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2023 HSR&D/QUERI National Conference Abstract

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4006 — A Telehealth Psychotherapy Hub Improves Access to Mental Health Care for Rural Veterans with Parkinson’s Disease

Lead/Presenter: Alejandro Interian ,  VA Office of Rural Health
All Authors: Dobkin RD (NJ VA Medical Center, Lyons, New Jersey; Rutgers–Robert Wood Johnson Medical School, Piscataway, New Jersey), Marsh L (Michael E. DeBakey VA Medical Center, Houston, Texas) Sarwar A (Parkinson's Disease Research, Education, and Clinical Center, Houston, Texas) Mack J (Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, Oregon/Seattle, Washington) Rodriguez K (NJ VA Medical Center, Lyons, New Jersey) King A (NJ VA Medical Center, Lyons, New Jersey) Hinojosa-Lindsey M (Michael E. DeBakey VA Medical Center, Houston, Texas) Miller R (NJ VA Medical Center, Lyons, New Jersey) St. Hill L (NJ VA Medical Center, Lyons, New Jersey) O'Connor S (Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, Oregon/Seattle, Washington) Ketchum K (Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, Oregon/Seattle, Washington) Latorre M (NJ VA Medical Center, Lyons, New Jersey) Interian A (NJ VA Medical Center, Lyons, New Jersey)

Objectives:
Rural Veterans are disproportionately impacted by Parkinson’s disease (PD) and by system wide shortfalls in mental health care. Although depression and anxiety are highly prevalent in PD, with broad, adverse effects, these neuropsychiatric complications are often undiagnosed or sub-optimally managed. To overcome these care gaps, a hub-based model was implemented that transforms the way in which treatment is delivered. A PD-informed telemedicine program was established in the New Jersey Veteran Affairs Healthcare System to remotely deliver mental health care, including specialized consultation and evidence-based psychotherapy, directly into the homes of rural Veterans with PD, across several states. The program will be rolled out in phases, with initial implementation efforts underway in collaboration with Houston and Portland PADRECCs (Parkinson Disease Research, Education, and Clinical Centers). The objective of this presentation is to describe the clinical and implementation outcomes associated with the Year 1 launch of the VA NJ telehealth psychotherapy hub to treat depression and anxiety in rural Veterans with PD.

Methods:
Veterans with a confirmed PD diagnosis and documented residence in a rural zip code (in a designated catchment area) received a program letter, followed by a phone call to assess interest and need for mental health services. Referrals were also made directly from PADRECC clinicians. Eligible individuals were offered a 60-minute initial consultation and enrollment in one of two PD-informed telemedicine treatments (Individual Cognitive-Behavioral Therapy and/or Group Mindfulness-Based Cognitive Therapy).

Results:
In Year 1, 424 rural Veterans with PD were outreached by phone; 133 completed brief mental health screenings and 94 received specialized evaluation and treatment. 733 rural health clinical encounters (1:1 consultations; psychotherapy sessions) occurred. Enrolled Veterans demonstrated significant reductions in depression and anxiety. Program satisfaction rates were very high.

Implications:
A hub-based approach for delivering PD-informed mental health care can feasibly engage, treat, and coordinate care, regardless of geographic location.

Impacts:
This project will lead to: 1. Improved quality of life and decreased morbidity and mortality for Rural Veterans with PD; 2. Enhanced understanding of barriers and facilitators to mental health engagement for PD rural Veterans in order to improve quality and sustainability of care; 3. Best practice guidelines to provide evidence-based mental health care to PD rural Veterans.