James A Bourgeois
Objective: The aims were to evaluate older HIV+ participant initial amenability towards telemedicine, change in amenability post-session, and clinician impressions of conducting the interview (including the Hamilton Depression Rating Scale (Ham-D)) via telemedicine. This paper focuses specifically on telemedicine as videoconferencing.
Methods: This 2-phase study evaluated telemedicine in an urban setting to people living with HIV (PLWH) aged 50+ with mild-moderate depression based on the Patient Health Questionnaire (PHQ-9). Initial perception on telemedicine was collected during Phase I. Amenable participants who completed Phase I engaged in an actual home-based telemedicine (HBT) session during Phase II, after which their perception was measured again.
Results: 41 subjects completed Phase I; 25 completed Phase II. Among Phase II completers, analysis using paired t-tests and chi-squared tests demonstrated a significantly improved outlook towards telemedicine after the session, including comfort with perceived privacy (p=0.001), overall satisfaction (p<0.001), and preference for telemedicine over in-person consultation (p<0.001). Those who were not amenable to scheduling a telemedicine session were more likely to be unsure about the privacy of such sessions (44% vs. 8%, p=0.011). Clinician questionnaires further supported the utility of telemedicine for clinical assessment.
Conclusion: Telemedicine with use of standardized assessments is a clinically viable means to evaluate depression in HIV-positives aged ≥50 with mild-moderate depression. Systems of care in HIV psychiatry may consider use of home-based telemedicine when expanding clinical services for this growing population, particularly those with barriers to participate in usual in-person clinical care
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