Integrated Telehealth Care for Chronic Illness and Depression in Geriatric Home Care Patients: The Integrated Telehealth Education and Activation of Mood (I-TEAM) Study

ObjectivesTo evaluate an integrated telehealth intervention (Integrated Telehealth Education and Activation of Mood (I-TEAM)) to improve chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression in the home healthcare setting. DesignRandomized controlled trial. SettingHospital-affiliated home healthcare setting. ParticipantsMedically frail older homebound individuals (N=102). InterventionThe 3-month intervention consisted of integrated telehealth chronic illness and depression care, with a telehealth nurse conducting daily telemonitoring of symptoms, body weight, and medication use; providing eight weekly sessions of problem-solving treatment for depression; and providing for communication with participants' primary care physicians, who also prescribed antidepressants. Control participants were allocated to usual care with in-home nursing plus psychoeducation (UC+P). MeasurementsThe two groups were compared at baseline and 3 and 6months after baseline on clinical measures (depression, health, problem-solving) and 12months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits). ResultsDepression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6months. Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition. The I-TEAM group had significantly fewer ED visits (P=.01) but did not have significantly fewer days in the hospital at 12months after baseline. ConclusionIntegrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.