Integrating Telehealth into Daily Practice Procedures

Internet-based eating disorder interventions such as audio/visual communication (tele-therapy) and smartphone applications have demonstrated some promising outcomes in recent studies. Early feedback from e-health research has suggested that Internet-based cognitive behavioral therapy and guided self-help programs have reduced eating disorder psychopathology and have provided greater access for rural and underserved populations.

Initial interest in Telehealth for ED was based on a widespread need for access to quality treatment regardless of geographic location and programs that would assist individuals in overcoming barriers to quality care. While eating disorders have one of the highest mortality rates among mental health conditions and cause marked impairment in an individual’s quality of life, unfortunately, stigmas, shame and financial constraints also prevent many from seeking the treatment they need. One study suggested that more than half of a community-based sample reported on average 1.1 years delay in receiving treatment due to an additional barrier–waitlists. In an attempt to circumvent these barriers to treatment, a number of treatment approaches and strategies have been developed over the past few years in the field of internet-based services.

While smartphone apps are available at just the click of a button, it is important for consumers and clients to understand that these applications were developed to use before, after, or as a supplement to existing treatments–not to replace treatment entirely. Alternatively, these solutions may serve as an adjunct to those who have completed a short intervention program but are still in need of therapeutic support to consolidate and maintain treatment gains. Blended care, which would require face-to-face therapy paired with an online component seems to be the most promising use of the applications and online programming to date. Blended care appears promising since online sessions can reduce costs, travel time, and provide more flexibility.  That said, thorough studies investigating blended care for EDs are not plentiful. A stepped care approach is also being evaluated, where guided or un-guided self-help could be offered to individuals who require additional support after completing a treatment program to maintain treatment gains. Additional research is required to better understand how clinics, clinicians and professionals can integrate these tools into their everyday practice procedures.

To evaluate the overall costs associated with an E-based intervention, a number of trials are currently being run to evaluate and substantiate cost effectiveness. Factors such as the cost associated with inclusion of therapist support are also being considered. One such study evaluated a stepped-care approach in which individuals with BN, begin with offline self-help from which patients could step up to more intensive treatment approaches. This stepped-care approach was more effective and less expensive. This suggests that low-intensity stepped approaches that initiate with an online component could lead to reduction of overall costs.

While factors such as cost-effectiveness, e-diagnostic tools and approaches to integrating care are still being researched, E-health is demonstrating strong results and providing access to treatment for many who would have otherwise gone without it.

While the potential for telehealth is great, current findings on efficacy and effectiveness are considered to be just the tip of the iceberg. Researchers are interested in better understanding how the field of eating disorder treatment may optimize E-health solutions within existing health care models, how to blend e-health into their everyday treatment procedures and further realize what role E-health may play in our healthcare delivery systems moving forward.

Stay Tuned!

In the coming months, Columbus Park will be launching an E-health tool in an effort to help more people who struggle with eating.  We’ll be using a video platform to reach people well beyond our midtown offices and to create a sense of community amongst those who are working toward recovery.  More to come soon!