Key result
Integrated telehealth care (I-TEAM) for older adults with chronic illness and depression resulted in 50% lower depression scores and significantly fewer ED visits at 12 months (P=.01).
Why the study?
Does a 3-month integrated telehealth intervention improve depression and reduce healthcare utilization in medically frail older homebound individuals with chronic illness and comorbid depression?
RCT (n=102)
Does a 3-month integrated telehealth intervention improve depression and reduce healthcare utilization in medically frail older homebound individuals with chronic illness and comorbid depression?
p-value: p=.01
An integrated telehealth intervention combining chronic illness monitoring and depression treatment significantly reduces depressive symptoms and emergency department visits in frail, homebound older adults.
May support integrated telehealth for comorbid depression in frail homebound HF/COPD patients; extends remote care evidence in geriatric home healthcare.
OBJECTIVES: To evaluate an integrated telehealth intervention (Integrated Telehealth Education and Activation of Mood (I-TEAM)) to improve chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression in the home healthcare setting. DESIGN: Randomized controlled trial. SETTING: Hospital-affiliated home healthcare setting. PARTICIPANTS: Medically frail older homebound individuals (N = 102). INTERVENTION: The 3-month intervention consisted of integrated telehealth chronic illness and depression care, with a telehealth nurse conducting daily telemonitoring of symptoms, body weight, and medication use; providing eight weekly sessions of problem-solving treatment for depression; and providing for communication with participants' primary care physicians, who also prescribed antidepressants. Control participants were allocated to usual care with in-home nursing plus psychoeducation (UC+P). MEASUREMENTS: The two groups were compared at baseline and 3 and 6 months after baseline on clinical measures (depression, health, problem-solving) and 12 months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits). RESULTS: Depression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6 months. Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition. The I-TEAM group had significantly fewer ED visits (P = .01) but did not have significantly fewer days in the hospital at 12 months after baseline. CONCLUSION: Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.
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Gellis et al. (2014) conducted an RCT in Chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression (n=102). Integrated Telehealth Education and Activation of Mood (I-TEAM) vs. Usual care with in-home nursing plus psychoeducation (UC+P) was evaluated on Clinical measures (depression, health, problem-solving) and health utilization (readmission, episodes of care, and emergency department visits) (p=.01). Integrated telehealth care (I-TEAM) for older adults with chronic illness and depression resulted in 50% lower depression scores and significantly fewer ED visits at 12 months (P=.01).
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