Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study
Objectives: To 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.
Design: Randomized controlled trial.
Setting: Hospital-affiliated home healthcare setting.
Participants: Medically frail older homebound individuals (N = 102).
Intervention: The 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).
Measurements: The two groups were compared at baseline and 3 and 6 months after baseline on clinical measures (depression, health, problem-solving) and 12 months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits).
Results: Depression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6 months. 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 12 months after baseline.
Conclusion: Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.
Comment Letter to the Federation of State Medical Boards Regarding the Draft Interstate Medical Licensure Compact
The Alliance submitted comments on the draft Interstate Medical Licensure Compact (the “Compact”). The Alliance recommended several additions to strengthen the draft Compact.
- Recommend that FSMB more clearly demonstrate the value that will be added as a result of the establishment of a Commission including additional detail on the Commission’s role in facilitating expedited licensure determinations; the streamlined communication channels between the home state, the Commission, and other member states; and the timeframe for expedited licensure.
- We recommend that FSMB include a timeframe in the document that specifies the length of time estimated for end-to-end processing.
- The Compact is a policy document, but in order for the vision encompassed in the document to become reality, there must be interoperable information technology (IT) systems in place.
- We recommend that FSMB clearly outline the eligibility requirements physicians will have to satisfy to be eligible to participate in the expedited process in the Compact.