A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.
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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 The aim was to test the feasibility acceptability and effectiveness of a remote collaborative care program for patients with depression living in rural areas METHODS In a nonrandomized open label blinded outcome assessor two arm clinical trial physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode DSM IV criteria Patients were assigned to the remote collaborative care program n 111 or to usual care n 139 The remote collaborative care program used Web based shared clinical records between rural primary care teams and a specialized centralized mental health team telephone monitoring of patients and remote supervision by psychiatrists through the Web based shared clinical records and or telephone Depressive symptoms health related quality of life service use and patient satisfaction were measured 3 and 6 months after baseline assessment RESULTS Six month follow up assessments were completed by 84 4 221 250 of patients The remote collaborative care program achieved higher user satisfaction odds ratio OR 1 94 95 CI 1 25 3 00 and better treatment adherence rates OR 1 81 95 CI 1 02 3 19 at 6 months compared to usual care There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health related quality of life beta 3 11 95 CI 0 19 6 02 CONCLUSIONS Higher rates of treatment adherence in the remote collaborative care program suggest that technology assisted interventions may help rural primary care teams in the management of depressive patients Future cost effectiveness studies are needed TRIAL REGISTRATION Clinicaltrials gov NCT02200367 https clinicaltrials gov ct2 show NCT02200367 Archived by WebCite at http www webcitation org 6xtZ7OijZ