Study probes how patients are affected by telehealth

Preliminary data show that practitioner-client ties may not be hampered.

By Lisa Rabasca
Monitor staff

Psychotherapy delivered by an audio-video link or speaker phone appears to be just as effective as face-to-face therapy, according to early data on one of the first controlled studies on the use of behavioral telehealth. ?Even though these findings are suggestive, they provide initial evidence questioning the notion that telecommunication-mediated therapy has a negative effect on the relationship between clients and counselors,? says Robert Glueckauf, PhD, an associate professor at Indiana University Purdue University Indianapolis. Preliminary results also show that the bond between the client and practitioner is unaffected by the delivery system.

Glueckauf will have an opportunity to corroborate his initial results this summer when the three-year study will move to the University of Florida in Gainesville, where Glueckauf will direct the new Center for Research on Telehealth and Healthcare Communications?the first psychology-based telehealth center. It is being partially funded by the Arthur Vining Davis Foundation and the Columbia Healthcare Corporation.

Since telehealth has been gaining popularity in rural areas, many practitioners have been calling for more clinical research on telehealth?s effectiveness. Studies like this are necessary to determine how telecommunications can affect the delivery of health care, says Russ Newman, PhD, JD, APA?s executive director for practice.

?The real issue is how do we know that the method of delivering services doesn?t end up influencing, in a negative way, the services that are being delivered,? Newman says. ?That?s what happened with managed care and cost-containment strategies, if you look at it as a technology that was intended to help deliver services more cost-effectively. Now it is driving the health-care service rather than simply delivering the health-care service and negatively affecting the service.

?We would want to make sure the same thing wouldn?t happen when telecommunication technologies are used to deliver services.?

Methodology

Glueckauf?s research, funded by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR), began in December 1996. The study focused on teen-agers who have epilepsy and a significant psychosocial or educational concern. The teens range in age from 12 to 19 and live in rural Indiana, Michigan, Ohio, Kentucky and Illinois. To participate, a teen-ager must live with a parent or guardian, be able to read or comprehend a questionnaire written at a third-grade reading level, and live 50 miles outside a metropolitan area in a town with fewer than 25,000 people.

The telehealth study focused on adolescents with epilepsy because a previous NIDRR study on teen-agers with epilepsy found that about 30 percent of the families that wanted to participate dropped out because it was too expensive and inconvenient to travel into the city for counseling sessions, Glueckauf says. In Glueckauf?s telehealth study families received six counseling sessions, which each lasted an hour to 90 minutes. Sessions included two practitioners and at least two family members, but all family members were welcomed to participate in sessions.

In a two- to-three hour assessment session, parents and teens were asked to identify psychosocial or behavioral concerns that they wanted to address in therapy. More than half the families identified learning problems, including difficulty with concentration, attention and memory, problems completing assignments and poor organizational skills. Verbal conflicts between parents and teens were identified by nearly half of the families.

Other concerns included self-esteem, problems socializing, concerns about the cause of seizures, emotional difficulties, memory concerns and behavioral problems such as aggressive behaviors between siblings or with classmates or parents.

The 14 families that completed the program reported a ?considerable improvement? in the identified problem, whether the therapy was provided face-to-face, by a two-way, audio-video link or by speakerphone, Glueckauf says. Three families received therapy through a two-way, audio-video link, four received counseling by speakerphone and seven received counseling in an office setting. All 14 families said they felt a ?moderately high? alliance with the practitioner, he says.

Although Glueckauf says the study?s preliminary findings are promising, he does offer a caveat: ?These are people who don?t get services. They would have to spend an average of two to three hours each way to travel to get services.? People who usually receive services in an office setting may not be as receptive to counseling provided by audio-video link or speakerphone, he says. Furthermore, he says, the study has not analyzed how the practitioner perceives the therapy.

Speakerphone is cheapest

However, the study found that the cost of providing therapy was fairly comparable for face-to-face office visits and two-way, audio-video counseling, but four times less expensive by speakerphone. ?What we seem to be getting here is a picture that the speakerphone is the cheapest method of conducting family intervention to rural teens with disabilities,? Glueckauf says.

The speakerphone option becomes even more attractive when researchers consider that the technology needed for a two-way, audio-video link is often unavailable in rural areas. Of the 12 families in the study assigned to receive video counseling, Glueckauf says, less than half had the necessary telecommunication services available in their town. However, Glueckauf says he expects that over time this will change as the cost decreases and access increases.

Going south

The remaining families who participated in the Indiana study are expected to complete their six counseling sessions before the study moves to the University of Florida in August, Glueckauf says.

The study will continue to focus on teens with epilepsy, and participants will need to meet the same criteria. However, Glueckauf says he wants to involve more minorities because the Southeast has a greater proportion of African Americans and Hispanics than the Midwest. A key issue that telehealth research needs to explore is whether adolescents who are not familiar with computers are receptive to two-way, audio-video counseling.

Because the Center for Research on Telehealth and Healthcare Communications will be part of the College of Health Professions, the schools of medicine, nursing and physical therapy are expected to participate in future studies. They will investigate whether it is beneficial and cost-effective to use telecommunications in their professions, Glueckauf says. ?The University of Florida has been a guiding force in health psychology over the years and I think the faculty realizes telehealth will be an important vehicle for service in the future,? Glueckauf says.

?We are extremely proud of this ground-breaking study on integrated telehealth and hope to support and extend his research,? says Robert Frank, PhD, dean of the College of Health Professionals, University of Florida. While there have been other behavioral health studies on telehealth, Frank says none is as sophisticated as Glueckauf?s study.

About 60 families will participate in the next phase of the study, with 20 families assigned to each delivery system, Glueckauf said. The study is expected to be completed in June 2000.