gms | German Medical Science

Background and status of international research: Between 2009 and 2011, a pragmatic RCT with the aim to evaluate the effects of a telemedical intervention on the psychopathological outcomes of depressive symptoms, anxiety and somatization was performed. This telemedical intervention involved bi-weekly phone contacts and sms-messages, in addition to routine care for patients that were moving from inpatient to outpatient care. The results showed a significant positive improvement in symptomology after 6 months of treatment and positive responses on patient acceptance measures. Hence, the telemedicine programme was transferred to regular care services. Now, it was evaluated how this evidence-based intervention performs in routine clinical practice.

Question and objective: Can the effects of a telemedical health intervention RCT be reproduced when transferred from a controlled setting into real world healthcare?

Method: Patient data from telemedicine users was analysed for those enrolled since 2011. Quarterly, trained nurses administered the BSI-18 questionnaire to users of the service to assess symptom severity.

Descriptive and statistical analysis was performed on the regular care service data for a 2-year treatment period. Subgroups for different BSI-18 scores with respect to clinical relevance and symptom severity were created based on a normative German sample (BSI-18-score >12.1 . In addition to this, a comparison with historical data from the control and intervention groups of the RCT for a 6-month treatment duration was performed.

Results: The regular care service data included N=261 patients (52 lost to follow up). They showed an overall significant improvement from start to the last BSI-18 measuring point (MDN= -3, SD= 10.35; Wilcoxson signed rank test S(209)= - 4307.5, p<0.001; also significant for all subscales). Compared to the historical RCT data, this improvement was found overall and for the subscales of anxiety and depression, but not for somatoform disorders.

The ANOVA showed a statistically significant difference between clinical relevance groups F(1, 211) = 26.33, p<.0001. Post-hoc analyses revealed that the group with a clinically relevant score had a significantly better improvement than the other group (clinically relevant M=-5.48, clinically non-relevant M=0.88). This improvement for the clinically relevant groups was also found in the comparison with the RCT data: Welch’s ANOVA F(1,292)=2.52, P<0.05, however no significant interaction of treatment group and clinical severity was found.

Discussion: The results of the RCT intervention could be reproduced in a regular healthcare setting. It can be concluded that telemedicine is effective as a support tool after inpatient treatment, especially for users that are more severely ill. Some users had telemedicine in addition to outpatient treatment, which might have an influence on their results.

Reflection: Collecting health outcomes during normal treatment allows for a retrospective detailed analysis of ‘what works for whom under which circumstances’. Telemedicine is a great tool for patients with anxiety and depression, as it is a low effort way of adapting health services to the individual need of the user.