Objective: To describe the ongoing implementation and expansion of a telehealth psychotherapy hub to treat depression in rural Veterans with PD.

Background: Depression is common in patients with Parkinson’s disease (PD) and has negative impacts on function, quality of life, and other PD-related motor and psychiatric symptoms, yet PD-depression often goes undiagnosed and, even when recognized, undertreated, despite the availability of evidence-based interventions. Rural Veterans are disproportionately impacted by Parkinson’s disease and by system wide shortfalls in PD-informed mental health care. In FY2021, a hub-based telemedicine program was established in the New Jersey Veteran Affairs (VA) Healthcare System in collaboration with the Houston VA Parkinson Disease Research, Education, and Clinical Center (PADRECC) to remotely deliver PD-informed mental health consultation and evidence-based psychotherapy, directly into the homes of rural Veterans with PD, across several states. In FY2022-2023, the collaborative program extended its reach across the Portland VA PADRECC’s rural catchment area.

Method: 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: Since program inception (FY2021), over 1730 unique rural Veterans with PD have been screened, leading to 1646 full clinical encounters (1:1 consults and therapy sessions) with 183 Veterans enrolled across 3 distinct catchment areas, with expansion to the Portland VA Catchment area since FY2022 accounting for 82 enrolled Veterans across 9 home VA facilities. The program has placed approximately 100 consult referrals to other providers within the VA system to address care gaps. Enrolled Veterans demonstrated significant reductions in depression and anxiety. Program satisfaction rates remain very high across sites.

Conclusion: A hub-based approach for delivering PD-informed mental health care can feasibly engage, treat, and coordinate care, across geographic locations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/expanding-the-reach-of-a-telehealth-psychotherapy-hub-to-advance-coordinated-depression-care-for-rural-veterans-with-parkinsons-disease/