Rural individuals with depression face substantial barriers to care, seldom receive evidence-based treatment, and experience poor outcomes. Collaborative care has been documented to improve outcomes in large urban Primary Care (PC) clinics. Implementing collaborative care in small rural practices presents a unique challenge because it is not feasible to employ on-site multidisciplinary care teams dedicated to depression treatment. No published studies have documented the effectiveness of collaborative care in small rural PC clinics. In fact, one recent collaborative care effectiveness study conducted in both rural and urban practices found that outcomes were significantly improved in urban clinics, but not rural clinics. Results from our current VA study demonstrate that telemedicine-based collaborative care is effective in small rural PC clinics. Telemedicine-based collaborative care was provided to rural clinics by an off-site depression care team using telephones, emails, interactive video, and a shared electronic medical record. A critical question for the field is whether it is more effective for small rural clinics to provide collaborative care services on-site (practice-based collaborative care model) or to contract with an off-site care team that specializes in providing collaborative care to multiple clinics from a centralized location using telemedicine technologies (telemedicine-based model). We propose to compare the effectiveness/cost-effectiveness of telemedicine-based collaborative care to practice-based collaborative care in six Community Health Center (CHC) systems in rural Arkansas. In 2003, 890 federally-funded CHCs served over 12 million poor, ethnically diverse patients living in medically underserved areas. CHCs are in the process of re-engineering clinics to provide practice-based collaborative care as a part of the Health Disparities Collaboratives. The proposed research has the potential to have a major public health impact because the results should be generalizable to the hundreds of rural CHCs across the country. CHCs represent one of the largest and fasting growing PC systems in the nation, and thus results should be applicable to a large number of providers and patients across the nation. In addition, CHCs serve predominantly low income minority populations living in medically underserved areas. This population is at high risk for experiencing health disparities and thus, interventions targeting this population have the potential to have a major impact. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH076908-02
Application #
7289225
Study Section
Special Emphasis Panel (ZMH1-ERB-N (05))
Program Officer
Moten, Carmen P
Project Start
2006-09-21
Project End
2011-06-30
Budget Start
2007-07-01
Budget End
2008-06-30
Support Year
2
Fiscal Year
2007
Total Cost
$617,569
Indirect Cost
Name
University of Arkansas for Medical Sciences
Department
Psychiatry
Type
Schools of Medicine
DUNS #
122452563
City
Little Rock
State
AR
Country
United States
Zip Code
72205
Pyne, Jeffrey M; Fortney, John C; Mouden, Sip et al. (2015) Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs. Psychiatr Serv 66:491-9
Hudson, Teresa J; Fortney, John C; Pyne, Jeffrey M et al. (2015) Reduction of patient-reported antidepressant side effects, by type of collaborative care. Psychiatr Serv 66:272-8
Fortney, John C; Pyne, Jeffrey M; Mouden, Sip B et al. (2013) Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry 170:414-25
Deen, Tisha L; Fortney, John C; Schroeder, Gary (2013) Patient acceptance of and initiation and engagement in telepsychotherapy in primary care. Psychiatr Serv 64:380-4
Hunt, Justin B; Curran, Geoffrey; Kramer, Teresa et al. (2012) Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: theory and methods. Prog Community Health Partnersh 6:389-98
Fortney, John C; Pyne, Jeffrey M; Steven, Christopher A et al. (2010) A Web-based clinical decision support system for depression care management. Am J Manag Care 16:849-54