In the December issue of The Gerontologist (The Gerontological Society of America) is an article on “The BRIGHTEN Program: Implementation and Evaluation of a Program to Bridge Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking.” Now, even as a former academic myself, I cannot help wishing folks could use a title like, “Let’s Work Together and Share Data,” but the content is very interesting.
The focus of the program and the study is the diagnosis and treatment of depression in older adults. To a certain extent, on the surface, the results – as is the case in many academic studies – are, as we were fond of saying in high school in the 19th century, intuitively obvious to the casual observer:
The BRIGHTEN Program demonstrated that an interdisciplinary virtual team linked with outpatient medical clinics can be an effective, nonthreatening, and seamless approach to enable older adults to access treatment for depression.
The details, however, are more interesting.
First, is depression in older adults really a problem. Yes. Almost 30% of this population report “depressive symptoms” during visits to their primary care physicians (PCPs). Mental health, more broadly, is not a strength of many PCPs, so many issues go undiagnosed.
What do most studies mean by an “interdisciplinary virtual team,” also referred to as an integrated team? Usually the phrase refers to a PCP, nurse, psychologist and social worker. The BRIGHTEN Program expands that to include physical and occupational therapy, dieticians, chaplains and pharmacists. In our view, at Support For Home Health Care, this definition still overlooks the critical roles of (a) the non-clinical caregiver, whether family, friend or professional, and (b) the Geriatric Care Manager, in the collection and reporting of data and the translation of data into care. While we applaud the concept of expanding the team, let’s not make an arbitrary stop at the edge of the clinical world.
The other weakness, in my view, of the program is that when they talk about “Electronic Networking,” all that really means is emails to and from various members of the team, with responses from team members expected within two (2) weeks of receiving an email. For folks in crisis from depression or mental health issues, that does not feel very immediate.
Is the inter-disciplinary team a critical and positive change? Absolutely. Does the program go far enough? Not in my view. What is yours?
Best wishes. Bert