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Rural Patients With PTSD, Bipolar Disorder Engage Well in Telehealth Approaches
A study looking at 2 models of telehealth found that both approaches offer an opportunity to treat patients with complex psychiatric conditions who otherwise have limited access to mental health specialists. Researchers published findings from the study, which was conducted before the COVID-19 pandemic, in the Journal of General Internal Medicine.
“The study started at a time where clinicians had reservations about treating psychiatrically complex patients with telehealth or integrated care models. Understandably, engagement in care was one of the many concerns,” said study lead author Jennifer Severe, MD, of the psychiatry department at Michigan Medicine, the University of Michigan’s academic medical center. “This study showed that patients with multiple psychiatric conditions and who also struggle with several chronic physical health problems can engage well in mental health treatment with their primary care doctors or remote mental health specialists.”
The study included 1004 adults with post-traumatic stress disorder (PTSD), bipolar disorder, or both conditions at safety-net clinics in Michigan, Washington, and Arkansas. Researchers were interested in identifying clinical predictors of patient engagement in care for 2 telehealth approaches: (1) telepsychiatry collaborative care, in which a psychiatrist makes the initial diagnosis via video, the local primary clinic team provides brief psychotherapy, and the local primary care physician handles prescriptions with consultation from the telepsychiatrist; and (2) telepsychiatry/telepsychology enhanced referral, in which a psychiatrist makes the initial diagnosis and handles prescriptions, and a psychologist provides psychotherapy, via telehealth.
Patients responded well to medication and psychotherapy with either approach, the study found.
However, patients randomized to telepsychiatry collaborative care, which provided a form of psychotherapy from a specially trained nurse or social worker at the primary care clinic, completed 60% more session than patients who received psychotherapy solely via telehealth.
The study also showed that patients with bipolar disorder who had manic symptoms had reduced odds of initiating psychotherapy, while patients with drug issues tended to attend fewer psychotherapy sessions. Meanwhile, patients with multiple physical health comorbidities had greater engagement in psychotherapy and pharmacotherapy.
“Both models can be offered based on primary care practice resource availability,” researchers wrote. “Telepsychiatry collaborative care may be more favorable from a population health perspective insofar as it efficiently reaches and links more patients with mental health services compared to telepsychiatry/telepsychology enhanced referral.”
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