Tuesday, November 29, 2022

Telepsychiatry Collaborative Care Found Effective for Treatment of Complex Disorders in Rural Areas

Telepsychiatry collaborative care (TCC) can help primary care clinicians working in rural or underserved areas to identify and treat patients with posttraumatic stress disorder (PTSD) and bipolar disorder with more confidence. These were the findings of a report published today in Psychiatric Services, which describes how care managers, primary care clinicians, and telepsychiatrists work together to support these patients.

Theresa J. Hoeft, Ph.D., of the University of Washington and colleagues analyzed data from the Study to Promote Innovation in Rural Integrated Telepsychiatry trial. The trial was conducted in 24 community health centers associated with 12 Federally Qualified Health Centers (FQHCs) in underserved areas of Arkansas, Michigan, and Washington between 2016 and 2020.

As part of this trial, patients with PTSD or bipolar disorder were randomly assigned to receive TCC or referral for direct treatment by a telepsychiatrist or telepsychologist for up to 12 months. Patients in the TCC group saw a telepsychiatrist over a videoconference for an initial visit. The consulting telepsychiatrist then communicated the diagnosis and treatment plan through the electronic health record or the care manager to the primary care clinician, who oversaw the patients’ care (including prescribing medications).

Hoeft and colleagues conducted 30- to 60-minute interviews with 22 primary care clinicians who had patients assigned to the TCC group. Clinicians were asked to describe their role on the TCC team, experiences communicating and working with team members, and the extent to which TCC changed how they managed patients’ mental health care. The authors highlighted several key takeaways from these interviews:

  • Primary care clinicians—especially early career clinicians—appreciated support from the telepsychiatrist consultant both in medication management and in improving their ability to recognize, diagnose, and treat PTSD and bipolar disorder.
  • Primary care clinicians identified the care manager (typically a social worker or registered nurse) as key to fostering communication between clinical care team members and with each patient. The authors noted that while the clinicians could access the telepsychiatrist’s notes via the electronic health record, they had minimal real-time interaction with the telepsychiatrist and relied on care managers for this information. Similarly, these managers “ensured that information on diagnosis, medication management, and side effects was clearly communicated to the clinician and patient while also relaying treatment progress to the telepsychiatrist consultant.”
  • Primary care clinicians noted TCC increased patient engagement, and collaboration with the clinical manager reduced clinicians’ administrative burden.

“Primary care clinicians in underserved areas valued TCC and offered positive feedback about their experiences treating patients with PTSD or bipolar disorder,” Hoeft and colleagues wrote. “This approach has the potential to extend the reach of specialty mental health care and to support primary care clinicians treating patients with these more complex psychiatric disorders.”

For related information, see the Psychiatric News article “Collaborative Care as a Way to Stave Off Burnout.”

(Image: iStock/Anchiy)

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