Cited by 296Telemedicine and Telehealth ImplementationMental Health Treatment and AccessPsychotherapy Techniques and Applications

Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial

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Fortney, John C., Pyne, Jeffrey M., Mouden, Sip B., Mittal, Dinesh, Hudson, Teresa J., Schroeder, Gary W., Williams, David K., Bynum, Carol A. +2 more·2013·American Journal of Psychiatry

Abstract

OBJECTIVE: Practice-based collaborative care is a complex evidence-based practice that is difficult to implement in smaller primary care practices that lack on-site mental health staff. Telemedicine-based collaborative care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multisite randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients assigned to practice-based and telemedicine-based collaborative care. METHOD: From 2007 to 2009, patients at federally qualified health centers serving medically underserved populations were screened for depression, and 364 patients who screened positive were enrolled and followed for 18 months. Those assigned to practice-based collaborative care received evidence-based care from an on-site primary care provider and a nurse care manager. Those assigned to telemedicine-based collaborative care received evidence-based care from an on-site primary care provider and an off-site team: a nurse care manager and a pharmacist by telephone, and a psychologist and a psychiatrist via videoconferencing. The primary clinical outcome measures were treatment response, remission, and change in depression severity. RESULTS: Significant group main effects were observed for both response (odds ratio=7.74, 95% CI=3.94-15.20) and remission (odds ratio=12.69, 95% CI=4.81-33.46), and a significant overall group-by-time interaction effect was observed for depression severity on the Hopkins Symptom Checklist, with greater reductions in severity over time for patients in the telemedicine-based group. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence base in the telemedicine-based group. CONCLUSIONS: Contracting with an off-site telemedicine-based collaborative care team can yield better outcomes than implementing practice-based collaborative care with locally available staff.

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  1. [56]Bursac Z Gauss H Williams DK Hosmer D A purposeful selection of variables macro for logistic regression 2007 Proceedings at the SAS Global Forum 2007 Conference Cary, NC

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Authors
Fortney, J. C., Pyne, J. M., Mouden, S. B., Mittal, D., Hudson, T. J., Schroeder, G. W., Williams, D. K., Bynum, C. A., Mattox, R., & Rost, K. M.
Affiliations
  • Central Arkansas Veterans Healthcare System (US)
  • From the Division of Health Services Research, Department of Psychiatry, College of Medicine, the Department of Biostatistics, College of Public Health, and the Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock; Health Services Research and Development and the South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock; Community Health Centers of Arkansas, North Little Rock; United Family Services, Little...
Venue
American Journal of Psychiatry
Published
2013-04
Volume
170
Issue
4
Pages
414-425
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2137904243
Cited by
296
References
57
Citations by year
2026: 5 · 2025: 10 · 2024: 15 · 2023: 14 · 2022: 16 · 2021: 29 · 2020: 23 · 2019: 19 · 2018: 47 · 2017: 32 · 2016: 21 · 2015: 32 · 2014: 19 · 2013: 14
FWCI
29.24
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (MH076908-04S1, R01MH076908)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
collaborative care, telemedicine, depression, rural health facilities, federally qualified health centers, nurse care managers, videoconferencing, treatment response, remission, depression severity, implementation fidelity, medically underserved populations
MeSH terms
Antidepressive Agents, Arkansas, Depression, Female, Humans, Male, Medically Underserved Area, Middle Aged, Outcome and Process Assessment, Health Care, Patient Care Team, Primary Health Care, Psychiatric Status Rating Scales, Psychotherapy, Remission Induction, Treatment Outcome, Telemedicine, Rural Health Services

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