BACKGROUND: Asynchronous (delayed time) Telepsychiatry (ATP) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with Synchronous Telepsychiatry (STP) are lacking. OBJECTIVE: The aim of this study was to determine the effectiveness of ATP in improving clinical outcomes in English and Spanish speaking primary care patients, as compared with STP, the telepsychiatry "usual care" method. METHODS:Thirty-six primary care physicians (PCP) from 3 primary care clinics referred a heterogeneous sample of 401 treatment seeking adult patients with non-urgent psychiatric disorders. A total of 184 (94 ATP, 90 STP) English and Spanish speaking participants (20% Hispanic) were enrolled and randomized;160 (80 ATP, 80 STP) completed baseline evaluations. Patients were treated by their PCPs using a collaborative care model in consultation with University of California Davis Health telepsychiatrists who consulted with the patients every 6 months for up to 2 years using ATP or STP. Primary (clinician rated Clinical Global Impressions scale [CGI] and the Global Assessment of Functioning [GAF]) and secondary (patients' self-reported physical and mental health, and depression) outcomes were assessed every 6 months. RESULTS: For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at the 6- (ATP vs. STP, adjusted difference in follow-up at 6 months vs. baseline differences for CGI: 0.2, 95%CI -0.2 to 0.6, P=.28 and GAF: -0.6, 95%CI -3.1 to 1.9, P=.66) or 12-month follow-up (ATP vs. STP, adjusted difference in follow-up at 12 months vs. baseline differences for CGI: 0.4, 95%CI -0.04 to 0.8, P=.07 and GAF: -0.5, 95%CI -3.3 to 2.2, P=.70), but patients in both arms had statistically and clinically significant improvements on both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all Ps>.15). Dropout rates were higher than predicted, but similar in the two arms. Of those with baseline visits, 75/160 (47%) did not have a follow-up at 1 year and 107/147 (75%) at 2 years. No serious adverse events were related to the intervention. CONCLUSIONS: This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English and Spanish speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. CLINICALTRIAL: Clinicaltrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
RCT Entities:
BACKGROUND: Asynchronous (delayed time) Telepsychiatry (ATP) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with Synchronous Telepsychiatry (STP) are lacking. OBJECTIVE: The aim of this study was to determine the effectiveness of ATP in improving clinical outcomes in English and Spanish speaking primary care patients, as compared with STP, the telepsychiatry "usual care" method. METHODS: Thirty-six primary care physicians (PCP) from 3 primary care clinics referred a heterogeneous sample of 401 treatment seeking adult patients with non-urgent psychiatric disorders. A total of 184 (94 ATP, 90 STP) English and Spanish speaking participants (20% Hispanic) were enrolled and randomized;160 (80 ATP, 80 STP) completed baseline evaluations. Patients were treated by their PCPs using a collaborative care model in consultation with University of California Davis Health telepsychiatrists who consulted with the patients every 6 months for up to 2 years using ATP or STP. Primary (clinician rated Clinical Global Impressions scale [CGI] and the Global Assessment of Functioning [GAF]) and secondary (patients' self-reported physical and mental health, and depression) outcomes were assessed every 6 months. RESULTS: For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at the 6- (ATP vs. STP, adjusted difference in follow-up at 6 months vs. baseline differences for CGI: 0.2, 95%CI -0.2 to 0.6, P=.28 and GAF: -0.6, 95%CI -3.1 to 1.9, P=.66) or 12-month follow-up (ATP vs. STP, adjusted difference in follow-up at 12 months vs. baseline differences for CGI: 0.4, 95%CI -0.04 to 0.8, P=.07 and GAF: -0.5, 95%CI -3.3 to 2.2, P=.70), but patients in both arms had statistically and clinically significant improvements on both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all Ps>.15). Dropout rates were higher than predicted, but similar in the two arms. Of those with baseline visits, 75/160 (47%) did not have a follow-up at 1 year and 107/147 (75%) at 2 years. No serious adverse events were related to the intervention. CONCLUSIONS: This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English and Spanish speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. CLINICALTRIAL: Clinicaltrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
Authors: Monica K Lieng; Magi S Aurora; Young Kang; Joseph M Kim; James P Marcin; Steven R Chan; Jamie L Mouzoon; Daniel J Tancredi; Michelle Parish; Alvaro D Gonzalez; Lorin Scher; Glen Xiong; Robert M McCarron; Peter Yellowlees Journal: Telemed J E Health Date: 2021-11-02 Impact factor: 5.033