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Five-year study shows success of telepsychiatry

Journal of Business - 9/22/2021

Virtual formats benefit rural patients having PTSD, bipolar disorder

Telepsychiatry in rural health centers has been a "resounding success" for patients who had screened positive for bipolar disorder or post-traumatic stress disorder, according to a five-year study conducted by a team that includes University of Washington researchers.

The results of the study, titled The Study to Promote Innovation in Rural Integrated Telepsychiatry, or SPIRIT, were published Aug. 25 in JAMA Psychiatry.

SPÍRIT was designed to identify the best approach to delivering tele-mental health services to rural primary-care clinics.

"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," says lead researcher John Fortney, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.

The trial, which was the largest telepsychiatry trial to date, had 1,004 participants who were enrolled from 24 federally qualified health centers in Washington, Arkansas, and Michigan.

Without telepsychiatry, most of these patients likely wouldn't receive help from a mental health specialist for their complex psychiatric disorders, the researchers contend.

In fact, only onethird of people with bipolar disorder and PTSD receive specialty mental health care in a year, the study says.

The researchers say only 10% of patients with such disorders receive adequate care in primary care settings.

One participant cited in the study is John Nolan, who served in - the U.S. Army and Marines and later worked in law enforcement and as a correctional officer.

A career spent dealing with traumatic events led to PTSD and insomnia. Nolan says he felt like his life was spinning out of control.

Nolan, who says he had been "greatly helped" by telepsychiatry services in his town, 125 miles from Little Rock, Arkansas, was invited to become chairman of the community advisory board for the SPIRIT trial.

Nolan had originally enrolled in an earlier study titled Telemedicine for Outreach for PTSD, which also was overseen by Fortney and was conducted at the U.S. Department of Veterans Affairs facilities, in Little Rock.

Nolan says, "It made a huge difference in my life."

He adds that he could hear the hope and relief in the voices of participants who shared their stories in a video documentary filmed as the SPIRIT trial wound down.

The trial compared two interactive video approaches to integrate remote specialty mental health services in participating clinics. Tele-referral services involved one-on-one visits with a psychiatrist or licensed clinical psychologist.

Tele-collaborative services involved telepsychiatry and care manager supporting visits with a primary care provider. This collaborative model, pioneered at the UW School of Medicine, allows a psychiatrist to manage more patients than the traditional referral model.

After patients completed the baseline survey, they were randomized to either get tele-referral care or tele-collaborative care.

The clinics partnered with medical schools to provide telepsychiatry and telepsychology services. While many federally qualified health centers provide mental health care, only about 10% of staff are psychiatrists or licensed clinical psychologists, Fortney said.

By providing care from medical schools, they minimized patients' travel burdens. And the potential stigma of a mental health care visit was averted by having the medical school providers credentialed to practice at the health center, giving the appearance of a regular health care visit.

Patients in both groups reported statistically significant improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life.

Dr. Paul Pfeiffer, associate professor of psychiatiy at the University of Michigan Medical School, says the study found no difference between the groups, and there were no differences in outcomes regarding age, gender, race, or ethnicity.

"One of the major contributions of this study is what we knew to be effective for depression and anxiety we now know also achieves good outcomes for patients with PTSD and bipolar disorder," says Pfeiffer, who led the study's Michigan-based activities.

The trial results come as the COVID-19 pandemic has enabled providers and patients alike to experience virtual care and to see the benefits for themselves, paving the way for wider adoption of telepsychiatry, the researchers note.

Dr. Jürgen Unützer, chair of the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine, asserts both the timing and impact of this trial are important.

"We're at a time now where almost everybody has come to realize what a huge burden untreated mental illness and addiction problems have been." Uniitzer says.

While he contends there is still a critical shortage of psychiatrists, psychologists, clinical social workers, and counselors, Unützer says the SPIRIT trial indicates the available workforce can be distributed more effectively.

This trial was funded by the Patient-Centered Outcomes Research Institute.