Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Telemed J E Health. 2011 Oct;17(8):620-6. doi: 10.1089/tmj.2011.0011. Epub 2011 Jul 22.
The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services.
Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol.
An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up.
Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.
本研究旨在测试利用现有的家庭医疗远程监测技术为西班牙语和英语的居家老年医疗服务接受者提供抑郁护理管理（DCM）的方法的可行性、可接受性和初步临床结果。
位于纽约、佛蒙特和迈阿密的三个独立的非营利性社区家庭护理机构参与了这项研究。通过编程有关抑郁症状、抗抑郁药依从性和副作用的问题和教育信息，将基于证据的 DCM 改编到远程监测平台上。招募的患者至少参加 3 周。远程健康护士接受了 DCM 培训，并接受了每周两次的监督。经过培训的现场研究助理对抑郁诊断和严重程度以及患者对方案的满意度进行了家访研究访谈。
48 名只会说英语和西班牙语的患者以及 7 名远程健康护士参加了这项研究，他们都报告了高水平的方案接受度。在符合重度抑郁症诊断标准的 19 名患者中，基线时的抑郁严重程度处于“明显严重”范围，随访时处于“轻度”范围。
这项试点研究的结果支持利用家庭护理现有的远程监测技术为其居家的老年患者提供 DCM 的可行性。这对英语和西班牙语患者都适用。初步临床结果表明抑郁严重程度有所改善，但这些发现需要在随机临床试验中进行检验。讨论了基于远程医疗的老年患者抑郁护理的科学和服务的意义。
