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Practice-Based Versus Telemedicine-Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial
Open accessAbstract
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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“a study of telemedicine-based collaborative care for depression in Veterans (Fortney et al., 2007) found smaller effect sizes for symptom improvement than a similar study of telemedicine-based collaborative care in patients from federally qualified health centers (Fortney et al., 2013)”
From Cognitive-behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants (2015) · cites this paper as Fortney et al., 2013
In the citing paper
“Effectiveness studies of collaborative care have included rural populations10 and some have primarily focused on rural populations.33,34”
From Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review (2018) · cites this paper as [34]
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“Televideo conferencing can effectively support the delivery of collaborative care for depression in primary care.33,34”
From Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review (2018) · cites this paper as [34]
In the citing paper
“Studies conducted in the United Kingdom and the United States have found that remote collaborative care programs for depression (ie, those complex interventions in which a component is delivered through the use of ICT) are at least as effective as those collaborative care programs delivered face-to-face [26].”
From A remote collaborative care program for patients with depression living in rural areas: open-label trial (2018) · cites this paper as [26]
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The Effectiveness of Telemental Health: A 2013 Review
Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013) · Telemedicine and e-Health · doi:10.1089/tmj.2013.0075 · Cited by 1,048
Interactive telemedicine: effects on professional practice and health care outcomes
Flodgren, G., Rachas, A., Farmer, A. J., Inzitari, M., & Shepperd, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002098.pub2 · Cited by 806
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Fortney, J. C., Unützer, J., Wrenn, G. L., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2016) · Psychiatric Services · doi:10.1176/appi.ps.201500439 · Cited by 592
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Metadata
- 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
- PMC
- PMC3816374
- 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
- green
- europepmc.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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