West Virginia is one of the poorest and most rural states in America, and major depressive disorder (MDD) is very common, as indicated by West Virginia having the highest suicide rate of any state east of the Mississippi River (the most common cause of which is MDD) and the highest opioid death rate in the country.
But mental health treatment resources are low in West Virginia (ranked 42nd among the 50 states), and this is especially true in rural parts of the state, according to the Washington, D.C.-based Patient-Centered Outcomes Research Institute.
According to PCORI, effective treatment is available, but treatment is often not optimized in low-resource settings because of absence of psychotherapy. In an effort to address this health problem in rural areas, PCORI is funding a study to expand the MDD treatment options available to primary care treatment providers in rural West Virginia to include easy-to-implement and cost-effective electronic cognitive behavioral therapy (CBT).
Researchers at West Virginia University and Harvard Medical School are getting $13.3 million in PCORI funding for a trial that compare strategies for primary care providers in rural areas for treating people with major depressive disorders. Some patients will be treated with antidepressant medication alone, others with medication and cognitive behavior therapy provided remotely, and others with medication plus remote CBT with the help of trained online coaches. The goal is to determine whether telehealth provides effective care options for people in rural areas, PCORI said in a press release.
“Guided eCBT, in which a bachelor’s-level eCoach working under the supervision of a clinical psychologist or psychiatrist helps guide patients through a computerized series of psychotherapy sessions via email, text, and telephone, can be delivered on a mass scale because effective eCoaches are relatively easy to recruit, train, and supervise, and they make much lower salaries than psychotherapists. Controlled treatment trials show that guided eCBT is as effective in treating major depressive disorder as live CBT,” PCORI stated in a summary of the project.
“Furthermore, eCoaches delivering centralized remote eCBT in integrated healthcare networks like the one we will study can also provide elements of remote collaborative care case management, such as encouraging antidepressant medication adherence, monitoring antidepressant medication side effects and treatment response, coordinating with the primary care treatment provider, and facilitating specialty referral, all of which increase major depressive disorder recovery rates.”
The PCORI Board of Governors recently approved $85 million to fund 16 new studies comparing two or more approaches to improve care and outcomes for a range of conditions and problems that impose high burdens on patients, caregivers and the healthcare system, including unsafe opioid use, cancer, depression and stroke.
The funding total includes $5 million for a University of Washington natural experiment study comparing two approaches to reducing unsafe opioid prescribing in the workers’ compensation system in two state systems, Ohio and Washington. This is the latest project in PCORI’s portfolio of patient-centered comparative clinical effectiveness (CER) studies on substance use disorders and pain management, including 15 of which focus on opioid use.
Researchers Vanderbilt University Medical Center were awarded $15.7 million to conduct a study comparing the current way stroke care is delivered with a redesigned model that better integrates rehabilitation and skilled nursing facilities as well as lay health educators who make home visits. A pilot project suggests this new model can decrease hospital length of stay and readmissions, recurrence rates, and lower cost.
University of Washington researchers received $8.5 million for a study that will compare bladder-removal surgery with a treatment that delivers therapeutic agents to the bladder via catheter to treat recurrent bladder cancer, the fourth most common cancer in men and 10th most common in women. Study findings will help patients and clinicians make an informed decision between two treatments.
“These new awards will help answer significant questions about treatment and care delivery that are important to patients and those who care for them,” PCORI Executive Director Joe Selby, M.D. said in a statement. “They reflect the best ideas for urgently needed research on topics prioritized based on input from patients, caregivers, clinicians and other stakeholders. The results will give healthcare decision makers evidence they need to make better-informed health and healthcare decisions.”
With these latest awards, PCORI has invested $2.4 billion to fund more than 440 patient-centered CER studies and other projects designed to enhance CER methods and the infrastructure necessary to conduct CER rigorously and efficiently.