A newly published clinical trial led by University of Louisville physicians has shown that a computer-assisted cognitive behavior (CCBT) therapy can overcome these barriers while providing effective treatment for depression.

Jesse Wright, professor of psychiatry at UofL and director of the , documented treatment results for a diverse group of 175 adults for depression. The study, published in in February, showed that patients in a primary care setting who participated in CCBT reported significantly greater improvement in their depressive symptoms than those receiving treatment as usual.

“With modest amounts of telephone support from a clinician, CCBT was associated with greater improvement in depression, anxiety and quality of life than usual treatment in a diverse group of primary care patients. We were pleased to see that CCBT had more than double the remission and response rates as usual treatment,” Wright said.

“There has been a historical lack of effective care for depression in the primary care setting,” he said. “Because this study population included people with lower income and lack of internet access, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings.”

Rather than requiring frequent office visits, a patient can engage in CCBT online whenever their schedule allows and from the comfort of their home. A primary care provider can monitor and support the patient’s progress, helping patients who may not desire or be able to see a psychologist or psychiatrist for their therapy.

“Particularly during the COVID pandemic, we have seen how limited appointments are for mental health services and the rise of telemedicine has led to increasing comfort with utilizing technology to support health, which makes computer-assisted cognitive behavioral therapy a great option,” said Laura Bishop, an associate professor and internal medicine-pediatrics physician at UofL and a co-author of the study.

In the study, CCBT participants used the nine-lesson computer program “Good Days Ahead,” along with as many as 12 weekly telephone support sessions with a master’s level therapist, along with the treatment usually provided by the primary care sites.

“I think this is a preferable option for younger patients who often are more comfortable with self-reflection and working through the CCBT on a computer rather than meeting face-to-face with a provider,” Bishop said. “We’ve seen more and more familiarity with wellness and meditation apps over the past few years that have paved the way for CCBT to be widely accepted.”

Wright began work on computer-assisted therapy in the 1990s and led the initial development of Good Days Ahead. In addition to depression, Wright said CCBT also could be adapted to treatment for obsessive-compulsive disorder, anxiety, eating disorders or other conditions.

Patients in the Louisville area can request use of Good Days Ahead through the .

Good Days Ahead is being reviewed by the U.S. Food and Drug Administration under a new protocol for certification of therapeutic computer programs.

Wright retains an equity interest in MindStreet Inc., the company that now manages Good Days Ahead.

“There is both an urgent and widespread need to not only treat patients but deliver expertise and training remotely and safely to both professionals and medical learners,” said R. Brent Wright, MD, associate dean for rural health innovation at the UofL School of Medicine, who has been working with various companies to explore a smart glasses solution for telemedicine since 2014.

Long-term care facilities and emergency departments represent two of the areas with greatest need for the glasses for direct physician care during the pandemic. The UofL Trager Institute, emergency medicine and psychiatry are part of a feasibility study to test the Vuzix M400 smart glasses.

“It is imperative that we find solutions for health care to continue for the vulnerable nursing home population in Kentucky,” said Anna Faul, PhD, executive director and professor, UofL Trager Institute. “The use of smart glasses to provide real-time, expert geriatric care to residents of long-term care facilities is a huge step in increasing access to care, particularly during COVID-19. Each nursing home in our study will receive smart glasses that will allow for remote video consults with specialized medical providers and behavioral health experts without the need for the providers to enter the facilities and expose themselves and other patients to COVID-19.”

The concept is fairly straightforward. An advanced practice nurse practitioner or other health care professional working at a LTC facility will put on the web-connected glasses and dial-in with an attending physician through the Zoom conference platform. A camera and microphone are attached to the glasses, and the technology has the potential to display and obtain information for the physician to access remotely. The physician can see and interact directly with the LTC resident, providing immediate consultation and evaluation.

The glasses allow for ease of mobility and hands-free interaction for the on-site provider, an advantage over current standard telehealth delivery which requires computers and monitors to be transported from bed-to-bed on large carts. Additionally, data can be input into medical records hands-free, and can be controlled by voice-commands.

Smart glasses will support health care workers at five LTC facilities and one emergency department in Kentucky. UofL researchers will conduct a brief feasibility study related to the use of these six pairs of smart glasses. If the data is promising, the study will be extended. Once the pandemic has subsided, researchers hope to investigate the utility of usage for medical education.

“This technology holds great promise. UofL faculty are exploring how to transform health care and this is part of an innovative solution as we provide care and educate the next generation of physicians,” said Toni Ganzel, MD, dean of the UofL School of Medicine, and vice president for academic medical affairs.

“The pandemic has served as the catalyst for changing delivery of care. When you have to do things so rapidly and emergently, there is a call to be creative and innovative. Telemedicine allows us to share expertise while keeping a safe distance, and the smart glasses are very high-fidelity.

“The timing had to be right for this technology to become more accepted,” Wright said. “It will be big part of health care moving forward, even after this swell with the COVID-19 pandemic, and it will be exciting to see some of our current medical residents incorporate telemedicine into their future practices.”

“Travel distance, along with often other serious health conditions, make it difficult for patients to get to a weekly appointment,” said Jodi Wojcik-Marshall, MSN, APRN, ANP-BC, manager of the UofL Hospital Department of Advanced Practice Nursing and nurse practitioner in the Burn Center. “We saw a need to reduce the high number of missed appointments by reducing access barriers.”

In response to the need, a telehealth burn wound care pilot initiative was developed in collaboration with J’Aime Jennings, PhD, assistant professor and co-director, at the .

Jennings led the effort to translate the outpatient burn center’s in-person standards and protocol into a telehealth format.

The program uses the technology for providers Wojcik-Marshall and Michelle Broers, PT, DPT, CWS, FACCWS, to have a dialogue with patients during telehealth visits. Each patient downloads the free BlueJeans app to their smartphone or device and uses a unique connection number to sign in for each appointment.

“We found both in the literature and in early observations of this pilot benefits not only for patients but also for home health providers and family members who help the patients with their treatment,” Jennings said.

Jennings and her team are in process of evaluating patient and provider satisfaction surveys. Next steps include determining adjustments to the program, and how the burn center may expand the initiative to benefit more patients.