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BACKGROUND/RATIONALE:
Telemedicine uses communications technologies to provide health care when distance separates participants. Applied to general medical care practice, telemedicine is associated with improved continuity of care, cost-effectiveness, and improved service quality. To date, all evaluations of telepsychiatry have concentrated on video technology. The telephone is a more readily available and less expensive communication technology that has not been evaluated as a method of health services delivery in the medication management of stable psychiatric outpatients.
OBJECTIVE(S):
The objectives of this study are to answer the following questions: 1) Does substituting brief, scheduled, clinician-initiated telephone calls (telephone care) for routine psychiatric medication management visits reduce overall healthcare utilization? and, 2) Is substituting brief, scheduled, clinician-initiated telephone calls (telephone care) for routine psychiatric medication management visits as effective as routine care?
METHODS:
We will enroll 346 psychiatrically stable subjects who carry a diagnosis of major depression, post-traumatic stress disorder (PTSD), or non-PTSD anxiety disorder. We will use a balanced randomization strategy to assign subjects to routine care or telephone care for a two-year period within each provider panel. Patients randomized to receive routine care will be scheduled to see their psychiatric medication provider at the recommended interval. Patients randomized to receive telephone care are scheduled to see their provider at twice the recommended clinic visit interval, and two ten-minute telephone contacts are scheduled at a specific time at standard 0.67 and 1.3 times the multiple of the recommended interval.
At two years, we will use ten data sources to compare two primary outcomes (total VHA health services utilization and mental health component scores from the SF-12-V) as well as VHA costs, imputed non-VHA costs, patient and provider satisfaction, medication compliance, and diagnosis specific outcomes.
FINDINGS/RESULTS:
In 34 months of active enrollment the White River Junction site has enrolled 175 subjects from all of the 9 providers: site study retention to date is 89.7%. During 30 months of active enrollment, the Manchester site has enrolled 149 subjects from all of the 5 providers; site study retention rate is 81.9%. To date, we have enrolled 324 subjects. Control and intervention subjects do not differ demographically, and blinded analysis comparing treatment and control groups yielded no differences in adverse event rates.
IMPACT:
The research will contribute to efficiency of health care provision and quality effectiveness within VA by determining the potential cost-savings associated with this method of management of stable psychiatric patients. Our findings should be of interest to VHA management and strategic planners, VHA policymakers, and taxpayers and insurers. As of September 2008, this project is still ongoing.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Mental Illness, Military and Environmental Exposures
DRE:
Treatment, Technology Development and Assessment
Keywords:
Access, PTSD, Telemedicine, Deployment Related
MeSH Terms:
Depression, Telemedicine
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