TEAM Study to Improve Depression Care in Rural CBOCs

This study has been completed.
Information provided by (Responsible Party):
Department of Veterans Affairs Identifier:
First received: March 16, 2005
Last updated: April 25, 2014
Last verified: April 2014

We adapted the collaborative care model using telemedicine (e.g., telephone, interactive video, electronic medical records) to support antidepressant therapy initiated by primary care providers in small rural practices and evaluated the effectiveness and cost-effectiveness of telemedicine-based collaborative care.

Condition Intervention
Behavioral: Telemedicine intervention

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind
Primary Purpose: Treatment
Official Title: Telemedicine Intervention to Improve Depression Care in Rural CBOCs

Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • 1) Antidepressant prescribing, 2) Medication adherence, 3) Treatment response and remission, 4) Health status and health related quality of life [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • 1) Satisfaction with care, 2) service utilization, 3) Cost, 4) Cost-effectiveness [ Designated as safety issue: No ]

Estimated Enrollment: 400
Study Start Date: April 2003
Study Completion Date: October 2004
Arms Assigned Interventions
Arm 1 Behavioral: Telemedicine intervention

Detailed Description:

BACKGROUND / RATIONALE: Implementing collaborative care for depression in small rural Primary Care (PC) practices without on-site mental health specialists presents unique challenges. We adapted the collaborative care model using telemedicine (e.g., telephone, interactive video, electronic medical records) to support antidepressant therapy initiated by PC providers in small rural practices. The Telemedicine Enhanced Antidepressant Management (TEAM) collaborative care intervention was implemented by offsite personnel and all intervention components were implemented using telemedicine technologies. OBJECTIVE(S): Specific Aim 1: Determine whether the TEAM intervention improves quality and outcomes compared to usual care. Specific Aim 2: Determine whether the TEAM intervention will be cost-effective in routine practice settings. METHODS: Seven VISN 16 CBOCs participated in the study. CBOCs were included if they 1) treated >1,000 and <5,000 unique veterans, 2) had no on-site psychiatrists, and 3) had interactive video equipment. Matched CBOCs were randomized to receive the intervention or usual care. Of the 24,882 clinic patients, 73.6% (n=18,306) were successfully screened and 6.9% screened positive for depression (PHQ9 =12). Of those eligible for the study, 91.3% agreed to participate, and 91.9% of those attended their appointment and were consented. Over an 18-month period, 395 patients were enrolled, and 91.1% (n=360) were followed-up at six months. Telephone research interviews were conducted at baseline, six and twelve months. Effectiveness was tested using an intent-to-treat analysis. Cost-effectiveness analysis was assessed from the perspective of the VA. Costs included intervention costs, encounter costs, and medication costs. Quality Adjusted Life Years (QALYs) were calculated using the Quality of Well Being Scale.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

PHQ9 Score > or = to 12

Exclusion Criteria:

A diagnosis of schizophrenia, current suicide ideation, recent bereavement, or receiving specialty mental health treatment

  Contacts and Locations
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Please refer to this study by its identifier: NCT00105690

United States, Arkansas
Central Arkansas VHS Eugene J. Towbin Healthcare Ctr, Little Rock
No. Little Rock, Arkansas, United States, 72114-1706
United States, Louisiana
VA Medical Center
Shreveport, Louisiana, United States, 71101
United States, Mississippi
G.V. (Sonny) Montgomery VA Medical Center, Jackson
Jackson, Mississippi, United States, 39216
Sponsors and Collaborators
Principal Investigator: John C. Fortney, PhD Central Arkansas Veterans Healthcare System (North Little Rock)
Principal Investigator: Jeffrey M. Pyne, MD Central Arkansas Veterans Healthcare System (North Little Rock)
  More Information


Responsible Party: Department of Veterans Affairs Identifier: NCT00105690     History of Changes
Other Study ID Numbers: IIR 00-078
Study First Received: March 16, 2005
Last Updated: April 25, 2014
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Behavioral Symptoms processed this record on March 26, 2015