Efficacy of Nurse Telehealth Care and Peer Support in Augmenting Treatment of Depression in Primary Care
Enid M. Hunkeler, MA;
Joel F. Meresman, PhD;
William A. Hargreaves, PhD;
Bruce Fireman, MS;
William H. Berman, PhD;
Arlene J. Kirsch, PhD;
Jennifer Groebe, LCSW;
Stephen W. Hurt, PhD;
Patricia Braden;
Michael Getzell, MD;
Paul A. Feigenbaum, MD;
Tiffany Peng, MA;
Mark Salzer, PhD
Arch Fam Med. 2000;9:700-708.
Background Primary care treatment of depression needs improvement.
Objective To evaluate the efficacy of 2 augmentations to antidepressant drug treatment.
Design Randomized trial comparing usual care, telehealth care, and telehealth care plus peer support; assessments were conducted at baseline, 6 weeks, and 6 months.
Setting Two managed care adult primary care clinics.
Participants A total of 302 patients starting antidepressant drug therapy.
Interventions For telehealth care: emotional support and focused behavioral interventions in ten 6-minute calls during 4 months by primary care nurses; and for peer support: telephone and in-person supportive contacts by trained health plan members recovered from depression.
Main Outcome Measures For depression: the Hamilton Depression Rating Scale and the Beck Depression Inventory; and for mental and physical functioning: the SF-12 Mental and Physical Composite Scales and treatment satisfaction.
Results Nurse-based telehealth patients with or without peer support more often experienced 50% improvement on the Hamilton Depression Rating Scale at 6 weeks (50% vs 37%; P = .01) and 6 months (57% vs 38%; P = .003) and on the Beck Depression Inventory at 6 months (48% vs 37%; P = .05) and greater quantitative reduction in symptom scores on the Hamilton scale at 6 months (10.38 vs 8.12; P = .006). Telehealth care improved mental functioning at 6 weeks (47.07 vs 42.64; P = .004) and treatment satisfaction at 6 weeks (4.41 vs 4.17; P = .004) and 6 months (4.20 vs 3.94; P = .001). Adding peer support to telehealth care did not improve the primary outcomes.
Conclusion Nurse telehealth care improves clinical outcomes of antidepressant drug treatment and patient satisfaction and fits well within busy primary care settings.
From the Division of Research, Kaiser Permanente Northern California, Oakland (Mss Hunkeler, Groebe, Braden, and Peng, Dr Hargreaves, and Mr Fireman); Departments of Psychiatry (Dr Meresman) and Medicine (Dr Getzell), Kaiser Permanente Northern California, Hayward; Department of Psychiatry, University of California, San Francisco (Dr Hargreaves); Department of Psychology, Fordham University, Bronx, NY (Dr Berman); SmithKline Beecham Pharmaceuticals (Dr Kirsch) and Department of Psychiatry, Weill Medical College of Cornell University, Westchester Division, White Plains, NY (Dr Hurt); and Department of Medicine, Kaiser Permanente Northern California, San Francisco (Dr Feigenbaum).
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