By OPEN MINDS Circle
By using telepsychiatry, Federally Qualified Health Centers (FQHCs) in rural areas were able to manage the mental health care for people diagnosed with bipolar disorder and/or post-traumatic stress disorder (PTSD). Using telepsychiatry for consumers with these illnesses, improvements were noted in perceived access to care, decreases in mental health symptoms, and decreases in medication side effects. Quality of life scores improved by 32% based on the Veterans RAND 12-item Health Survey (VR-12) Mental Component Summary (MCS).
FQHCs delivered telehealth mental health services using two models: telepsychiatry/telepsychology enhanced referral (TER) and telepsychiatry collaborative care (TCC). In TER, the remote professionals assumed responsibility for treatment, primarily cognitive processing therapy and/or cognitive behavioral therapy. For consumers who did not engage in treatment, TER also included an adaptive interventionātelephone-enhanced referralāwhich involved telephone outreach and motivational interviewing. In TCC, the remote psychiatrist consulted with the FQHC primary care team to conduct an initial telehealth consultation with the consumer to establish the diagnosis and recommend medications to prescribe, and later consult weekly with on-site care managers who provided behavioral activation for the consumer. The researchers compared the effectiveness of TER and TCC.
Mental health-related quality -of-life outcomes were measured using the VR-12 MCS. The VR-12 is a brief, generic, multi-use, self-administered health survey comprised of 12 items, which measures health-related quality of life (with a range of 0, the worst, to 100, the best), to estimate disease burden and to evaluate disease-specific benchmarks with other populations. For TER, MCS scores increased 32%, from 31.3 at baseline to 41.2 at 12 months. For TCC, MCS scores increased 31%, from 30.4 to 39.7. There was no difference between the two groups, and there were no differences in outcomes regarding age, gender, race, or ethnicity.
Both groups reported large and clinically meaningful score decreases in their PTSD Check List (PCL-5) scores from baseline to 12 months, indicating that their PTSD severity had declined. For TER, PCL-5 scores decline from 47.7 at baseline to 31.1. For TCC, the scores declined from 48.2 to 35.7. Both groups had large increases in the proportion of days without mood disturbances, from 0.11 days to 0.22 days for the TER group, and from 0.08 days to 0.23 days in the TCC group.
These findings were reported in āComparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care; A Pragmatic Randomized Comparative Effectiveness Trialā by John C. Fortney, Ph.D.; Amy M. Bauer, MS, M.D.; Joseph M. Cerimele, MPH, M.D.; and colleagues. The researchers compared the outcomes of The Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) tele-referral approach to outcomes of the tele-collaborative approach. They tested the two approaches at 24 FQHCs located in Washington, Arkansas, and Michigan. In total, 1,004 people were enrolled. Each completed a baseline survey and were then randomized to receive tele-referral care or tele-collaborative care. Health care organizations partnered with the state medical schools to provide the telepsychiatry and telepsychology services. The goal was to determine whether it is better for offsite mental health specialists to support primary care providers’ treatment of patients with PTSD and/or bipolar disorder through an integrated care model or to use telemedicine technology to facilitate referrals to offsite mental health specialists.
For more information, contact: John Fortney, Ph.D., Director of the Division of Population Health & Professor, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356560, Seattle, Washington 98195-6560; 206-685-6955; Email: fortneyj@uw.edu; Website: https://psychiatry.uw.edu/profile/john-fortney-2/