Please select the eligibility criteria that correspond to the clinical trial below.
Title: Telemedicine-Based Collaborative Care to Reduce Rural Disparities
Brief Summary: Across the country, Community Health Centers are participating in the Health Disparities Collaboratives sponsored by the Health Services Resources and Services Administration (HRSA). The Health Disparities Collaboratives integrate three complementary conceptual frameworks: 1) the Institute for Healthcare Improvement's (IHI) Breakthrough Series Model; 2) the Improvement Model (i.e., Plan-Do-Study-Act cycles); and 3) Wagner's Chronic Care Model. The Chronic Care model uses patient self-management, delivery system re-design, decision support, and clinical information systems to maximize the effectiveness of interactions between prepared proactive care teams and informed activated patients with chronic illnesses such as diabetes, asthma, and depression. The Chronic Care model for depression, also known as Collaborative Care, involves primary care providers working with a depression care team comprising non-physicians (e.g., nurses, pharmacists) and mental health specialists (e.g., psychiatrists). Practice-based collaborative care involves primary care providers working with an on-site depression care team. In contrast, telemedicine-based collaborative care involves primary care providers working with an off-site depression care team using telemedicine technologies. The purpose of this research project is to compare the effectiveness and cost effectiveness of practice-based and telemedicine-based collaborative care in Community Health Centers (without on-site mental health specialists) implementing the Health Disparities Collaborative for depression.


Options:
A: Inclusion Criteria:

* VA patients followed by the Durham VA Primary Care, Women's Health, and Geriatric clinics
* Must have had more than one visit to the VA in preceding 12 months
* Age 60 and over
* Impaired glucose intolerance documented by recent fasting blood glucose between 100 and 125 mg/dL
* Body mass index between 25-40 kg/m2
* Able to walk 10 meters without human assistance (assistive device acceptable)
* All participants must be assigned a primary care provider and have had more than one visit to the VA in the preceding 12 months

Exclusion Criteria:

* Free of frank diabetes
* Fasting blood sugar above 125 mg/dL
* HbA1c \> 7%
* Unstable angina
* Recent history of ventricular tachycardia
* Unstable chronic obstructive pulmonary disease (two hospitalizations within the previous 12 months and/or on oxygen)
* Uncontrolled hypertension (diastolic blood pressure \>110 mm/Hg or systolic \> 200mm/Hg)
* Stroke with moderate to severe aphasia
* Diagnosis of chronic pain which may interfere with their ability to be physically active
* Diagnosis of unstable mental or behavioral disorder
* Diagnosis of memory loss or dementia
* Visual or hearing loss severe enough to interfere with ability to receive telephone counseling and review written materials
* Active substance abuse
* A terminal diagnosis
* Followed by VA for medications only
* Regularly, vigorously physically active for six months or longer.
B: Inclusion Criteria are:

1. Male or female subjects, age \> 18 years.
2. Prior enrollment into the STRokE DOC ("STRokE DOC Trial (NCT00283868)") clinical research trial.

Exclusion criteria are:

1. Male or female subjects, age \< 18 years.
2. Patients not previously enrolled into the STRokE DOC ("STRokE DOC Trial (NCT00283868)") clinical research trial.
C: Inclusion Criteria:

* Clinically Significant Depression

Exclusion Criteria:

* Sub-threshold Depression,
* Non-english speaking,
* Patients not having telephone access,
* Bereaved,
* Suicidal,
* Currently being treated by a mental health specialist,
* Bipolar disorder,
* Psychotic disorders,
* Drug or alcohol dependence,
* Cognitively impaired,
* Terminal illness,
* Having a court appointed guardian, or
* Pregnant (if applicable)
D: Inclusion Criteria:

* Patients presenting to Rural Emergency Department within 12 hours of acute stroke symptom onset.
* Written informed consent.

Exclusion Criteria:

* Unlikely to complete study through 90-day follow-up.

Answer: C