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Study Affirms Strategies for Telepsychiatry Care Delivery

Analysis  |  By John Commins  
   September 14, 2021

The study sought to determine whether an integrated or referral approach was more effective when providing clinic-to-clinic mental health care in a primary care setting. 

Telepsychiatry delivered from rural, federally qualified health centers provides highly effective treatment for patients struggling with care access for complex mental health disorders.

However, integrated telepsychiatry allows for more efficient use of precious and sparse mental health resources than do traditional referrals,  according to a study published in JAMA Psychiatry.

The five-year trial -- Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) -- examined the efficacy of remote mental healthcare access for 1,004 patients who had been screened for post-traumatic stress disorder and/or bipolar disorder and who were receiving telepsychiatry from one of 24 federally qualified health centers in Washington, Arkansas, and Michigan.

The study, conducted by researchers from the University of Michigan Medicine School and the University of Washington School of Medicine, sought to determine whether the integrated or referral approach was more effective when providing clinic-to-clinic mental health care in a primary care setting via interactive video.  

Tele-referrals require one-on-one visits with a psychiatrist or psychologist. Tele-collaboratives use a telepsychiatrist and care manager to support a primary care provider, which allows a psychiatrist to manage more patients than the referral model.

"Both approaches significantly and substantially improved clinical outcomes. The referral approach used substantially more mental health specialist time than the integrated approach," the researchers wrote.  

"Based on findings from this trial, from a healthcare system perspective, clinical leadership should implement whichever approach is most sustainable; from a societal perspective, policy makers should incentivize the integrated approach because it required less scarce mental health specialist time."

The patients in the study were divided to receive either tele-referral care or tele-collaborative care, and the clinics partnered with the state medical schools to provide the care. 

Patients in both groups reported improvements in access to care and quality of life and decreases in their mental health symptoms and medication side effects, with no differences between the groups, and no differences based on age, sex, race, or ethnicity.

"The results of our trial showed that if you give access to high-quality care for patients who are underserved, they improve their quality of life," said lead researcher John Fortney, Ph.D., a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.    

“The results of our trial showed that if you give access to high-quality care for patients who are underserved, they improve their quality of life.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The trial examined the efficacy of remote mental healthcare access for 1,004 patients who had been screened for post-traumatic stress disorder and/or bipolar disorder and who were receiving telepsychiatry from one of 24 FQHCs.

Tele-referrals require one-on-one visits with a psychiatrist or psychologist. Tele-collaboratives use a telepsychiatrist and care manager to support a primary care provider, which allows a psychiatrist to manage more patients.


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