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      Bringing Specialty Telebehavioral Medicine Home: Feasibility of a Quality Improvement Pilot for Medically Complex Patients

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          Abstract

          Objectives

          The aims of this quality improvement project were twofold: Phase 1: conduct a needs assessment study for home-based telebehavioral medicine (H-TBM) among medically complex patients living in rural areas seeking care at an academic medical center (AMC) in a Behavioral Medicine Clinic, and Phase 2: evaluate the feasibility of a pilot implementation of H-TBM to improve therapy access for these underserved patients.

          Results

          The needs assessment study supported patient interest and need for H-TBM services. In the pilot, patients and providers were “satisfied to completely satisfied” using H-TBM. Patients engaging in H-TBM (Phase 2) reported significantly lower acute distress after H-TBM sessions than they experienced prior to sessions (t(29)=4.26; p<.001).

          Conclusion

          Results demonstrated preliminary acceptance by and feasibility for Behavioral Medicine Clinic patients with complex medical conditions to receive psychotherapy via H-TBM (in their homes), reducing their travel burden. H-TBM services offer the following benefits to chronically ill patients: they help to manage psychosocial complications associated with chronic disease and to prepare for intensive medical interventions.

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          Most cited references 19

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          The effectiveness of telemental health: a 2013 review.

          The effectiveness of any new technology is typically measured in order to determine whether it successfully achieves equal or superior objectives over what is currently offered. Research in telemental health-in this article mainly referring to telepsychiatry and psychological services-has advanced rapidly since 2003, and a new effectiveness review is needed. The authors reviewed the published literature to synthesize information on what is and what is not effective related to telemental health. Terms for the search included, but were not limited to, telepsychiatry, effectiveness, mental health, e-health, videoconferencing, telemedicine, cost, access, and international. Telemental health is effective for diagnosis and assessment across many populations (adult, child, geriatric, and ethnic) and for disorders in many settings (emergency, home health) and appears to be comparable to in-person care. In addition, this review has identified new models of care (i.e., collaborative care, asynchronous, mobile) with equally positive outcomes. Telemental health is effective and increases access to care. Future directions suggest the need for more research on service models, specific disorders, the issues relevant to culture and language, and cost.
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            Delivery of Evidence-Based Psychotherapy via Video Telehealth

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              Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial.

              The purpose of this randomized noninferiority trial was to compare video teleconferencing (VTC) versus in-person (IP) delivery of an 8-week acceptance and commitment therapy (ACT) intervention among veterans with chronic pain (N = 128) at post-treatment and at 6-month follow-up. The primary outcome was the pain interference subscale of the Brief Pain Inventory. Secondary outcomes included measures of pain severity, mental and physical health-related quality of life, pain acceptance, activity level, depression, pain-related anxiety, and sleep quality. In intent to treat analyses using mixed linear effects modeling, both groups exhibited significant improvements on primary and secondary outcomes, with the exception of sleep quality. Further, improvements in activity level at 6-month follow-up were significantly greater in the IP group. The noninferiority hypothesis was supported for the primary outcome and several secondary outcomes. Treatment satisfaction was similar between groups; however, significantly more participants withdrew during treatment in the VTC group compared with the IP group, which was moderated by activity level at baseline. These findings generally suggest that ACT delivered via VTC can be as effective and acceptable as IP delivery for chronic pain. Future studies should examine the optimal delivery of ACT for patients with chronic pain who report low levels of activity. This trial was registered at ClinicalTrials.gov (NCT01055639).
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                Author and article information

                Journal
                TMT
                Telehealth and Medicine Today
                Partners in Digital Health
                2471-6960
                12 June 2019
                2019
                : 4
                Affiliations
                [1 ]Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
                [2 ]Department of Pediatrics, Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina
                Author notes
                Corresponding Author: Lillian M. Christon, Email: christon@ 123456musc.edu
                Article
                152
                10.30953/tmt.v4.152
                © 2019 Lillian M. Christon

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

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                Original Research

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