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Martiniuk A, Toepfer A, Lane-Brown A. A review of risks, adverse effects and mitigation strategies when delivering mental health services using telehealth. J Ment Health 2024; 33:415-438. [PMID: 36866784 DOI: 10.1080/09638237.2023.2182422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/31/2022] [Accepted: 01/07/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This paper presents a scoping review of the peer-reviewed literature regarding reported risks, adverse effects and mitigation factors related to providing mental health services using telehealth. AIMS The paper aims to describe risks and risk management strategies. METHODS Publications were included if they reported upon risks, adverse events or mitigation factors experienced, hypothesised or discussed for: any population (any country, any age), service (any mental health services), intervention (telehealth), English language, 2010 to 10 July 2021, any publication type (commentary, research, policy), excluding protocol papers, and self-help tools. The following databases were searched: PsycINFO (from 2010 to 10 July 2021), MEDLINE (2010 to 10 July 2021) and the Cochrane Database from 2010 to 10 July 2021. RESULTS The search strategy resulted in 1,497 papers and after exclusions a final 55 articles were selected. Results of this scoping review are presented in terms of types of risk, risk by client population, risk by modality (eg group therapy using telehealth) and risk management. CONCLUSIONS Recommendations for future research include gathering and publishing more detailed information regarding near-miss and actual adverse events when delivering mental health assessment and care using telehealth. In clinical practice, training is required for potential adverse events, and to prevent them and reporting mechanisms in place to collate and learn from these.
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Affiliation(s)
| | - Amy Toepfer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amanda Lane-Brown
- Work: Clinical Psychologist, KidsRehab, Children's Hospital Westmead, South Turramurra, NSW, Australia
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LePage JP, Walters ST, Cipher DJ, Crawford AM. Development and evaluation of an online vocational program for veterans with legal convictions and psychiatric illness. EVALUATION AND PROGRAM PLANNING 2023; 97:102254. [PMID: 36806008 DOI: 10.1016/j.evalprogplan.2023.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE We describe the development and pilot evaluation of an online vocational rehabilitation program, the About Face Online System (AFOS), for veterans with a history of felony convictions and either mental illness and/or substance use disorders. METHOD Phase One was the development and acceptability testing of the online system. Phase Two was a small, randomized trial comparing the likelihood of obtaining employment among people using the AFOS, compared to people receiving a self-directed hardcopy manual, after 6 months. RESULTS In Phase One, 17 veterans provided feedback as the system was being developed. The final system allows veterans to receive education on vocational reintegration skills, watch short videos describing the techniques, and communicate with a vocational staff member via chat features. Veterans found the AFOS to be as acceptable as a hardcopy manual that covered similar material. In Phase Two, 38 veterans with a history of felony convictions and either mental illness or substance use disorder were randomized to receive the AFOS or a hardcopy manual. After 6 months, people randomized to the AFOS were more likely to obtain employment than people randomized to the hardcopy manual. CONCLUSION An online vocational program may help veterans who cannot attend traditional in-person vocational services to successfully obtain employment.
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Affiliation(s)
- James P LePage
- VA North Texas Health Care System and Department of Psychiatry, The University of Texas Southwestern Medical Center, United States of America
| | - Scott T Walters
- School of Public Health, University of North Texas Health Science Center, United States of America.
| | - Daisha J Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, United States of America
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3
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Lopez AM, Lam K, Thota R. Barriers and Facilitators to Telemedicine: Can You Hear Me Now? Am Soc Clin Oncol Educ Book 2021; 41:25-36. [PMID: 34010056 DOI: 10.1200/edbk_320827] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In its most direct interpretation, telemedicine is medical care provided at a distance. Although telemedicine's use had been steadily increasing, the COVID-19 pandemic prompted an unprecedented interest and urgency among patients, health care professionals, and policymakers to facilitate health care devoid of the need for in-person contact. The growth in personal access to telecommunications technology meant an unprecedented number of people in the United States and around the world had access to the equipment and technology that would make virtual care possible from the home. As the mass implementation of telemedicine unfolded, it became quickly apparent that scaling up the use of telemedicine presented considerable new challenges, some of which worsened disparities. This article describes those challenges by examining the history of telemedicine, its role in both supporting access and creating new barriers to access in trying to get everyone connected, frameworks for thinking about those barriers, and facilitators that may help overcome them, with a particular focus on older adults and patients with cancer in rural communities.
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Affiliation(s)
- Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Kenneth Lam
- University of California, San Francisco, San Francisco, CA
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4
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Muir SD, de Boer K, Nedeljkovic M, Meyer D. Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review. BMC Health Serv Res 2020; 20:999. [PMID: 33131495 PMCID: PMC7603749 DOI: 10.1186/s12913-020-05858-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations. METHODS A systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems. RESULTS The initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians). CONCLUSIONS This review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.
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Affiliation(s)
- Samuel D Muir
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.
| | - Kathleen de Boer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Maja Nedeljkovic
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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5
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Smoktunowicz E, Barak A, Andersson G, Banos RM, Berger T, Botella C, Dear BF, Donker T, Ebert DD, Hadjistavropoulos H, Hodgins DC, Kaldo V, Mohr DC, Nordgreen T, Powers MB, Riper H, Ritterband LM, Rozental A, Schueller SM, Titov N, Weise C, Carlbring P. Consensus statement on the problem of terminology in psychological interventions using the internet or digital components. Internet Interv 2020; 21:100331. [PMID: 32577404 PMCID: PMC7305336 DOI: 10.1016/j.invent.2020.100331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022] Open
Abstract
Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.
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Affiliation(s)
- Ewelina Smoktunowicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19, 31 03-815 Warsaw, Poland,Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden
| | - Azy Barak
- Department of Counseling and Human Development, University of Haifa, Israel
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rosa M. Banos
- Universidad de Valencia, Valencia, Spain,CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Cristina Botella
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain,Uiversitat Jaume I, Valencia, Spain
| | - Blake F. Dear
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Tara Donker
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - David D. Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Institute of Child Health, UCL, London, UK
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps–University of Marburg, Marburg, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden,Corresponding author at: Department of Psychology, SE-106 91 Stockholm, Sweden.
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To Approach or to Avoid? Motivation Differentially Mediates the Effect of Hardiness on Depressive Symptoms in Chinese Military Personnel. BIOMED RESEARCH INTERNATIONAL 2020; 2019:7589275. [PMID: 31263708 PMCID: PMC6556805 DOI: 10.1155/2019/7589275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/18/2019] [Indexed: 11/17/2022]
Abstract
Objective To investigate the mediation effect of approach/avoidance motivation between hardiness and depressive symptoms. Methods Cross-sectional design was utilized. Two independent samples of military servicemen (G1: military personnel in the Armed Forces; G2: Chinese army military cadets) (n1 = 98, n2 =140) were sampled and investigated. The assessment tools of hardiness scale (DRS), behavioral activation and inhibition scales (BAS/BIS), and Center for Epidemiological Survey-Depression Scale (CES-D)/Beck Depression Inventory (BDI) were used. General linear model was conducted to examine the predictive role of hardiness (DRS) and motivation (BAS/BIS) on depressive symptoms (CES-D or BDI). The mediating role of BAS/BIS between hardiness and depressive symptoms was examined. Results (1) Across army soldiers and military medical university cadets, hardiness (β=-0.394, P<0.001) and behavioral inhibition (β=0.297, P<0.001) significantly predicted depressive symptoms. (2) For soldiers only, behavioral inhibition mediated the significant association between hardiness and depressive symptoms (β=-0.043, SE=0.027, 95%CI=-0.130~-0.008). (3) For cadets only, behavioral activation-Drive significantly predicted depressive symptoms (β=-0.237, P=0.012), and hardiness operates through behavioral activation-Drive to influence depressive symptoms (β=-0.057, SE=0.036, 95%CI=-0.151~-0.078). Conclusion Individuals who are low in hardiness and behavioral activation-Drive and who are high in behavioral inhibition showed more severe depressive symptoms. The relationship between hardiness and depressive symptoms was mediated by behavioral activation-Drive in cadets and behavioral inhibition in soldiers. The proposed model offers a useful approach for the development of hardiness training programs to alter approach/avoidance motivation in the military context. Future training program of hardiness could lay more emphasis on promotion of perseverance in pursuing goals in hardy individuals, which may in turn improve active coping.
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Caver KA, Shearer EM, Burks DJ, Perry K, De Paul NF, McGinn MM, Felker BL. Telemental health training in the Veterans Administration Puget Sound Health Care System. J Clin Psychol 2019; 76:1108-1124. [PMID: 31115049 DOI: 10.1002/jclp.22797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/13/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
As a pioneer of training in the field of psychology, the Veterans Affairs (VA) HealthCare System serves as a leader in the training in and provision of Telemental Health (TMH) services in the United States. To meet goals toward continued expansion of these services, the VA TMH training program includes both web-based didactic courses and a skills competency test at a basic level with supervision and consultation in TMH for more advanced training and is available to staff psychologists and psychologist trainees. Despite these efforts, barriers for training in and implementation of TMH occur at the provider, system, and patient level. At the national level, the VA is actively working to resolve these barriers and we share site-specific examples implemented by the VA Puget Sound Health Care System promoting access through TMH team to further address barriers to training and implementation.
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Affiliation(s)
- Kelly A Caver
- VA Puget Sound Health Care System, Seattle, Washington
| | | | - Derek J Burks
- VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Kristen Perry
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | | | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Bradford L Felker
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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Bingham KS, Kumar S, Dawson DR, Mulsant BH, Flint AJ. A Systematic Review of the Measurement of Function in Late-Life Depression. Am J Geriatr Psychiatry 2018; 26:54-72. [PMID: 29050912 DOI: 10.1016/j.jagp.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/17/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
Recovery of everyday premorbid function is a primary goal in the treatment of depression. Measurement of function is an important part of achieving this goal. A multitude of scales have been used to measure function in depression, reflecting the complex, multifaceted nature of functioning. Currently, however, there are no evidence-based guidelines to assist the researcher or clinician in deciding which instruments are best suited to measure function in late-life depression (LLD). Thus, the aims of this study are to 1) systematically review and identify the instrumental activities of daily living and social functioning assessment instruments used in the LLD literature; 2) identify and appraise the measurement properties of these instruments; and 3) suggest factors for LLD researchers and clinicians to consider when selecting functional assessment instruments and make pertinent recommendations. We performed a systematic review of MEDLINE and CINAHL to identify studies that i) incorporated subjects aged 60 years and older with a depressive disorder, and ii) measured instrumental activities of daily living and/or social functioning. Our search yielded 21 functional assessment instruments. Only two of these instruments, the 36-Item Short Form Survey and the Performance Assessment of Self-Care Skills, have formal validation data in LLD. Four additional instruments, although not formally validated, have relevant data regarding their measurement properties. The primary finding of this study is that very few functional assessment instruments have been validated in LLD, and the available measurement property data are mixed; there is a need for further instrument validation in late-life depression. With this caveat in mind, we provide evidence-based suggestions for researchers and clinicians assessing functioning in LLD patients.
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Affiliation(s)
- Kathleen S Bingham
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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Egede LE, Walker RJ, Payne EH, Knapp RG, Acierno R, Frueh BC. Effect of psychotherapy for depression via home telehealth on glycemic control in adults with type 2 diabetes: Subgroup analysis of a randomized clinical trial. J Telemed Telecare 2017; 24:596-602. [PMID: 28945160 DOI: 10.1177/1357633x17730419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective We evaluated the impact of telemedicine-delivered behaviour activation treatment (BAT) on glycemic control in a subgroup of older adults with diabetes who participated in a randomized controlled trial for depression. Research design and methods We randomized older adults with major depression to same-room or telemedicine BAT. Each group received eight weekly sessions. For the subgroup analysis, we identified individuals with type 2 diabetes and obtained hemoglobin A1c at baseline and 12 months' follow-up. We used mixed-effects models (MEM) for repeated measures analysis to compare the longitudinal mean A1c. We estimated model-derived mean A1c values and considered an adjusted model to account for baseline health status. Results We included 90 individuals with type 2 diabetes of the original 241 in the subgroup analysis (43 in telemedicine and 47 in same room). Treatment groups were not significantly different at baseline for demographics, depression, anxiety or A1c levels (telemedicine 6.9 vs. same room 7.3, p = 0.19). Baseline mean A1c for the telemedicine group remained at 6.9 (55 mmol/mol) at 12 months, whereas baseline mean A1c for the same-room group increased to 7.7 (61 mmol/mol). Longitudinal trajectories of model-derived mean A1c indicated a significant main effect of treatment group on mean A1c value at study end (difference = -0.82, 95% CI -1.41, -0.24). Adjusted analyses gave comparable results. Conclusions Telemedicine-delivered BAT was superior to same room in achieving lower mean A1c values in participants with type 2 diabetes, suggesting BAT-delivered via telemedicine is a viable treatment option for adults with diabetes.
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Affiliation(s)
- Leonard E Egede
- 1 Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, USA.,2 Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, USA
| | - Rebekah J Walker
- 1 Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, USA.,2 Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, USA
| | | | - Rebecca G Knapp
- 4 Department of Public Health Sciences, Medical University of South Carolina, USA.,5 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, USA
| | - Ronald Acierno
- 6 College of Nursing, Medical University of South Carolina, USA
| | - B Christopher Frueh
- 7 Department of Psychology, University of Hawaii, USA.,8 Department of Psychology, The Menninger Clinic, USA
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Mavandadi S, Wray LO, DiFilippo S, Streim J, Oslin D. Evaluation of a Telephone-Delivered, Community-Based Collaborative Care Management Program for Caregivers of Older Adults with Dementia. Am J Geriatr Psychiatry 2017; 25:1019-1028. [PMID: 28433550 DOI: 10.1016/j.jagp.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate whether a community-based, telephone-delivered, brief patient/caregiver-centered collaborative dementia care management intervention is associated with improved caregiver and care recipient (CR) outcomes. DESIGN Longitudinal program evaluation of a clinical intervention; assessments at baseline and 3- and 6-month follow-up. SETTING General community. PARTICIPANTS Caregivers (N = 440) of older, community-dwelling, low-income CRs prescribed a psychotropic medication by a primary care provider who met criteria for dementia and were enrolled in the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program for older adults. INTERVENTION Dementia care management versus clinical evaluation only. MEASUREMENTS Perceived caregiving burden and caregiver general health (primary outcomes); CR neuropsychiatric symptoms and caregiver distress in response to CRs' challenging dementia-related behaviors (secondary outcomes). RESULTS Caregivers were, on average, 64.0 (SD: 11.8) years old and 62.6% provided care for the CR for 20 or more hours per week. The majority of the sample was female (73.2%), non-Hispanic White (90.2%), and spousal caregivers (72.5%). Adjusted longitudinal models of baseline and 3- and 6-month data suggest that compared with caregivers receiving clinical evaluation only, caregivers receiving care management reported greater reductions in burden over time. Subgroup analyses also showed statistically significant reductions in caregiver-reported frequency of CR dementia-related behaviors and caregiver distress in response to those symptoms at 3-month follow-up. CONCLUSIONS A community-based, telephone-delivered care management program for caregivers of individuals with dementia is associated with favorable caregiver and CR-related outcomes. Findings support replication and further research in the impact of tailored, collaborative dementia care management programs that address barriers to access and engagement.
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Affiliation(s)
- Shahrzad Mavandadi
- VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Laura O Wray
- VA Center for Integrated Healthcare, Buffalo VA Medical Center, Buffalo, NY; School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
| | - Suzanne DiFilippo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel Streim
- VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Oslin
- VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz VA Medical Center, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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11
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Egede LE, Gebregziabher M, Walker RJ, Payne EH, Acierno R, Frueh BC. Trajectory of cost overtime after psychotherapy for depression in older Veterans via telemedicine. J Affect Disord 2017; 207:157-162. [PMID: 27721190 DOI: 10.1016/j.jad.2016.09.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/30/2016] [Accepted: 09/27/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Little evidence exists regarding the costs of telemedicine, especially considering changes over time. This analysis aimed to analyze trajectory of healthcare cost before, during, and after a behavioral activation intervention delivered via telepsychology and same-room delivery to elderly Veterans with depression. METHODS 241 participants were randomly assigned into one of two study groups: behavioral activation for depression via telemedicine or via same-room treatment. Patients received 8 weeks of weekly 60-min individual sessions of behavioral activation for depression. Primary outcomes were collected at 12-months. Inpatient, outpatient, pharmacy, and total costs were collected from VA Health Economics Resource Center (HERC) datasets for FY 1998-2014 and compared between the two treatment groups. Generalized mixed models were used to investigate the trajectories over time. RESULTS Overall cost, as well as, outpatient and pharmacy cost show increasing trend over time. Unadjusted and adjusted trajectories over time for any cost were not different between the two treatment groups. There was a significant overall increasing trend over time for outpatient (p<0.001) and total cost (p<0.001) but not for inpatient (p=0.543) or pharmacy cost (p=0.084). LIMITATIONS Generalizability to younger, healthier populations may be limited due to inclusion criteria for study participants. CONCLUSION Healthcare costs before, during, and after intervention did not differ between the telemedicine and in-person delivery methods. Outpatient costs accounted for most of the increasing trend of cost over time. These results support policies to use both telehealth and in-person treatment modalities to effectively and efficiently provide high quality care.
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Affiliation(s)
- Leonard E Egede
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States.
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Rebekah J Walker
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth H Payne
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Ron Acierno
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - B Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, United States; Department of Psychology, The Menninger Clinic, Houston, TX, United States
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Hoeft TJ, Hinton L, Liu J, Unützer J. Directions for Effectiveness Research to Improve Health Services for Late-Life Depression in the United States. Am J Geriatr Psychiatry 2016; 24:18-30. [PMID: 26525996 PMCID: PMC4706767 DOI: 10.1016/j.jagp.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 06/20/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022]
Abstract
Considerable progress has been made in the treatment of late-life depression over the past 20 years, yet considerable gaps in care remain. Gaps in care are particularly pronounced for older men, certain racial and ethnic minority groups, and those with comorbid medical or mental disorders. We reviewed the peer-reviewed literature and conducted interviews with experts in late-life depression to identify promising directions for effectiveness research to address these gaps in care. We searched the PubMed, PsychInfo, and CINHAL databases between January 1, 1998, through August 31, 2013, using terms related to late-life depression and any of the following: epidemiology, services organization, economics of care, underserved groups including health disparities, impact on caregivers, and interventions. The results of this selective review supplemented by more current recommendations from national experts highlight three priority research areas to improve health services for late-life depression: focusing on the unique needs of the patient through patient-centered care and culturally sensitive care, involving caregivers outside the traditional clinical care team, and involving alternate settings of care. We build on these results to offer five recommendations for future effectiveness research that hold considerable potential to advance intervention and health services development for late-life depression.
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Affiliation(s)
- Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jessica Liu
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Magidson JF, Lejuez CW, Kamal T, Blevins EJ, Murray LK, Bass JK, Bolton P, Pagoto S. Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq. Glob Ment Health (Camb) 2015; 2:e24. [PMID: 27478619 PMCID: PMC4962865 DOI: 10.1017/gmh.2015.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/12/2015] [Accepted: 10/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolton et al. 2014a) supported the efficacy of two CHW-delivered interventions, cognitive processing therapy (CPT) and brief behavioral activation treatment for depression (BATD), for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq. METHODS This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial (Bolton et al.2014a), informed by the Assessment-Decision-Administration-Production-Topical experts-Integration-Training-Testing (ADAPT-ITT) framework for intervention adaptation (Wingood & DiClemente, 2008). Cultural modifications, adaptations for low-literacy, and tailored training and supervision for non-specialist CHWs are presented, along with two clinical case examples to illustrate delivery of the adapted intervention in this setting. RESULTS Eleven CHWs, a study psychiatrist, and the CHW clinical supervisor were trained in BATD. The adaptation process followed the ADAPT-ITT framework and was iterative with significant input from the on-site supervisor and CHWs. Modifications were made to fit Kurdish culture, including culturally relevant analogies, use of stickers for behavior monitoring, cultural modifications to behavioral contracts, and including telephone-delivered sessions to enhance feasibility. CONCLUSIONS BATD was delivered by CHWs in a resource-poor, conflict-affected area in Kurdistan, Iraq, with some important modifications, including low-literacy adaptations, increased cultural relevancy of clinical materials, and tailored training and supervision for CHWs. Barriers to implementation, lessons learned, and recommendations for future efforts to adapt behavioral therapies for resource-limited, conflict-affected areas are discussed.
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Affiliation(s)
- J. F. Magidson
- Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School, Boston, MA, USA
| | - C. W. Lejuez
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, USA
| | - T. Kamal
- Fine Arts Institute, University of Sulaimani, Kurdistan Region, Iraq
| | - E. J. Blevins
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, USA
| | - L. K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J. K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P. Bolton
- Center for Refugee and Disaster Response and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S. Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Psychotherapy for depression in older veterans via telemedicine: a randomised, open-label, non-inferiority trial. Lancet Psychiatry 2015; 2:693-701. [PMID: 26249300 DOI: 10.1016/s2215-0366(15)00122-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/17/2015] [Accepted: 03/16/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many older adults with major depression, particularly veterans, do not have access to evidence-based psychotherapy. Telemedicine could increase access to best-practice care for older adults facing barriers of mobility, stigma, and geographical isolation. We aimed to establish non-inferiority of behavioural activation therapy for major depression delivered via telemedicine to same-room care in largely male, older adult veterans. METHODS In this randomised, controlled, open-label, non-inferiority trial, we recruited veterans (aged ≥58 years) meeting DSM-IV criteria for major depressive disorder from the Ralph H Johnson Veterans Affairs Medical Center and four associated community outpatient-based clinics in the USA. We excluded actively psychotic or demented people, those with both suicidal ideation and clear intent, and those with substance dependence. The study coordinator randomly assigned participants (1:1; block size 2-6; stratified by race; computer-generated randomisation sequence by RGK) to eight sessions of behavioural activation for depression either via telemedicine or in the same room. The primary outcome was treatment response according to the Geriatric Depression Scale (GDS) and Beck Depression Inventory (BDI; defined as a 50% reduction in symptoms from baseline at 12 months), and Structured Clinical Interview for DSM-IV, clinician version (defined as no longer being diagnosed with major depressive disorder at 12 months follow-up), in the per-protocol population (those who completed at least four treatment sessions and for whom all outcome measurements were done). Those assessing outcomes were masked. The non-inferiority margin was 15%. This trial is registered with ClinicalTrials.gov, number NCT00324701. FINDINGS Between April 1, 2007, and July 31, 2011, we screened 780 patients, and the study coordinator randomly assigned participants to either telemedicine (120 [50%]) or same-room treatment (121 [50%]). We included 100 (83%) patients in the per-protocol analysis in the telemedicine group and 104 (86%) in the same-room group. Treatment response according to GDS did not differ significantly between the telemedicine (22 [22·45%, 90% CI 15·52-29·38] patients) and same-room (21 [20·39%, 90% CI 13·86-26·92]) groups, with an absolute difference of 2·06% (90% CI -7·46 to 11·58). Response according to BDI also did not differ significantly (telemedicine 19 [24·05%, 90% CI 16·14-31·96] patients; same room 19 [23·17%, 90% CI 15·51-30·83]), with an absolute difference of 0·88% (90% CI -10·13 to 11·89). Response on the Structured Clinical Interview for DSM-IV, clinician version, also did not differ significantly (39 [43·33%, 90% CI 34·74-51·93] patients in the telemedicine group and 46 [48·42%, 90% CI 39·99-56·85] in the same-room group), with a difference of -5·09% (-17·13 to 6·95; p=0·487). Results from the intention-to-treat population were similar. MEM analyses showed that no significant differences existed between treatment trajectories over time for BDI and GDS. The criteria for non-inferiority were met. We did not note any adverse events. INTERPRETATION Telemedicine-delivered psychotherapy for older adults with major depression is not inferior to same-room treatment. This finding shows that evidence-based psychotherapy can be delivered, without modification, via home-based telemedicine, and that this method can be used to overcome barriers to care associated with distance from and difficulty with attendance at in-person sessions in older adults. FUNDING US Department of Veterans Affairs.
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Williams K, Kern S, Thorp SR, Paulus M, Shah N, Morland L, Hauser P. VISN 22 Evidenced-Based Psychotherapy Telemental Health Center and Regional Pilot. Fed Pract 2015; 32:32-39. [PMID: 30766076 PMCID: PMC6363295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A pilot program that delivers telemental health care for posttraumatic stress disorder provides best practices for facilities looking to expand in-home and remote care to veterans.
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Affiliation(s)
- Kathryn Williams
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Shira Kern
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Steven R Thorp
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Martin Paulus
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Nilesh Shah
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Leslie Morland
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
| | - Peter Hauser
- is the associate director of VISN 22 Evidenced-Based Telemental Health Center; is a research psychologist; was the past director of VISN 22 Evidence-Based Telemental Health Center; is the director of Telehealth; and is the current director of VISN 22 Evidence-Based Telemental Health Center, all at the VA San Diego Healthcare System in California. is a research assistant and is a research psychiatrist, both at the Long Beach VA Healthcare System in California. Dr. Hauser is a clinical professor at the University of California's San Diego and Irvine campuses and mental health care services lead at the VISN 22 office in Long Beach. Dr. Thorp is an associate professor; Dr. Paulus is a professor; and Dr. Shah is an assistant professor, all also at the University of California, San Diego. Dr. Thorp is a research psychologist at the Center of Excellence for Stress and Mental Health in San Diego
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Luxton DD, Pruitt LD, O'Brien K, Stanfill K, Jenkins-Guarnieri MA, Johnson K, Wagner A, Thomas E, Gahm GA. Design and methodology of a randomized clinical trial of home-based telemental health treatment for U.S. military personnel and veterans with depression. Contemp Clin Trials 2014; 38:134-44. [DOI: 10.1016/j.cct.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 10/25/2022]
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Gros DF, Morland LA, Greene CJ, Acierno R, Strachan M, Egede LE, Tuerk PW, Myrick H, Frueh BC. Delivery of Evidence-Based Psychotherapy via Video Telehealth. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9363-4] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Deslich S, Stec B, Tomblin S, Coustasse A. Telepsychiatry in the 21(st) century: transforming healthcare with technology. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2013; 10:1f. [PMID: 23861676 PMCID: PMC3709879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article describes the benefits and constraints of telemedicine, focusing primarily on the field of psychiatry in the United States with the current system of healthcare. Telepsychiatry is believed to provide better access and higher-quality care to patients who need psychiatric care and cost savings to providers of such care. Telemedicine has been successfully integrated into psychiatric facilities reaching rural areas, prisons, and urban facilities. It has increased the volume of patients that physicians can reach and diagnose, as well as allowing them to treat patients with limitations in mobility. While telepsychiatry has been shown to be beneficial, this technology does have some limitations. Concerns about reimbursement, licensure, privacy, security, patient safety, and interoperability have been identified and present current challenges that providers using telepsychiatry must overcome in order to provide the most effective patient care. As more insurance companies start to reimburse for telepsychiatry treatments at the same rate as for face-to-face visits, this evolving medical field has the potential to grow exponentially.
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Affiliation(s)
- Stacie Deslich
- College of Business, Marshall University, Graduate College, South Charleston, WV, USA
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Kitchen KA, McKibbin CL, Wykes TL, Lee AA, Carrico CP, McConnell KA. Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use. Clin Gerontol 2013; 36:10.1080/07317115.2013.767872. [PMID: 24409008 PMCID: PMC3881270 DOI: 10.1080/07317115.2013.767872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.
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Affiliation(s)
| | | | | | - Aaron A Lee
- University of Wyoming, Laramie, Wyoming, USA
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Strachan M, Gros DF, Ruggiero KJ, Lejuez CW, Acierno R. An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings. Behav Ther 2012; 43:560-9. [PMID: 22697444 DOI: 10.1016/j.beth.2011.03.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 03/09/2011] [Accepted: 03/15/2011] [Indexed: 11/30/2022]
Abstract
Combat-exposed military personnel from the wars in Iraq and Afghanistan report high rates of PTSD and associated psychiatric problems. A formidable body of research supports exposure therapy as a front-line intervention for PTSD; however, relative to studies of civilians, fewer investigations have evaluated the effectiveness of exposure therapy using military samples. Specifically, barriers to care (e.g., stigma associated with receiving mental health services ) may compromise utilization of evidence-based psychotherapy. As such, researchers have argued that veterans with PTSD may require an integrated and innovative approach to the delivery of exposure techniques. This paper presents the rationale for and preliminary data from an ongoing clinical trial that compares the home-based telehealth (HBT) application of a brief, behavioral treatment (Behavioral Activation and Therapeutic Exposure; BA-TE) for veterans with PTSD to the standard, in-person application of the same treatment. Forty OIF/OEF veterans with PTSD and MDD were consented, enrolled, and randomized to condition (BA-TE in-person, or BA-TE HBT) and symptoms of anxiety and depression were assessed at pre- and posttreatment. Participants in both conditions experienced reductions in depression, anxiety, and PTSD symptoms between pre- and posttreatment, suggesting that HBT application of an integrated PTSD treatment may be feasible and effective.
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Affiliation(s)
- Martha Strachan
- Ralph H. Johnson Veterans Administration Medical Center, and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA.
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Innovations in the treatment of anxiety psychopathology: introduction. Behav Ther 2012; 43:465-7. [PMID: 22697436 DOI: 10.1016/j.beth.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 03/03/2012] [Accepted: 03/04/2012] [Indexed: 11/22/2022]
Abstract
Behavioral and cognitive interventions have an established history of efficacy for the treatment of anxiety disorders. The majority of patients receiving these empirically supported interventions for anxiety exhibit improvement and these changes tend to be maintained following treatment. Moreover, emerging data suggest that cognitive-behavioral protocols can be effectively transferred to real-world settings such as primary care practices. On the other hand, historical reviews indicate that the relative efficacy of treatments for anxiety have not substantially improved over time. A further concern is that there are relatively few innovations in the treatment of anxiety during the past 20years. Thus, we appear to have reached somewhat of a plateau with regard to treatment response, which would suggest a need to consider novel methods and approaches. This special series will describe new and innovative approaches to the treatment of anxiety psychopathology.
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Age group differences among veterans enrolled in a clinical service for behavioral health issues in primary care. Am J Geriatr Psychiatry 2012; 20:205-14. [PMID: 20808141 DOI: 10.1097/jgp.0b013e3181ec828a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES : To examine age group differences in the identification, engagement, clinical outcomes, and monitoring of older, relative to middle aged and younger, veterans with behavioral health needs enrolled in an integrated care management program DESIGN : Cross-sectional and longitudinal SETTING : Primary care clinics affiliated with two Veterans Affairs Medical Centers PARTICIPANTS : A total of 9,087 veterans were referred to the Behavioral Health Laboratory (BHL) for a behavioral health assessment and 7,251 completed an initial assessment MEASUREMENTS : Data on consult source and reason for the referral, clinical assessment outcomes, and engagement were collected during a 3-year period. Variations in process and patient-level factors were examined as a function of age group. RESULTS : Although all age groups evidenced high rates of engagement in clinical assessment calls, older adults were slightly more likely to complete the assessments than young/middle-aged veterans. Clinical assessment outcomes revealed that although older adults were less likely to meet criteria for more complex, severe conditions, rates of disorder remained clinically significant, and comorbidity was common. Finally, older veterans receiving treatment monitoring for a newly prescribed antide- pressant consistently reported high rates of antidepressant adherence during the course of the monitoring calls and showed significant reductions in depressive symptomatology during the course of monitoring. CONCLUSIONS : Results indicate age-related variability in processes and outcomes among veterans referred to the BHL and suggest that older veterans are just as likely to benefit from a program designed to facilitate the identification, engagement, monitoring, and care management of primary care patients experiencing behavioral health issues.
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Strachan M, Gros DF, Yuen E, Ruggiero KJ, Foa EB, Acierno R. Home-based telehealth to deliver evidence-based psychotherapy in veterans with PTSD. Contemp Clin Trials 2011; 33:402-9. [PMID: 22101225 DOI: 10.1016/j.cct.2011.11.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/01/2011] [Accepted: 11/03/2011] [Indexed: 11/28/2022]
Abstract
Although medical service delivery via home-based telehealth technology (HBT) is gaining wider acceptance in managing chronic illnesses such as diabetes or chronic obstructive pulmonary disease, few studies have tested HBT applications of psychotherapy. Clinicians, administrators, and researchers question whether delivering psychotherapeutic services to patients in their homes via video-conferencing technology compromises patient safety, potency of treatment, or data security. Despite these concerns, HBT service delivery may increase access to evidence-based psychotherapies for veterans with posttraumatic stress disorder (PTSD), who may be less willing or less able to receive weekly treatment at a VA medical center or outpatient clinic due to symptom severity or other similar barriers to care. Indeed, although combat-exposed service members endorse high rates of psychiatric disorders, few appear to initiate mental health services or receive an adequate dose of treatment. Thus, using HBT technologies to administer evidence-based therapies remains uncharted territory in both the clinical and research arenas. This manuscript describes an ongoing four year randomized controlled trial comparing in-person Prolonged Exposure (PE) - a specialized evidence-based psychotherapy for PTSD - and PE delivered via HBT, with a particular focus on the selection, application, and strengths/weaknesses of HBT procedures.
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Affiliation(s)
- Martha Strachan
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States.
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Godleski L, Cervone D, Vogel D, Rooney M. Home telemental health implementation and outcomes using electronic messaging. J Telemed Telecare 2011; 18:17-9. [PMID: 22052966 DOI: 10.1258/jtt.2011.100919] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In 2007, the VA Connecticut Healthcare System began a home electronic messaging programme for mental health patients. During the first two years, 76 patients with diagnoses of schizophrenia, post traumatic stress disorder, depression and substance-use disorders received a home messaging device, which was connected via an ordinary telephone line. There were daily questions, which were based on disease management protocols, and included alerts, data and educational components. Patient data were sent to a nurse practitioner each day for triage and follow-up. Patients used the device for at least six months. In the six months prior to enrolment, 42 patients were hospitalized for 46 admissions. In the following six months, six patients were hospitalized for nine admissions (P < 0.0001). In the six months prior to enrolment, 47 patients had a total of 80 ER visits. In the following six months, 16 patients had a total of 32 ER visits (P < 0.0001). Questionnaire responses indicated a high level of satisfaction with the home messaging programme.
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Affiliation(s)
- Linda Godleski
- National Telemental Health Center, Veterans Health Administration, West Haven, Connecticut, USA.
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Kullgren JT, McLaughlin CG, Mitra N, Armstrong K. Nonfinancial barriers and access to care for U.S. adults. Health Serv Res 2011; 47:462-85. [PMID: 22092449 DOI: 10.1111/j.1475-6773.2011.01308.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify prevalences and predictors of nonfinancial barriers that lead to unmet need or delayed care among U.S. adults. DATA SOURCE 2007 Health Tracking Household Survey. STUDY DESIGN Reasons for unmet need or delayed care in the previous 12 months were assigned to one of five dimensions in the Penchansky and Thomas model of access to care. Prevalences of barriers in each nonfinancial dimension were estimated for all adults and for adults with affordability barriers. Multivariable logistic regression models were used to estimate associations between individual, household, and insurance characteristics and barriers in each access dimension. PRINCIPAL FINDINGS Eighteen percent of U.S. adults experienced affordability barriers and 21 percent experienced nonfinancial barriers that led to unmet need or delayed care. Two-thirds of adults with affordability barriers also reported nonfinancial barriers. Young adults, women, individuals with lower incomes, parents, and persons with at least one chronic illness had higher adjusted prevalences of nonfinancial barriers. CONCLUSIONS Nonfinancial barriers are common reasons for unmet need or delayed care among U.S. adults and frequently coincide with affordability barriers. Failure to address nonfinancial barriers may limit the impact of policies that seek to expand access by improving the affordability of health care.
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Affiliation(s)
- Jeffrey T Kullgren
- Robert Wood Johnson Foundation Clinical Scholars, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia, PA, USA
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Lejuez CW, Hopko DR, Acierno R, Daughters SB, Pagoto SL. Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behav Modif 2011; 35:111-61. [PMID: 21324944 DOI: 10.1177/0145445510390929] [Citation(s) in RCA: 344] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Following from the seminal work of Ferster, Lewinsohn, and Jacobson, as well as theory and research on the Matching Law, Lejuez, Hopko, LePage, Hopko, and McNeil developed a reinforcement-based depression treatment that was brief, uncomplicated, and tied closely to behavioral theory. They called this treatment the brief behavioral activation treatment for depression (BATD), and the original manual was published in this journal. The current manuscript is a revised manual (BATD-R), reflecting key modifications that simplify and clarify key treatment elements, procedures, and treatment forms. Specific modifications include (a) greater emphasis on treatment rationale, including therapeutic alliance; (b) greater clarity regarding life areas, values, and activities; (c) simplified (and fewer) treatment forms; (d) enhanced procedural details, including troubleshooting and concept reviews; and (e) availability of a modified Daily Monitoring Form to accommodate low literacy patients. Following the presentation of the manual, the authors conclude with a discussion of the key barriers in greater depth, including strategies for addressing these barriers.
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Affiliation(s)
- C W Lejuez
- Department of Psychology, Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD 20742, USA.
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Breen P, Murphy K, Browne G, Molloy F, Reid V, Doherty C, Delanty N, Connolly S, Fitzsimons M. Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part I: utility, technical performance and service provider perspective. BMC Med Inform Decis Mak 2010; 10:48. [PMID: 20843309 PMCID: PMC2949692 DOI: 10.1186/1472-6947-10-48] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 09/15/2010] [Indexed: 11/29/2022] Open
Abstract
Background Formative evaluation is conducted in the early stages of system implementation to assess how it works in practice and to identify opportunities for improving technical and process performance. A formative evaluation of a teleneurophysiology service was conducted to examine its technical and sociological dimensions. Methods A teleneurophysiology service providing routine EEG investigation was established. Service use, technical performance and satisfaction of clinical neurophysiology personnel were assessed qualitatively and quantitatively. These were contrasted with a previously reported analysis of the need for teleneurophysiology, and examination of expectation and satisfaction with clinical neurophysiology services in Ireland. A preliminary cost-benefit analysis was also conducted. Results Over the course of 40 clinical sessions during 20 weeks, 142 EEG investigations were recorded and stored on a file server at a satellite centre which was 130 miles away from the host clinical neurophysiology department. Using a virtual private network, the EEGs were accessed by a consultant neurophysiologist at the host centre for interpretation. The model resulted in a 5-fold increase in access to EEG services as well as reducing average waiting times for investigation by a half. Technically the model worked well, although a temporary loss of virtual private network connectivity highlighted the need for clarity in terms of responsibility for troubleshooting and repair of equipment problems. Referral quality, communication between host and satellite centres, quality of EEG recordings, and ease of EEG review and reporting indicated that appropriate organisational processes were adopted by the service. Compared to traditional CN service delivery, the teleneurophysiology model resulted in a comparable unit cost per EEG. Conclusion Observations suggest that when traditional organisational boundaries are crossed challenges associated with the social dimension of service delivery may be amplified. Teleneurophysiology requires a governance and management that recognises its socio-technical nature.
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Affiliation(s)
- Patricia Breen
- Epilepsy Programme, Beaumont Hospital, Dublin 9, Ireland.
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