Explore the groundbreaking study published in JAMA, revealing the transformative influence of an audio-only telehealth intervention on the quality of life for individuals battling chronic conditions. Led by Dr. David Bekelman, the research introduces the Advancing Symptom Alleviation With Palliative Treatment (ADAPT) intervention, showcasing its efficacy in addressing symptoms of chronic conditions like COPD, heart failure, and ILD. With a team-based approach, involving a registered nurse and a social worker, the ADAPT intervention demonstrates significant improvements in overall quality of life, COPD health status, heart failure health status, depression, and anxiety symptoms. This study exemplifies telehealth’s potential to bridge gaps in palliative care and contribute to broader healthcare transformations.
Chronic conditions such as COPD, heart failure, and ILD pose significant challenges to patients, impacting their quality of life as symptoms persist over time. Limited access to palliative care specialists in the United States prompts the need for innovative solutions. This JAMA-published study led by Dr. Bekelman investigates the effectiveness of the ADAPT intervention—a telehealth strategy delivering palliative care via audio-only means. The study addresses the persistent symptoms of chronic conditions through a team-based approach involving a registered nurse and social worker. The results highlight the potential of telehealth to enhance quality of life, presenting a scalable alternative for early palliative care, especially in areas with limited specialist resources.
Challenges in Palliative Care:
Patients grappling with COPD, heart failure, and ILD often experience a decline in their quality of life as their conditions progress. Lingering symptoms like breathlessness and pain compound the difficulties they face. Despite advancements in disease-specific treatments, the persistence of symptoms such as depression, anxiety, shortness of breath, and sleep problems necessitates additional measures to enhance the overall well-being of these individuals. However, access to outpatient palliative care specialists remains a challenge, prompting the exploration of scalable alternatives.
The ADAPT Intervention:
The study investigates the effectiveness of the Advancing Symptom Alleviation With Palliative Treatment (ADAPT) intervention, a team-based audio-only telehealth approach. Comprising a registered nurse and a social worker, the ADAPT intervention aims to address chronic condition symptoms and provide structured counseling to patients. Throughout the intervention, participants received six phone calls each from the nurse and social worker. Regular meetings with a primary care and palliative care physician, and specialists when needed, ensure comprehensive and coordinated care.
Study Participants and Design:
The study involved 306 patients, with 154 receiving the ADAPT intervention and 152 receiving usual care. Usual care included an educational handout outlining self-care practices for COPD, ILD, or heart failure. Among the participants, 58 percent had COPD, 22 percent had heart failure, 16 percent had both COPD and heart failure, and 4 percent had ILD. Nearly half had experienced hospitalization in the previous year, and 21 percent had two or more hospitalizations.
Key Findings:
At the outset, participants reported poor disease-specific health status and overall quality of life. The primary outcome measure, Functional Assessment of Chronic Illness Therapy-General (FACT-G) scores, demonstrated a marked improvement in the intervention group compared to the usual care arm. At the six-month mark, the mean FACT-G score increased by 6.0 points in the intervention group, showcasing a substantial enhancement in their quality of life. In contrast, the usual care group showed a modest increase of 1.4 points.
Impacts on Specific Health Conditions:
In addition to the overall improvement in quality of life, the ADAPT intervention demonstrated positive effects on COPD health status, heart failure health status, depression, and anxiety symptoms at the six-month follow-up. Importantly, the intervention did not result in any adverse events or patient harm, reinforcing its safety and feasibility.
Broader Implications and Future Directions:
The study’s authors propose that the ADAPT intervention presents an opportunity for health systems and payors within the context of value-based care. The virtual and population-based nature of the intervention lends itself to a hub-and-spoke model, potentially extending the reach of palliative care services to traditionally under-resourced areas. This research aligns with the broader trend of leveraging telehealth to facilitate team-based care, exemplified by a virtual care team strategy detailed in previous research.
Telehealth’s Role in Team-Based Care:
Earlier research, published in March, highlights the success of a virtual care team strategy in guiding treatment strategies and increasing therapy uptake among heart failure patients in Massachusetts hospitals. The Implementation of Medical Therapy in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction (IMPLEMENT-HF) intervention involved a centralized physician, study staff, and a local pharmacist at each care site. This collaborative approach resulted in an increased number of patients adopting new treatments and improvements in guideline-directed medical therapy dosing.
Overall, the ADAPT intervention represents a milestone in palliative care, offering a scalable and innovative solution to the challenges faced by individuals with chronic conditions. The study’s positive outcomes, including improved quality of life and symptom management, underscore the potential of telehealth in reshaping healthcare delivery. As a viable option for early palliative care, especially where specialist resources are scarce, the ADAPT intervention aligns with the broader trend of value-based care. This transformative approach not only addresses gaps in access to palliative care but also emphasizes the collaborative, team-based nature of healthcare delivery in the evolving landscape of medical advancements.
