Thursday, September 2, 2021

Telepsychiatry-Based Collaborative Care Approach as Effective as Traditional Referrals

A telepsychiatry-based collaborative care model (CoCM) for managing patients with posttraumatic stress disorder (PTSD) or bipolar disorder was as effective as telepsychiatry-enhanced referral at improving patient outcomes over one year, according to a study in JAMA Psychiatry.

“This study expands the evidence base for CoCM in two ways: First, it demonstrates that the CoCM can effectively manage more complex [psychiatric] disorders just as well as referring to a specialist,” lead author John C. Fortney, Ph.D., the director of the Division of Population Health and professor of psychiatry and behavioral sciences at University of Washington’s School of Medicine, told Psychiatric News. “Second, it adds to the small evidence base that CoCM can be delivered through a virtual care team using video visits. In other words, members of the CoCM team do not need to be physically located together.”

The study took place in 24 primary care clinics that had no psychiatrist or psychologist on site in rural Arkansas, Michigan, and Washington. All 1,004 participants were adults who screened positive PTSD and/or bipolar disorder during an annual wellness visit. Most were already receiving psychotropic medications prescribed by a primary care physician, but none were seeing a mental health specialist. The patients were randomized to one of the following groups:

  • Telepsychiatry collaborative care: Following a diagnostic assessment from a consulting telepsychiatrist, patients were prescribed all psychotropic medications by the primary care clinician, who was supported by behavioral health care managers (for example, social workers or nurses) and off-site telepsychiatrist consultants. Behavioral health care managers, who checked in with telepsychiatrists weekly, monitored patient symptoms and provided psychoeducation, psychotherapy, and treatment engagement activities.
  • Telepsychiatry/telepsychology–enhanced referral: Patients were referred for a telepsychiatry visit to confirm a diagnosis and develop a treatment plan. Afterwards, the telepsychiatrist ordered lab tests, prescribed medications, and/or referred for psychotherapy. Telepsychiatrists and telepsychologists monitored patient symptoms.

The patients were given phone or online surveys at baseline, six months, and 12 months to assess their mental health functioning using the Veterans RAND 12-item Health Survey Mental Component Summary (MCS).

The researchers found that patients in both groups experienced large, clinically meaningful improvements in MCS scores from baseline to 12 months (9-point to 10-point increase on average). Both groups also had greater perceived access to and engagement in care and experienced fewer adverse effects from psychotropic medications. However, the telepsychiatry/telepsychology–enhanced referral group had three times more encounters with telepsychiatrists (4.3 visits on average for referral group vs. 1.4 visits for collaborative care group).

“From a health care system perspective, [the] results suggest that clinical leadership should implement whichever evidence-based practice [collaborative care or referral] is most sustainable,” Fortney and colleagues wrote. “From a societal perspective, [telepsychiatry collaborative care] should be incentivized by policy makers because it leverages scarce telepsychiatrist capacity through consultation and case-review.”

For related information, see the Psychiatric News article “Collaborative Care Fits COVID-19 Workflows.”

(Image: iStock/DjelicS)

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