Effect of Telephone-Administered vs Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes Among Primary Care Patients

Abstract

EPRESSION IS COMMON, WITHthe 1-year prevalence rate of major depressive disorder estimated at between 6.6% and 10.3% in the general population 1,2 and roughly 25% of all primary care visits involving patients with clinically significant levels of depression. 3 Psychotherapy is effective at treating depression, 4 and most primary care patients prefer psychotherapy to antidepressant medication. 5 When referred for psychotherapy, however, only a small percentage of patients follow through. 6 Attrition from psychotherapy in randomized controlled trials is often 30% or greater 7 and can exceed 50% in clinical practice. 8 The discrepancy between patients' preference for psychotherapy and the low rates of initiation and adherence is likely due to access barriers. Approximately 75% of depressed primary care patients report barriers that make it extremely difficult or impossible to attend regular psychotherapy sessions. 9,10 These barriers are largely structural and include time constraints, lack of available and accessible services, transportation problems, and cost.

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

“…A skilled therapist will be able to deal with such comorbidity and formulate more long-lasting beliefs that, according to cognitive theory, underpin the longer-term risk of depression. Other modes of delivering CBT over the internet 109 or by telephone 118 could retain such a flexible approach, but may also afford an opportunity for greater efficiency in the provision of such treatment.…”

Community Pharmacist-Led New Medicine Service for Patients With a Long Term Medical Condition: A Cross-Sectional Study

“…There is some evidence to suggest that telephonic consultations can achieve better compliance to treatment as compared to face-to-face consultations [24]. Telephonic consultations can be a preferable method of contact both for patients who do not live close to the pharmacy and for pharmacists as it can allow them to conduct consultations at less busy times [25].…”

CBT in Affective Disorders – New Frontiers

“…This study highlights that there is a specific effect of telephone-administered CBT that goes beyond the nonspecific effects of a supportive telephone-based intervention. In a more recent study it has been examined how tCBT performs as compared to face-to-face CBT with respect to attrition and symptom reduction [86]. Thereby, it has been shown that while both treatments were associated with a significant symptom reduction posttreatment, with CBT not being noteworthy superior to tCBT, more patients completed tCBT as compared to traditional CBT.…”