Telepsychiatry is a novel means of providing expert psychiatric treatment to patients who live far from a source of care. If it can be demonstrated that treatment via telepsychiatry is as effective as in-person treatment, then many individuals with psychiatric illness will have easy access to psychiatric care, even if they live in geographically remote areas.
The major goal of this study was to determine whether treatment of depressive disorders via telepsychiatry is as effective as in-person treatment. In addition, this study was designed to determine if depressed patients are as compliant and as satisfied with telepsychiatry as with in-person treatment. Another goal was to compare the cost and cost-effectiveness of remote treatment via telepsychiatry to in-person treatment.
In this randomized controlled trial, veterans who presented with depression to any of three VA Maryland Health Care facilities with a SCID-IV depression diagnosis and a Hamilton Rating Scale for Depression (Ham-D) score of 16 or above were eligible for participation. Eligible veterans were randomized to either "in-person" treatment or "remote" treatment. Treatment occurred over six months and consisted of psychotropic medication and psycho-education concerning the disease, medications, and side effects. The major outcome variables included changes in Ham-D depression ratings and Beck Depression Inventory (BDI) self-reported depression ratings.
Sixty subjects were randomized to the "in-person" treatment group, and 59 to the "remote" treatment group. HAM-D and BDI scores improved over the treatment period, and did not differ by treatment group. The groups were equally compliant with appointments and medication. There were no differences in drop-out rates. Patient satisfaction scores were no different between groups. Telepsychiatry was more expensive per treatment session, but this difference in expense disappeared if psychiatrist travel cost was considered when the psychiatrist had to travel over 22 miles to the clinic. Telepsychiatry treatment did not increase overall health care expense.
This study demonstrates that remote treatment of depression via telepsychiatry is as effective as in-person treatment with equal levels of patient compliance, patient satisfaction, and health care cost. Thus, VA health care can be widely expanded, at great convenience to veterans and without incurring high costs with the use of telepsychiatry.
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