December 1st, 2010

Telemedicine protocol helpful to depressed elderly people

A telemedicine-based protocol for treating depression among homebound elders has shown promise in a preliminary study, pointing the way for more rigorous research.

The study, conducted by Rhode Island Hospital in collaboration with the University of Vermont’s Telemedicine Program, applied telemedicine – now used by the homecare industry to help manage chronic illnesses, such as heart disease – to a condition known to afflict many of the elderly, though relatively few receive treatment.

The 48 participants were already receiving home care for other medical conditions and either had depressive symptoms or were taking antidepressants. Pre-programmed monitoring devices alerted participants at set times to answer questions about low mood and lack of interest and whether or not they were taking antidepressants. Answers were transmitted via telephone line to a home health agency for monitoring.

“[The system] asks about symptomology, adherence and side effects and provided education,” says Thomas Sheeran, Ph.D., a clinical psychologist in the department of psychiatry at Rhode Island Hospital and leader of the study. “It’s a nice way of collecting data remotely.”

If patients said they felt depressed or were experiencing side effects from their medication, a telehealth nurse trained in depression management would follow up with them by phone. These nurses collaborated with visiting nurses and in some cases, a psychiatric nurse, offering a robust treatment approach.

The majority of participants in the study improved, including 19 patients who met the full diagnostic criteria for major depression. Most said they would be willing to take part in a similar program in the future.

“They said they used it a lot when they were depressed and then could back off when they weren’t, which was what we wanted,” Sheeran says. “One person even said they felt they could be more honest with the monitor.”

Telehealth nurses also indicated satisfaction with the protocol, reporting that it was easy to implement for a majority of their patients.

While the cost-savings of telehealth programs are still up for debate, Sheeran points to the efficiencies offered by a collaborative-care program. A psychiatric nurse, for instance, can reach many more patients by consulting with telehealth nurses than by providing care to patients directly, he says.

The participants also seemed comfortable with the technology, Sheeran adds.

“There can be a perception that the elderly are technophobic, but from we’ve seen, most got used to it quite easily,” he says.

As a next step, Sheeran hopes to conduct a larger-scale, randomized study of the telemedicine model in geriatric depression treatment.

“We believe the results are encouraging in that people may be able to experience a greater quality of life through this sort of research,” he says.

By Ami Albernaz

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