Wednesday, December 9, 2015

Using Telemedicine to Deliver Family-based Treatment for Teens with AN

A new project fulfills a need for patients and families without good access to therapy.

Reprinted from Eating Disorders Review
November/December Volume 26, Number 6
©2015 IAEDP
An ongoing project is testing the power of telemedicine to deliver family-based treatment (FBT) for adolescents with anorexia nervosa (AN). Drs. Kristen E. Anderson, MD, and Daniel Le Grange and three co-workers at the University of California, San Francisco, recently reported that they have completed the first steps in a two-year study designed to deliver FBT to adolescents and their families in remote, rural, or underrepresented areas of the US (J Eat Disord. 2015; 3:25).
AN is still the most deadly psychiatric illness, and compared with their peers of the same age, individuals with AN have nearly a 12-fold greater risk of death from all causes, along with a 57-times greater risk of death from suicide. FBT is currently the most effective treatment available for teens with AN. However, there are relatively few FBT therapists in the US, and most work in urban areas (there is 1 certified FBT therapist for every 2000 adolescents with AN in the US). Families have traditionally traveled long distances to get such therapy.
Dr. Anderson and her team are currently in the midst of a treatment development study to address the needs of families and teens with in remote, rural or underrepresented areas of the US. They are currently enrolling teens aged 13 to 18 who have DSM-5 criteria for AN and who are at or below 87% of expected body weight. Candidates for the telemedicine program have to be medically stable enough for outpatient treatment and if receiving psychotropic medication must have been on a stable dosage for at least 8 weeks. Teens are excluded who require hospitalization, or who have a psychotic or other mental illness, or dependence on drugs or alcohol, or any physical condition that might influence eating or weight. Teens who have had previous FBT treatment for AN are also excluded.

Establishing a safe health portal

The researchers have established a Cloud-based health portal that will allow the therapist to connect with the family via a secure videoconferencing stream. Participating families will also be able to communicate with the therapist with a messaging system that is similar to email. Because of the importance of patient confidentiality and security, the authors are using HIPAA-compliant software. 

A standard battery of tests will be conducted at baseline, and then at a midway point, at the end of treatment, and at 6 months follow-up. Each assessment will be completed using the Cloud-based health portal's videoconferencing feature. Even the numerous questionnaires will be filled out online.
The first of two case series has been completed, and the second series is underway. The authors report that the study has already enrolled 80% of patients and is on track to have all participants enrolled by the end of December 2015. In the second wave of the study, families will have access to a digital weight scale that they can use to access real-time weight-restoration programs online. The team is also addressing some technological issues; for example, not all families have good Internet connections or supported web browsers. 

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