PRP147: Putting PEP in Your Patient’s Life During a Pandemic: The Positive Experience Project

Nancy Morioka-Douglas, MD, MPH; Steven Crane, BA, MS; BJ Fogg, PhD; Dolores Gallagher-Thompson, PhD, ABPP


Context: The elderly are at high risk for depression related to social isolation. They already have a disproportionate disadvantage in accessing mental health resources due to logistics and not enough MediCare providers. Primary care providers are limited due to lack of time per visit, delayed appointment availability, and lack of training. Objective: This pilot study seeks to understand whether elders with mild to moderate self-reported depressive symptoms can benefit from a brief, evidence-based, behavioral activation small group program. Trained primary care providers deliver a series of four 30-minute, video conferencing visits that are tightly scripted. Primary care providers can fit these visits into their usual scheduling and billing templates. To facilitate treatment fidelity, providers will use scripts written for this study to deliver brief behavioral activation programs supported by “Tiny Habits” behavior design principles to optimize results. Study Design: Mixed-methods study. Setting: Community-based primary care outpatient clinics. Population studied: 50 or more English-speaking, community dwelling patients , aged 65 to 85 years, without cognitive impairment, psychosis, or terminal illness, but with mild to moderate depressive symptoms. Intervention: Group video conferencing to provide brief behavioral activation, in a small group, employing scripted sessions led by trained primary care providers. Scripts were developed by the intervention team to minimize training time and maximize patient engagement in behavior change. Outcome Measures: For patients, depression as measured by the PHQ-8; loneliness as measured by the social isolation subscale of the Stanford WELL for Life Survey (items taken from UCLA Loneliness Scale); engagement in positive activities as measured in activity diaries. Structured qualitative interviews with a sample of participating primary care providers and patients. Results: We anticipate reduced depression and loneliness and increased engagement in personalized everyday positive activities for patients. Expected Outcomes: Our qualitative analysis explores providers’ ease of use and intention to continue, and if application of a HIPAA-compliant telehealth platform to deliver this program and its tailored fit to standard MediCare achieve sustainability during this time of COVID-19. Use of evidence based scripts is designed to optimize reproducibility in similar primary care or community mental health settings

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