08

Locations

US (1)