Telehealth Treatments for Depression with Low-Income Homebound Seniors

低收入居家老年人抑郁症的远程医疗治疗

• 批准号: 9099955
• 负责人: NAMKEE G CHOI
• 金额: $ 46.04万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-26 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9099955
• 关键词: Address; Adoption; Aging; Anxiety; Behavioral; Budgets; Caring; Case Management; Clinic; Clinical; Clinical Trials; Clinical effectiveness; Community Health; Consent; Data; Disabled Persons; Effectiveness; Elderly; Evidence based intervention; Evidence based treatment; Foundations; Hamilton Rating Scale for Depression; Health; Healthcare; Home environment; Hybrids; Improve Access; Institute of Medicine (U.S.); Intake; Laws; Licensing; Life; Low income; Measures; Mediating; Medical; Medicare/Medicaid; Mental Depression; Mental Health; Mental Health Services; Modeling; Outcome; Participant; Persons; Pharmacotherapy; Population; Population Group; Pragmatic clinical trial; Primary Care Physician; Problem Solving; Provider; Psychotherapy; Public Health; Quality-Adjusted Life Years; Randomized; Research Infrastructure; Self Care; Services; Severities; Social Change; Symptoms; System; Target Populations; Technology; Telephone; Testing; Time; Training; Training Support; Treatment Cost; Underserved Population; United States Centers for Medicare and Medicaid Services; United States Substance Abuse and Mental Health Services Administration; World Health Organization Disability Assessment Schedule; antidepressant effect; arm; austin; base; brief screening; care delivery; clinically significant; cost; cost effective; cost effectiveness; delivered meals; depressive symptoms; disability; disparity reduction; ethnic minority population; evidence base; experience; geriatric depression; health care delivery; improved; innovation; late-life anxiety; peer; problem solving therapy; programs; psychoeducation; psychosocial; racial and ethnic; racial diversity; response; retention rate; skills training; telehealth; treatment as usual; uptake; Address; Adoption; Aging; Anxiety; Behavioral; Budgets; Caring; Case Management; Clinic; Clinical; Clinical Trials; Clinical effectiveness; Community Health; Consent; Data; Disabled Persons; Effectiveness; Elderly; Evidence based intervention; Evidence based treatment; Foundations; Hamilton Rating Scale for Depression; Health; Healthcare; Home environment; Hybrids; Improve Access; Institute of Medicine (U.S.); Intake; Laws; Licensing; Life; Low income; Measures; Mediating; Medical; Medicare/Medicaid; Mental Depression; Mental Health; Mental Health Services; Modeling; Outcome; Participant; Persons; Pharmacotherapy; Population; Population Group; Pragmatic clinical trial; Primary Care Physician; Problem Solving; Provider; Psychotherapy; Public Health; Quality-Adjusted Life Years; Randomized; Research Infrastructure; Self Care; Services; Severities; Social Change; Symptoms; System; Target Populations; Technology; Telephone; Testing; Time; Training; Training Support; Treatment Cost; Underserved Population; United States Centers for Medicare and Medicaid Services; United States Substance Abuse and Mental Health Services Administration; World Health Organization Disability Assessment Schedule; antidepressant effect; arm; austin; base; brief screening; care delivery; clinically significant; cost; cost effective; cost effectiveness; delivered meals; depressive symptoms; disability; disparity reduction; ethnic minority population; evidence base; experience; geriatric depression; health care delivery; improved; innovation; late-life anxiety; peer; problem solving therapy; programs; psychoeducation; psychosocial; racial and ethnic; racial diversity; response; retention rate; skills training; telehealth; treatment as usual; uptake

 DESCRIPTION (provided by applicant): The long-term objective of the proposed study is to improve access to depression treatments for low-income, racially diverse homebound seniors, a population experiencing significant disparities in mental health care due to their homebound and low-income status. Specific aims are to compare the acceptability, clinical effectiveness, treatment cost, and budget impact of the two teledelivered treatment delivery models: problem- solving therapy (PST) by licensed clinicians and self-care management (SCM) support by trained lay mental health workers/advisors. The interventionists will be integrated into an aging-service agency; hence, integrated tele-PST (IT-PST) ad integrated tele-SCM (IT-SCM). Although tele-psychotherapy is likely to be an effective mental health service delivery model for the target population, the current and projected shortage of such clinicians and the costs of deploying highly trained professionals pose barriers to this model's widespread real- world adoption and sustainability. A more plausible option may indeed have to utilize trained lay mental health workers. The study participants will be 276 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Austin, Tex. In a 3-arm, pragmatic clinical trial with randomization prior to consent (a preferred public health approach), the participants will receive five sessions of IT-PST, five sessions of IT-SCM, or five telephone check-in calls (for the usual care- UC-group). Our first hypothesis is that IT-PST and IT-SCM will be equally acceptable to the participants. Our second hypothesis is that both IT-PST and IT-SCM will be more effective than UC in reducing depressive symptoms, although IT-PST may be more effective than IT-SCM. Symptoms will be assessed with the 24-item Hamilton Depression Rating Scale (HAMD) at 12, 24, and 36 weeks after baseline. Additional outcomes will be depression-free days (DFDs) and disability (WHODAS 2.0). Our third hypothesis is that IT-SCM will have a lower delivery cost than IT-PST, but both IT-PST and IT-SCM will be more cost-effective than usual care. The analyses include (a) comparisons of delivery costs between IT-PST and IT-SCM; (b) assessment of cost- effectiveness (CEA) based on DFDs and health-related quality adjusted life-year measured by EuroQol-5 (EQ- 5D); and (3) budget impact (BIA) of IT-PST relative to IT-SCM. Both CEA and BIA will employ a hybrid public program perspective of the AoA and the Centers for Medicare and Medicaid. Public health significance of this study is that the data will help aging-service providers and funders assess respective strengths and weaknesses of each model as a sustainable approach to providing depression care for an underserved and growing population group and improving their access to evidence-based mental health services. (We use the terms older adults and seniors interchangeably because the latter term is frequently used in aging services.)

 描述（由适用提供）：拟议的研究的长期目标是改善低收入，大致多样化的居家老年人的抑郁症治疗的机会，由于他们的家中和低收入状况，人口在精神卫生保健方面经历了重大分布。具体目的是比较两个固定治疗交付模型的可接受性，临床有效性，治疗成本和预算影响：持牌临床医生和自我保健管理（SCM）支持受过训练的LIE精神卫生工作者/顾问的支持疗法（PST）。干预主义者将被整合到老龄化服务机构中；因此，集成的tele-pst（IT-PST）AD Integrated Telet-SCM（IT-SCM）。尽管远程心理治疗可能是目标人群的有效心理健康服务提供模式，但目前和预计的临床医生短缺以及部署训练有素的专业人员的成本构成了该模型的现实世界中采用和可持续性的障碍。确实，更合理的选择确实必须使用训练有素的外行精神卫生工作者。研究参与者将是276名低收入，大致多样化的家庭企业，由本国饮食餐点（HDM）计划（HDM）计划和德克萨斯州奥斯汀市的其他老龄化服务机构。通常的护理 - uc-group）。我们的第一个假设是，IT-PST和IT-SCM对参与者同样可以接受。我们的第二个假设是，尽管IT-PST可能比IT-SCM更有效，但IT-P​​ST和IT-SCM在减少抑郁症状方面都比UC更有效。症状将在基线后12、24和36周的24个项目汉密尔顿抑郁量表（HAMD）评估。其他结果将是无抑郁症（DFD）和残疾（WHODAS 2.0）。我们的第三个假设是，IT-SCM的交付成本将比IT-PST低，但是IT-PST和IT-SCM的成本都将比通常的护理更具成本效益。分析包括（a）IT-PST与IT-SCM之间的交付成本进行比较； （b）基于DFD和与健康相关的质量调整的生命年度成本效益（CEA）评估，以EUROQOL-5（EQ-5D）衡量； （3）IT-PST相对于IT-SCM的预算影响（BIA）。 CEA和BIA都将采用AOA和Medicare和Medicaid中心的混合公共计划观点。这项研究的公共卫生意义在于，数据将有助于老化服务提供商和资金评估每个模型的相对优势和劣势，作为一种可持续的方法，可以为服务不足和不断增长的人口组提供抑郁症护理，并改善其获得基于证据的心理健康服务的机会。 （我们可以互换使用老年人和老年人，因为后一个学期经常用于衰老服务。）