Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care

Background: Primary care treatment of depression needs improvement. Objective: To evaluate the efficacy of 2 augmentations to antidepressant drug treatment. Design: Randomized trial comparing usual care, telehealth care, and telehealth care plus peer support; assessments were conducted at baseline, 6 weeks, and 6 months. Setting: Two managed care adult primary care clinics. Participants: A total of 302 patients starting antidepressant drug therapy. Interventions: For telehealth care: emotional support and focused behavioral interventions in ten 6-minute calls during 4 months by primary care nurses; and for peer support: telephone and in-person supportive contacts by trained health plan members recovered from depression. Main Outcome Measures: For depression: the Hamilton Depression Rating Scale and the Beck Depression Inventory; and for mental and physical functioning: the SF-12 Mental and Physical Composite Scales and treatment satisfaction. Results: Nurse-based telehealth patients with or without peer support more often experienced 50% improvement on the Hamilton Depression Rating Scale at 6 weeks (50% vs 37%; P=.01) and 6 months (57% vs 38%; P=.003) and on the Beck Depression Inventory at 6 months (48% vs 37%; P=.05) and greater quantitative reduction in symptom scores on the Hamilton scale at 6 months (10.38 vs 8.12; P=.006). Telehealth care improved mental functioning at 6 weeks (47.07 vs 42.64; P=.004) and treatment satisfaction at 6 weeks (4.41 vs 4.17; P=.004) and 6 months (4.20 vs 3.94; P=.001). Adding peer support to telehealth care did not improve the primary outcomes. Conclusion: Nurse telehealth care improves clinical outcomes of antidepressant drug treatment and patient satisfaction and fits well within busy primary care settings.