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Study Suggests Telemedicine-Based Collaborative Care Does Not Increase Total Workload for Primary Care or Mental Health Providers


Studies have shown that patients with depression use substantially more healthcare resources than patients without depression, and higher costs are observed across most types of services (e.g., primary care, specialty mental health). This study examined patterns of healthcare utilization and cost associated with telemedicine-based collaborative care for depression. Investigators recruited 395 Veterans with depression who received care in seven VA community-based outpatient clinics (CBOCs) and were randomized to telemedicine-based collaborative care or usual care between 4/03 and 9/04. Veterans randomized to the intervention received a stepped-care model of depression treatment for up to 12 months, which included four types of providers: primary care providers located at CBOCs, off-site tele-psychiatrists, an off-site depression nurse care manager, and an off-site clinical pharmacist. VA data on costs were analyzed for FY02 through FY05.

Findings suggest that telemedicine-based collaborative care does not increase total workload for primary care or mental health providers; therefore, there is no disincentive for mental health providers to offer telemedicine-based care ? or for primary care providers to refer Veterans to telemedicine care. There was no significant difference in the total number or cost of primary care encounters between Veterans in the intervention group and those in the usual care group. Between the two groups, there also were no statistically significant differences in total mental health encounters or cost; however, Veterans in the intervention group did have significantly more cost and encounters in specialty physical health clinics. In addition, Veterans in the intervention group had a significantly greater total outpatient cost compared to Veterans in usual care. These differences were likely due to the high levels of physical and mental health comorbidities in this study population; the average number of serious chronic health conditions was 5.5 (e.g., diabetes, heart disease, lung disease, stroke, and cancer).

PubMed Logo Fortney J, Maciejewski M, Tripathi S, Deen T, Pyne J. A Budget Impact Analysis of Telemedicine-Based Collaborative Care for Depression. Medical Care May 26, 2011;e-pub ahead of print.

This study was funded by HSR&D (IIR 00-078). All authors except Dr. Maciejewski are part of HSR&D’s Center for Mental Healthcare and Outcomes Research, Little Rock, AR. Dr. Maciejewski is part of HSR&D’s Center for Health Services Research in Primary Care, Durham, NC.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.