Telehealth Problem-Solving Therapy for Depressed Homebound Older Adults

针对抑郁居家老年人的远程医疗问题解决疗法

• 批准号: 8075483
• 负责人: NAMKEE G CHOI
• 金额: $ 10.84万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8075483
• 关键词: Address; Affect; Aftercare; Aging; Attention; Benchmarking; Budgets; Case Management; Case Manager; Chronic Disease; Client; Clinical; Control Groups; Data; Depressed mood; Development; Devices; Disabled Persons; Disease remission; Effectiveness; Elderly; Enrollment; Equipment; Exploratory/Developmental Grant; Feasibility Studies; Funding; Future; Gold; Hamilton Rating Scale for Depression; Health; Health Status; Healthcare; Home environment; Homebound Persons; Intervention; Low income; Maintenance; Meals on Wheels; Measures; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Minority Groups; Modems; Modification; Nurses; Outcome; Persons; Phase; Pilot Projects; Population Group; Preparation; Procedures; Process Measure; Protocols documentation; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Design; Resources; Sampling; Schedule; Screening procedure; Services; Signal Transduction; Social Work; Social Workers; Social isolation; Solutions; Technology; Telephone; Television; Testing; Texas; Time; Training; Treatment Efficacy; Videoconferences; Videoconferencing; Vulnerable Populations; Wireless Technology; World Health Organization; age related; clinically significant; cost; cost effectiveness; depressive symptoms; design; disability; follow-up; health training; innovation; instrument; problem solving therapy; programs; public health relevance; telehealth; treatment response

DESCRIPTION (provided by applicant): This is a resubmission of an R34 exploratory/developmental grant application. The proposed pilot study is designed to evaluate the feasibility and preliminary efficacy of telehealth problem-solving therapy (tele-PST) for homebound older adults suffering from clinically significant moderate-to-severe depressive symptoms. Equipment includes a broadband cable or DSL modem and a wireless videoconferencing device that is securely connected to an older adult's home television set and to the therapist's workstation, with the conferencing beginning when the therapist calls the older-adult client. The real-time, interactive videoconferencing is likely to allow the therapist and the client most of the benefits of in-person sessions. In order to pursue the study aims, we have chosen a two-phase research design. In Phase I, we will implement an uncontrolled feasibility study of six weekly sessions of tele-PST with 10 subjects recruited from a Meals on Wheels program and an in-home support services program in central Texas and evaluate the subjects' acceptance of the intervention and procedural and logistical issues that may arise during its implementation. At a 2-week, one-time follow-up, the subjects' depression, disability, and resourcefulness will also be assessed. In Phase II, we will implement a small-scale, three-group RCT with 30 subjects in each group. The first group will receive up to six weekly tele-PST sessions. The second group will receive up to six weekly in- person PST sessions. Both groups will also receive six monthly maintenance calls from their therapists following the PST sessions. The Phase I findings will guide any modifications and adaptations in tele-PST and in-person PST procedures to be used in Phase II. In-person PST serves as the benchmark or gold standard of comparison for detecting signals that are suggestive of efficaciousness of tele-PST. The third group, an attention control group, will receive six weekly telephone calls and six monthly calls. All three groups will continue to receive their usual services of home-delivered meals or in-home support services and case management from their agency case managers. Two MSW-level therapists will be used, each of whom will conduct both tele-PST and in-person PST sessions. Specific aims in this phase are to (1) assess adequacy of recruitment, enrollment, and retention strategies with special attention to racial/ethnic minorities, and of research instruments; (2) compare compliance rates and service delivery cost between tele-PST and in- person PST; and (3) estimate preliminary effect size and detect clinically significant signals with regard to depression, disability, other health status, and resourcefulness outcomes of tele-PST compared to those of in- person PST and attention control condition at 2 weeks, 12 weeks, and 24 weeks following the conclusion of the 6 weekly PST sessions. The findings are expected to provide data necessary for designing a future RCT to test the replicability, therapeutic efficacy, and cost effectiveness of tele-PST with a larger sample of disabled homebound persons. The public health significance of this study lies in the fact that telehealth PST (tele-PST) may have potential to significantly reduce access barriers not only among homebound older adults but among other disabled persons. Given the current and projected shortage in the mental health workforce, tele-PST holds promise as the most practical and accessible depression treatment for homebound older adults and other disabled persons.

描述（由申请人提供）：这是 R34 探索性/开发资助申请的重新提交。拟议的试点研究旨在评估远程医疗问题解决疗法（tele-PST）对患有临床显着中度至重度抑郁症状的居家老年人的可行性和初步疗效。设备包括宽带电缆或DSL调制解调器和无线视频会议设备，该设备安全地连接到老年人的家庭电视机和治疗师的工作站，当治疗师呼叫老年人客户时会议开始。实时的交互式视频会议可能会让治疗师和客户从面对面会议中获得大部分好处。为了实现研究目标，我们选择了两阶段的研究设计。在第一阶段，我们将实施一项不受控制的可行性研究，对从德克萨斯州中部的送餐服务项目和家庭支持服务项目中招募的 10 名受试者进行每周六次的远程 PST 会议，并评估受试者对干预的接受程度实施过程中可能出现的程序和后勤问题。在为期两周的一次性随访中，还将评估受试者的抑郁、残疾和足智多谋。在第二阶段，我们将实施小规模、三组随机对照试验，每组 30 名受试者。第一组每周将接受最多六次远程 PST 会议。第二组将每周接受最多六次面对面的 PST 会议。 PST 课程结束后，两组患者还将收到治疗师每月六个月的维护电话。第一阶段的研究结果将指导第二阶段使用的远程 PST 和现场 PST 程序的任何修改和调整。现场 PST 充当检测暗示远程 PST 有效性信号的比较基准或黄金标准。第三组是注意力控制组，每周将接到六次电话，每月将接到六次电话。所有三个群体将继续从其机构案例经理那里获得通常的送餐服务或上门支持服务和案例管理服务。将使用两名 MSW 级别的治疗师，每位治疗师都将进行远程 PST 和面对面的 PST 治疗。此阶段的具体目标是 (1) 评估招募、入学和保留策略的充分性，特别关注少数种族/族裔以及研究工具； (2) 比较电话 PST 和现场 PST 之间的合规率和服务交付成本； (3) 估计初步效果大小，并检测与面对面 PST 相比，2 周、12 周时远程 PST 的抑郁、残疾、其他健康状况和足智多谋结果的临床显着信号和注意力控制状况，以及 6 周 PST 会议结束后的 24 周。研究结果预计将为设计未来的随机对照试验提供必要的数据，以通过更多的居家残疾人样本来测试远程 PST 的可复制性、治疗效果和成本效益。这项研究的公共卫生意义在于，远程医疗 PST (tele-PST) 可能不仅可以显着减少居家老年人的获取障碍，还可以显着减少其他残疾人的获取障碍。鉴于当前和预计的心理健康劳动力短缺，远程 PST 有望成为居家老年人和其他残疾人最实用、最容易获得的抑郁症治疗方法。

项目成果

Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older.

• DOI: 10.1186/1471-244x-12-233
• 发表时间: 2012-12-26
• 期刊: BMC psychiatry
• 影响因子: 4.4
• 作者: Choi, Namkee G;Marti, C Nathan;Kunik, Mark E
• 通讯作者: Kunik, Mark E

Telehealth problem-solving therapy for depressed low-income homebound older adults.

为抑郁的低收入居家老年人提供远程医疗问题解决疗法。

• DOI: 10.1097/jgp.0b013e318266b356
• 发表时间: 2014
• 期刊: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
• 作者: Choi,NamkeeG;Hegel,MarkT;Marti,Nathan;Marinucci,MaryLynn;Sirrianni,Leslie;Bruce,MarthaL
• 通讯作者: Bruce,MarthaL

Passive coping response to depressive symptoms among low-income homebound older adults: Does it affect depression severity and treatment outcome?

• DOI: 10.1016/j.brat.2012.07.003
• 发表时间: 2012-11-01
• 期刊: BEHAVIOUR RESEARCH AND THERAPY
• 影响因子: 4.1
• 作者: Choi, Namkee G.;Hegel, Mark T.;Bruce, Martha L.
• 通讯作者: Bruce, Martha L.