Turvey Carolyn L, Willyard Deborah, Hickman David H, Klein Dawn M, Kukoyi Oladipo
Department of Psychiatry, University of Iowa, Iowa City 52242-1000, USA.
Telemed J E Health. 2007 Feb;13(1):51-6. doi: 10.1089/tmj.2006.0036.
Chronic illness accounts for the majority of healthcare expenditures in the United States. Innovative telemedicine programs have been developed to help lessen the chronic illness burden, yet few have been developed to address comorbidity. Programs accommodating comorbidity are needed because most older adults suffer from two or more chronic illnesses. One of the most common and serious comorbidities in chronic illness is major depression, which has been shown to exacerbate morbidity, mortality, and cost. This study presents data on a telephone-based interactive voice recording (IVR) home monitoring program that was expanded to include quarterly screens for depression using the Patient Health Questionnaire (PHQ). Patients in an ongoing telehealth heart failure program were administered the PHQ-2 and PHQ-9 in November 2005 (Round 1) and February 2006 (Round 2). Patients were informed about the screen beforehand and an emergency protocol was established. At both screens, more than 90% of the patients completed the screen. Approximately 30% of the patients endorsed one of the PHQ-2 items in both rounds. Patients endorsing either of the PHQ-2 items then completed the full PHQ-9. Nurse care-managers contacted those scoring above the threshold of 10 on the PHQ-9 indicating possible depression. One patient expressed suicidality and was appropriately assessed for safety. There was no indication that patients were less likely to complete the screen in Round 2, although their average depression scores were slightly lower when compared with Round 1. A regular telephonic IVR screen for depression can be integrated into a standard illness management protocol. Following a preestablished emergency plan for the assessment of suicidality was successful. This serves as a model for using technology to manage comorbid depression and chronic illness.
慢性病占美国医疗保健支出的大部分。人们已开发出创新的远程医疗项目来帮助减轻慢性病负担，但很少有项目是针对合并症的。由于大多数老年人患有两种或更多种慢性病，因此需要有适应合并症的项目。慢性病中最常见且最严重的合并症之一是重度抑郁症，研究表明它会加剧发病率、死亡率和成本。本研究展示了一项基于电话的交互式语音记录（IVR）家庭监测项目的数据，该项目已扩展为使用患者健康问卷（PHQ）进行季度抑郁症筛查。2005年11月（第一轮）和2006年2月（第二轮），对正在进行的远程健康心力衰竭项目中的患者进行了PHQ - 2和PHQ - 9测评。事先告知患者该筛查，并制定了应急方案。在两次筛查中，超过90%的患者完成了筛查。两轮中约30%的患者认可PHQ - 2的一项内容。认可PHQ - 2任何一项内容的患者随后完成了完整的PHQ - 9测评。护士护理经理联系了那些PHQ - 9得分高于10分阈值表明可能患有抑郁症的患者。有一名患者表达了自杀倾向，并接受了适当的安全评估。没有迹象表明患者在第二轮中完成筛查的可能性降低，尽管与第一轮相比他们的平均抑郁得分略低。定期的抑郁症电话IVR筛查可以纳入标准的疾病管理方案。遵循预先制定的自杀倾向评估应急计划是成功的。这为利用技术管理合并症抑郁症和慢性病提供了一个范例。
