Transfer of a telemedicine intervention for mental disorders: a comparison between RCT results and regional routine care

Abstract

Introduction

Telemedicine for the treatment of depression and anxiety disorders was found to be successful in a randomised controlled trial (RCT); this intervention was then implemented in routine care in the Western Pomerania region in Germany. This made it possible to investigate the effectiveness of the intervention under routine care conditions and compare it with the results of the RCT.

Methods

For this retrospective controlled analysis, data from routine care (2011–2022) were analysed together with data from the previous RCT (2009–2010). A three-arm comparison (routine care, previous RCT intervention group, previous RCT control group) on the primary outcome of symptom severity (BSI-18) and a longitudinal analysis of the routine care data were conducted. The telemedical intervention was conducted in the university hospital’s psychiatric outpatient clinic in north-eastern Germany. All adult patients with an ICD-10 diagnosis of depression, anxiety or somatoform disorders could participate after discharge from the hospital. The telemedicine sessions included structured verbal questionnaires and conversational therapy concerning treatment goals and tasks. Repeated measures Welch ANOVA with the BSI-18 Global Severity Index and subscales (depression, anxiety and somatisation) was performed. A multivariate regression was conducted on the longitudinal regular care data.

Results

The n=254 subjects in the telemedical care in routine care arm (181 women, mean [95%CI] age 45.5 [44.0–47.1] years; 6-month follow-up) showed a BSI-18 score improvement M=− 4.1 [−5.3,−2.9], F(2)=3.50, p<0.05 compared to the preceding RCT intervention arms (61 women, mean [95%CI] age 44.7 [41.7–47.6] years. Telemedical care showed a significant difference in BSI-18 scores over a 10-year follow-up: M=− 3.9 [−5.4,−2.5], p<0.0001.

Conclusion

The positive results of the 2009 RCT were replicable in routine care. The more patient-centred approach resulted in improved outcomes in this telemedical intervention.

Keywords

Telemedicine - Routine care - Depression - Anxiety - Somatoform disorders

Publication History

Received: 31 July 2024

Accepted after revision: 13 December 2024

Article published online:
10 April 2025

• References

• 1 Guaiana G, Mastrangelo J, Hendrikx S. et al. A Systematic Review of the Use of Telepsychiatry in Depression. Community Mental Health Journal 2021; 57: 93-100
• 2 Lawes-Wickwar S, McBain H, Mulligan K. Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review. JMIR Ment Health 2018; 5: e62
• 3 van den Berg N, Schumann M, Kraft K. et al. Telemedicine and telecare for older patients – a systematic review. Maturitas 2012; 73: 94-114
• 4 Colle R, Ait Tayeb AEK, Larminat Dde. et al. Telepsychiatry in the Post-COVID-19 Era: Moving Backwards or Forwards. Psychother Psychosom 2021; 90: 69-70
• 5 Lutz W, Edelbluth S, Deisenhofer A-K. et al. The Impact of Switching from Face-to-Face to Remote Psychological Therapy during the COVID-19 Pandemic. Psychother Psychosom 2021; 90: 285-286
• 6 German federal ministry for health. Telemedizin [Telemedicine]. Im Internet: https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/t/telemedizin.html; Stand: 17.02.2023
• 7 Weinzimmer LG, Dalstrom MD, Klein CJ. et al. The relationship between access to mental health counseling and interest in rural telehealth. Journal of Rural Mental Health 2021; 45: 219-228
• 8 van den Berg N, Stentzel U, Hoffmann W. et al. Entlassmanagement in der Psychiatrie unter Einsatz telemedizinischer Leistungen [Discharge management in psychiatry using telemedical services]. 2016
• 9 Federal Chamber of Psychotherapists in Germany. Ein Jahr nach der Reform der Psychotherapie-Richtlinie [One year after the reform of the psychotherapy guidelines]. Wartezeiten 2018 [Waiting times 2018]; 2018
• 10 Patel S, Akhtar A, Malins S. et al. The acceptability and usability of digital health interventions for adults with depression, anxiety, and somatoform disorders: qualitative systematic review and meta-synthesis. Journal of medical Internet research 2020; 22: e16228
• 11 van den Berg N, Grabe H-J, Baumeister SE. et al. A telephone- and text message-based telemedicine concept for patients with mental health disorders: results of a randomized controlled trial. Psychother Psychosom 2015; 84: 82-89
• 12 van den Berg N, Grabe H-J, Freyberger HJ. et al. A telephone- and text-message based telemedical care concept for patients with mental health disorders -study protocol for a randomized, controlled study design. BMC Psychiatry 2011; 11: 30
• 13 Anglemyer A, Horvath HT, Bero L. Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials. Cochrane Database Syst Rev 2014; MR000034
• 14 Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. Trials 2010; 11: 32
• 15 World Health Organisation: International statistical classification of diseases and related health problems, 10^th revision. 2^nd ed Geneva, World Health Organisation. 2004
• 16 Franke GH, Ankerhold A, Haase M. et al. Der Einsatz des Brief Symptom Inventory 18 (BSI-18) bei Psychotherapiepatienten [The usefulness of the Brief Symptom Inventory 18 (BSI-18) in psychotherapeutic patients]. Psychother Psych Med 2011; 61: 82-86
• 17 Franke GH, Jaeger S, Glaesmer H. et al. Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample. BMC Med Res Methodol 2017; 17: 14
• 18 Spitzer C, Hammer S, Löwe B. et al. Die Kurzform des Brief Symptom Inventory (BSI -18): erste Befunde zu den psychometrischen Kennwerten der deutschen Version [The usefulness of the Brief Symptom Inventory 18 (BSI-18) in psychotherapeutic patients]. Fortschritte der Neurologie·Psychiatrie 2011; 79: 517-523
• 19 Meyer J, Fredrich D, Piegsa J. et al. A mobile and asynchronous electronic data capture system for epidemiologic studies. Computer methods and programs in biomedicine 2013; 110: 369-379
• 20 Bialke M, Penndorf P, Wegner T. et al. A workflow-driven approach to integrate generic software modules in a Trusted Third Party. Journal of Translational Medicine 2015; 13: 176
• 21 Tomarken AJ, Serlin RC. Comparison of ANOVA alternatives under variance heterogeneity and specific noncentrality structures. Psychological Bulletin 1986; 99: 90-99
• 22 Stewart M, Brown JB, Donner A. et al. The impact of patient-centered care on outcomes. The Journal of family practice 2000; 49: 796-804
• 23 Holloway F. Outcome measurement in mental health – welcome to the revolution. Br J Psychiatry 2002; 181: 1-2
• 24 Stryer D, Tunis S, Hubbard H. et al. The outcomes of outcomes and effectiveness research: impacts and lessons from the first decade. Health Serv Res 2000; 35: 977-993