Telephone-delivered, interpersonal psychotherapy for HIV-infected rural persons with depression: a pilot trial. Synchronizing clinician engagement and client motivation in telephone counseling. Impact of telephonic psycho-social support on adherence to post-exposure prophylaxis (PEP) after rape. Use and impact of an automated telephone outreach system for asthma in a managed care setting. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. Effects of telephone call interventions on patients' well-being in a radiation therapy department. A randomized, controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care. A telephone-based intervention for depression in HIV patients: negative results from a randomized clinical trial. Telephone therapy for patients with breast cancer.
Rural areas account for approximately 6% of AIDS cases in the United States. Many HIV-infected persons in rural areas live with elevated levels of psychiatric distress, suicidal ideation, and loneliness. This pilot study tested whether brief interpersonal psychotherapy delivered via telephone could reduce psychiatric distress among persons living with HIV-AIDS in rural areas in the United States.
                Seventy-nine participants were assigned randomly to a usual care control condition or to a six-session, telephone-delivered, interpersonal psychotherapy intervention (hereafter referred to as the teletherapy group); participants in the teletherapy group continued to receive standard services available to them in the community. Participants completed self-administered surveys pre- and postintervention that assessed depressive and psychiatric symptoms, perceptions of loneliness, and social support.
                Participants in the teletherapy group evidenced greater reductions in depressive symptoms and in overall levels of psychiatric distress, compared with those in the control group. Nearly one-third of teletherapy participants reported clinically meaningful reductions in psychiatric distress from pre- to postintervention.
                The telephone-delivered interpersonal therapy intervention showed potential to reduce depressive and psychiatric symptoms among HIV-infected persons in rural areas. On the basis of these encouraging findings, additional research examining this intervention with this clinical population is warranted. Health care increasingly incorporates telephone counseling, but the interactions supporting its delivery are not well understood. The authors' clinical trial of a tailored, nurse-administered smoking cessation intervention for surgical patients included a telephone counseling component and provided an opportunity to describe the interaction dynamics of proactive telephone counseling over the course of 4 months. Tape-recorded telephone counseling calls for 56 consecutively enrolled individuals randomized to the intervention group resulted in a data set of 368 calls, which were transcribed and analyzed using constant comparative methods. The findings revealed varying interaction dynamics depending on the nurse's level of engagement with participants and participants' motivation to stop smoking. The authors identified four interaction dynamics: affirming/working, chasing/skirting, controlling/withdrawing, and avoiding commitment. Shifts in interaction dynamics were common and influenced the provision of support both positively and negatively. The findings challenge many assumptions underlying telephone counseling and suggest strategies to improve its delivery. South Africa has one of the highest rates of both rape and HIV infections. Of great concern is the possibility of HIV transmission during the assault, but adherence to post-exposure prophylaxis (PEP) has been varied and low. We developed a telephonic psycho-social support, leaflet and adherence diary intervention for rape victims and tested its impact on adherence to PEP. A randomised control trial was conducted in the Western and Eastern Cape and 279 rape survivors were enrolled in two arms. The intervention involved the providing of an information leaflet including an adherence diary and follow-up support through telephone calls by a counsellor during the 28 days of taking the PEP. The controls received the leaflet. Follow-up interviews and tablet checks were done with 253 participants to assess adherence. The primary outcome was completion of 28 days of PEP with no more than three missed doses (94% adherence). There was more adherence in the intervention arm (38.2% vs. 31.9%), but the estimated intervention effect of 6.5% (95% CI: -4.6 to 17.6%) was not statistically significant, p=0.13. The intervention was associated with the reading of the pamphlet (p=0.07) and an increased use of the diary (p=0.01), but did not reduce depressive psychopathology. Overall adherence was greater amongst those who read the leaflet and used the medication diary. The study showed that the intervention was not effective in significantly improving adherence and adherence levels were low in both study arms. Further research to understand reasons for non-adherence is needed before further interventions are developed. To test the ability of an automated telephone outreach intervention to reduce acute healthcare utilization and improve quality of life among adult asthma patients in a large managed care organization.
                Randomized clinical trial.
                Patients with persistent asthma were randomly assigned to telephone outreach (automated = 3389, live caller = 192) or usual care (n = 3367). Intervention participants received 3 outreach calls over a 10-month period. The intervention provided brief, supportive information and flagged individuals with poor asthma control for follow-up by a provider. A survey was mailed to 792 intervention participants and 236 providers after the intervention. Additional feedback was obtained as part of the final intervention contact.
                The intent-to-treat analysis found no significant differences between the intervention and usual-care groups for medication use, healthcare utilization, asthma control, or quality of life. Post hoc analyses found that, compared with the control group, individuals who actually participated in the intervention were significantly more likely to use inhaled steroids and to have had a routine medical visit for asthma during the follow-up period and less likely to use short-acting beta-agonists. They also reported higher satisfaction with their asthma care and better asthma-specific quality of life. Of surveyed providers, 59% stated the program helped them to clinically manage their asthma patients and 70% thought the program should be continued.
                This study did not find improved health outcomes in the primary analyses. The intervention was well accepted by providers, however, and the individuals who participated in the calls appeared to have benefited from them. These findings suggest that further studies of automated telephone outreach interventions seem warranted. Both antidepressant medication and structured psychotherapy have been proven efficacious, but less than one third of people with depressive disorders receive effective levels of either treatment.
                To compare usual primary care for depression with 2 intervention programs: telephone care management and telephone care management plus telephone psychotherapy.
                Three-group randomized controlled trial with allocation concealment and blinded outcome assessment conducted between November 2000 and May 2002.
                A total of 600 patients beginning antidepressant treatment for depression were systematically sampled from 7 group-model primary care clinics; patients already receiving psychotherapy were excluded.
                Usual primary care; usual care plus a telephone care management program including at least 3 outreach calls, feedback to the treating physician, and care coordination; usual care plus care management integrated with a structured 8-session cognitive-behavioral psychotherapy program delivered by telephone.
                Blinded telephone interviews at 6 weeks, 3 months, and 6 months assessed depression severity (Hopkins Symptom Checklist Depression Scale and the Patient Health Questionnaire), patient-rated improvement, and satisfaction with treatment. Computerized administrative data examined use of antidepressant medication and outpatient visits.
                Treatment participation rates were 97% for telephone care management and 93% for telephone care management plus psychotherapy. Compared with usual care, the telephone psychotherapy intervention led to lower mean Hopkins Symptom Checklist Depression Scale depression scores (P =.02), a higher proportion of patients reporting that depression was "much improved" (80% vs 55%, P<.001), and a higher proportion of patients "very satisfied" with depression treatment (59% vs 29%, P<.001). The telephone care management program had smaller effects on patient-rated improvement (66% vs 55%, P =.04) and satisfaction (47% vs 29%, P =.001); effects on mean depression scores were not statistically significant.
                For primary care patients beginning antidepressant treatment, a telephone program integrating care management and structured cognitive-behavioral psychotherapy can significantly improve satisfaction and clinical outcomes. These findings suggest a new public health model of psychotherapy for depression including active outreach and vigorous efforts to improve access to and motivation for treatment. This study examined the effects of telephone call interventions by a collaborative team on patients' well-being. Fifty-five subjects undergoing radiation therapy for cure and who were able to communicate by telephone comprised the sample. Subjects were randomly assigned to a control group, who received the usual care or to an experimental group, who received a weekly telephone call intervention in addition to the usual care. Speilberger's State Trait Inventory, the Side Effects Profile, and the Coping Strategies Profile were used along with a telephone survey to collect data. Analysis of the data showed no significant differences between groups in anxiety, severity of side effects, helpfulness of self-care strategies, and coping strategies. However, the survey indicated that the telephone calls were clinically significant and provided a mechanism for demonstrating that the health care professionals cared about their patients and provided an opportunity for patients to talk about their concerns. The investigators believe that collaboration, caring, and communication are the essence of exemplary health care. Introduction. Disease management modules (DMM), including education, tracking, support, and medical care, have improved health for patients with asthma and diabetes. For rural patients, novel ways of delivery are needed to access clinical expertise from urban or academic specialists. Telemedicine (telephone and televideo) could be instrumental in this process, though no randomized, controlled trials have assessed their effectiveness.Methods. Self-report and structured psychiatric interviews were used to screen potential depressed subjects. Subjects were randomized to: 1) usual care with a DMM using telephone and self-report questionnaires; or 2) a DMM using telephone, questionnaires, and monthly televideo psychiatric consultation emphasizing primary care physician (PCP) skill development. Subjects' depressive symptoms, health status, and satisfaction with care were tabulated at three, six, and 12 months after study entry.Results. There was significant clinical improvement for depression in both groups, with a trend toward significance in the more intensive module. Satisfaction and retention was superior in the more intensive group. There was no overall change in health functioning in either group.Conclusions. Intensive modules using telepsychiatric educational interventions toward PCPs may be superior, but the most critical ingredient may be administrative tracking of patients, prompted intervention by PCPs, and (when necessary) new ideas by a specialist. To determine if a telephone support behavioral intervention improves depressive symptoms among HIV positive outpatients, we enrolled 177 persons with Beck Depression Inventory (BDI) scores scores of >/=10. Participants were randomized to receive up to 12 scheduled psycho-educational calls over 6 months or to an assessment-only control condition. Co-enrolled informal caregivers of HIV patients received the same telephone intervention in parallel. Among the 160 (90.4%) participants who were re-interviewed at 6 months, 56% were male, and 41% were Caucasian, with a mean baseline BDI score of 22.7. Overall, participants' mean BDI scores improved 5.3 points from baseline, but intervention group differences on depression outcomes including 50% or greater reduction in BDI scores and depression remission were not statistically significant. In the full cohort, men were significantly more likely to improve than women. We conclude that a psycho-educational telephone support intervention did not reduce depressive symptoms for HIV patients more than an assessment-only control condition. To test the value of telephone-administered cognitive-behavioral therapy in a study of patients with breast cancer.
                Women were assigned randomly to a therapy group or an assessment-only control group.
                A tertiary cancer treatment center serving rural areas of North Dakota and Minnesota.
                Women were recruited within three to four months of stage I (n = 27) or stage II (n = 26) breast cancer diagnosis. Age ranged from 30-82 (mean = 51.5 years). Most participants (n = 35) underwent a modified radical mastectomy; 17 underwent a lumpectomy.
                Therapy involved 10 30-minute (or less) telephone sessions. Data that were collected from mailed questionnaires included psychological distress (Profile of Mood States), perceived stress, coping (Coping Response Indices-Revised), quality of life (Medical Outcome Scale), and satisfaction with therapy. Measures were completed at baseline and at 4- and 10-month follow-up intervals.
                Telephone therapy, stress, coping, and quality of life.
                With time, women in the therapy and control groups reported reduced stress and improved quality of life. However, significant reductions in some kinds of distress (anxiety, anger, depression, and confusion) were not observed. Most therapy participants liked the telephone treatment sessions but showed only modest improvement (less anxiety and confusion) compared with women in the control group.
                Most patients reported being comfortable with the telephone therapy and said that they felt better as a result of it. However, the outcome data showed that telephone therapy--as carried out in this study--produced only modest benefits. Researchers need to consider who is best for delivering such therapy.
                Providing telephone therapy to patients with breast cancer has potential benefits, and nurses may be the appropriate professionals to administer the therapy.
Telephone voice interventions may have a role in improving medication adherence, reducing risky sexual behaviour, and reducing depressive and psychiatric symptoms, but current evidence is sparse, and further research is needed.