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

 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（由申请人提供）：拟议研究的长期目标是改善低收入、种族多样化的居家老年人获得抑郁症治疗的机会，这些老年人由于居家和低收入而在心理健康保健方面存在显着差异具体目标是比较两种远程治疗模式的可接受性、临床效果、治疗成本和预算影响：由有执照的群体进行的问题解决治疗（PST）和由经过培训的非专业人士提供的自我护理管理（SCM）支持。干预专家将被纳入老龄化服务机构；因此，综合远程 PST（IT-PST）和综合远程 SCM（IT-SCM）可能是一种有效的心理治疗。目标人群的卫生服务提供模式、目前和预计的此类牧师的短缺以及部署训练有素的专业人员的成本，都对该模式在现实世界中的广泛采用和可持续性构成了障碍。一个更合理的选择可能确实必须利用训练有素的非专业人士。研究参与者。将由德克萨斯州奥斯汀市的 276 名低收入、种族多样化的居家老年人组成，他们接受送货上门 (HDM) 计划和其他老龄服务机构的服务。这是一项三臂、务实的临床试验，在同意前进行随机分组（我们的第一个假设是 IT-PST我们的第二个假设是，IT-PST 和 IT-SCM 在减轻抑郁症状方面都比 UC 更有效，尽管 IT-PST 可能比 IT-SCM 更有效。将在基线后 12、24 和 36 周使用 24 项汉密尔顿抑郁评定量表 (HAMD) 进行评估 其他结果将是无抑郁天数 (DFD) 和残疾 (WHODAS)。我们的第三个假设是 IT-SCM 的交付成本低于 IT-PST，但 IT-PST 和 IT-SCM 都比常规护理更具成本效益。分析包括 (a) 交付的比较。 IT-PST 和 IT-SCM 之间的成本；(b) 基于 DFD 和 EuroQol-5 (EQ-5D) 衡量的健康相关质量调整生命年的成本效益 (CEA) 评估；以及 (3) 预算影响； (BIA) 相对于 IT-SCM，CEA 和 BIA 都将采用 AoA 和医疗保险和医疗补助中心的混合公共计划视角。这项研究的数据将有助于老龄化服务。提供者和资助者评估每种模式各自的优势和劣势，作为治疗抑郁症的可持续方法，为服务不足和不断增长的人口群体提供护理，并改善他们获得循证心理健康服务的机会（我们交替使用老年人和老年人这两个术语，因为后一个术语经常用于老龄化服务。）