APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, - PDF document

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 APNA Na tio na l Co nfe re nc e 2015 Se ssio n 3015.2: Intr oduc ing L ight T he r apy for T r e atme nt of De pr e ssive Symptoms in the In-Patie nt Se tting at the VA Pittsbur gh Hospital Syste m Ro b e rt K e nda ll, RN, MSN; Pa tric ia F e do rka , PhD, RNC-OB, C-E F M, CNE Ob je c tive s a nd Disc lo sure s  E xpla in ho w the use o f lig ht the ra py c a n b e use d to tre a t pa tie nts with de pre ssive sympto ms in in-pa tie nt se tting s.  De sc rib e the c o st b e ne fit a nd e ffe c tive ne ss o f using lig ht the ra py a s tre a tme nt fo r pa tie nts with de pre ssive sympto ms in the in-pa tie nt se tting s.  T he spe a ke rs ha ve no c o nflic t o f inte re st to disc lo se L ig ht T he ra py fo r T re a tme nt o f De pre ssive Sympto ms Why? Whe re ? Who ? Ho w? K e nd a ll 1

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 Why L ig ht T he ra py?  Pre va le nc e o f de pre ssive sympto ms a c ro ss dia g no se s ◦ PT SD ◦ Bipo la r diso rde rs ◦ Ma jo r de pre ssive diso rde rs ◦ Po st pa rtum de pre ssio n  Study re sults c o mpa ra b le to pha rma c o lo g ic a l tre a tme nt ◦ DSM-V re c o mme nda tio ns  Adva nta g e s o ve r pha rma c o lo g ic a l tre a tme nt ◦ De c re a se d c o sts ◦ De c re a se d side e ffe c ts ◦ Ra pid e ffe c t ◦ I nc re a se d c o mplia nc e ◦ De c re a se d risks in c o mb ining with o the r tre a tme nt mo da litie s Co st Co mpa riso n F luo xe tine L ig ht T he ra py $200 lig ht b o x $24 pe r mo nth $5 ma inte na nc e pe r ye a r Co st fo r o ne ye a r SAD tre a tme nt: $120 Co st fo r o ne ye a r SAD tre a tme nt: $205 Co st fo r two ye a rs: $240 Co st fo r two ye a rs: $210 Co st fo r five ye a rs: $600 Co st fo r five ye a rs: $225 (Che ung , e t a l., 2012) Co st Co mpa riso n  Che ung , e t a l. ◦ Ca na dia n study ◦ SAD- 5 mo nths o f tre a tme nt pe r ye a r ◦ Outpa tie nt- o ne lig ht b o x pe r pa tie nt  E xtra po la te ◦ Using study pe r unit c o sts ◦ No nse a so na l de pre ssio n- 12 mo nths pe r ye a r ◦ Inpa tie nt- lig ht b o xe s use d b y multiple pa tie nts K e nd a ll 2

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 E xtra po la te d Co st Co mpa riso n F luo xe tine L ig ht T he ra py L ig ht b o x: $200 Co st pe r mo nth: $24 Ma inte na nc e pe r ye a r: $5 Co st fo r 1 pa tie nt fo r ye a r: $288 Co st fo r 1 pa tie nt fo r 1 ye a r: $205 Co st fo r 10 pa tie nts fo r 1 ye a r: $2880 Co st fo r 10 pa tie nts fo r 1 ye a r: $205 Co st fo r 10 pa tie nts fo r 5 ye a rs: Co st fo r 10 pa tie nts fo r 5 ye a rs: $225 $14,400 De mo nstra te d E ffe c tive ne ss  Me ta a na lysis sho ws b rig ht lig ht tre a tme nt re sulting in sig nific a nt re duc tio n o f no nse a so na l de pre ssio n sympto m se ve rity in 15 se pa ra te ra ndo mize d, c o ntro lle d tria ls (E ve n, e t a l., 2008)  E ffe c tive a s so le tre a tme nt a nd in c o njunc tio n with pha rma c o lo g ic a l tre a tme nts (E ve n, e t a l., 2008)  I mpro ve d Ha milto n Sc a le sc o re s in e lde rly pa tie nts with no nse a so na l ma jo r de pre ssio n (L ie ve rse , e t a l., 2011)  Re pe a te d sig nific a nt impro ve me nt in de pre ssive sympto ms fro m the first we e k o f tre a tme nt (Pa il, e t a l., 2011) (Ca ma rde se , 2015) De mo nstra te d E ffe c tive ne ss  Outpe rfo rme d tra ditio na l pha rma c o lo g ic a l tre a tme nt in pa tie nts with c hro nic de pre ssio n o f a t le a st 2 ye a rs (E ve n, e t a l., 2008)  Sig nific a nt de c re a se in de pre ssive sympto ms fo r b o th unipo la r a nd b ipo la r pa tie nts who we re re sista nt to pha rma c o lo g ic a l tre a tme nt (Ca ma rde se , e t a l., 2015)  Ha s mo ve d b e yo nd b e ing e xpe rime nta l a nd is no w c o nside re d a n a ffo rda b le a nd po we rful c linic a l inte rve ntio n fo r tre a tme nt o f de pre ssio n K e nd a ll 3

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 Side E ffe c ts Pha rma c o lo g ic a l T re a tme nt • We ig ht g a in • Pa ra d o xa l e ffe c t • Inso mnia • Se xua l dysfunc tio n • Na use a • F a tig ue a nd dro wsine ss • Dry mo uth • Blurre d visio n • Co nstipa tio n • Dizzine ss • Ag ita tio n • Irrita b ility • Anxie ty L ig ht T he ra py • E me rg e nt hypo ma nia • Auto no mic hype ra c tiva tio n Ba rrie rs to I mple me nta tio n Org a niza tio na l ine rtia L imite d pra c titio ne r kno wle dg e (Oldha m 2014) L a rg e numb e r o f sta ke ho lde rs L a c k o f insura nc e c o ve ra g e (Oldha m 2014) Ab se nc e in tre a tme nt a lg o rithms (Oldha m 2014) Initia l inve stme nt in purc ha sing lig ht b o xe s Whe re to Use L ig ht T he ra py?  L ite ra ture a ll invo lve s o utpa tie nt e nviro nme nts  Gre a t po te ntia l fo r inpa tie nt tre a tme nt ◦ L ike ly inc re a se in e ffe c tive ne ss o ve r o utpa tie nt use  I nc re a se d c o mplia nc e  Use in c o mb ina tio n with o the r the ra pie s  E sta b lishing g o o d ha b its b e fo re disc ha rg e ◦ Co nse rva tio n o f re so urc e s  One a ppa ra tus c a n tre a t do ze ns o f pa tie nts  Pa tie nts c a n b e tre a te d b y the ro o mful  T re a tme nt time c a n simulta ne o usly b e use d fo r g ro up the ra py o r o the r inte rve ntio ns K e nd a ll 4

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 Who a re the Sta ke ho lde rs? PMH Nurse Psyc hia trist Psyc ho lo g ist De pa rtme nt o f Ve te ra ns’ Affa irs Pa tie nt F a mily Ho w to I mple me nt L ig ht T he ra py? Suc c e ssful Imple me nta tio n E d uc a tio n Co mmunic a tio n Da ta Pro fe ssio na ls a nd Org a niza tio n Pro vid e rs PMH Nurse Co lle c tio n o rg a niza tio n Pro fe ssio na ls a nd Pa tie nt Ana lysis pa tie nt/ fa mily F a mily Sug g e ste d Pro to c o l 30 minute s pe r die m E xpo sure a t 10,000 lux Auro ra o r No rthe rn L ig hts 10,000 mo de l lig ht Be twe e n 7 a nd 8a m I nc lude a s pa rt o f mo rning me d ro utine K e nd a ll 5

APNA 29th Annua l Co nfe re nc e Se ssio n 3015.2: Oc to b e r 30, 2015 Ho w to Va lida te Re sults? Be fo re T re a tme nt Se ve rity o f Ha milto n De pre ssio n PHQ9 Se lf De pre ssive Ra ting Re po rt Sympto ms Sc a le F o llo wing T re a tme nt Ho w to Va lida te Re sults? Multiple me a suring po ints Multiple to o ls E sta b lishe d to o ls fo r me a suring de pre ssio n Co rre la tio n o f se lf-re po rt a nd pro fe ssio na lly-a dministe re d re sults Wha t is the Ultima te Go a l? I ntro duc ing lig ht the ra py fo r the tre a tme nt o f de pre ssive sympto ms in the inpa tie nt se tting will e na b le the PMH nurse to me e t the physic a l a nd me nta l ne e ds o f the po pula tio n a c ro ss the life spa n, a nd impro ve the po pula tio n’ s me nta l he a lth b y inc re a sing inte r- a nd intra -pro fe ssio na l sta ke ho lde r, e spe c ia lly pa tie nt, c o lla b o ra tio n in tre a tme nt. K e nd a ll 6