Telehealth screen for depression in a chronic illness care management program

Area of Science:

• Gerontology
• Health Services Research
• Psychiatry

Background:

• Chronic illnesses represent a significant healthcare cost in the US.
• Existing telemedicine programs often overlook comorbidity, particularly in older adults with multiple conditions.
• Major depression is a common and serious comorbidity that worsens outcomes and increases costs.

Purpose of the Study:

• To evaluate the integration of depression screening into an established telehealth program for heart failure patients.
• To assess the feasibility and patient engagement with a telephone-based interactive voice recording (IVR) system for depression screening.
• To establish an emergency protocol for managing patients identified with potential depression, including suicidality.

Main Methods:

• Patients in a heart failure telehealth program underwent quarterly depression screening using the Patient Health Questionnaire (PHQ-2 and PHQ-9) via an IVR system.
• An emergency protocol was established for patients scoring above a threshold of 10 on the PHQ-9.
• Nurse care-managers intervened with patients identified as potentially depressed.

Main Results:

• Over 90% of patients completed the depression screens in both assessment rounds.
• Approximately 30% of patients screened positive on the PHQ-2 in both rounds.
• An emergency protocol successfully managed a case of expressed suicidality, demonstrating the system's safety and effectiveness.

Conclusions:

• A telephonic IVR depression screen can be effectively integrated into standard chronic illness management protocols.
• This technology-assisted approach provides a model for managing comorbid depression alongside chronic diseases.
• The established emergency protocol ensured patient safety during the screening process.