E05 – PCORI Trial Comparing Telepsychiatry Collaborative Care to Telepsychiatry Referral Care: SPIRIT Study to Promote Innovation in Rural Integrated Telepsychiatry

Summary

Only a third of patients with complex psychiatric disorders, such as PTSD or bipolar disorder, engage in specialty mental health care.  Of those seen in primary care, only a tenth receive adequate treatment.  Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. This session will report the results of a large PCORI-funded trial designed to compared two clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients with PTSD and/or bipolar disorder in primary care clinics.  Twenty-four primary care clinics without on-site psychiatrists or psychologists from 12 Federally Qualified Health Centers in three states participated in this pragmatic trial.  Adult patients (n=1,004) patients screening positive for posttraumatic stress disorder and/or bipolar disorder who were not already receiving pharmacotherapy from a mental health specialist were enrolled.  Patients were randomized to receive either: 1) Telepsychiatry/Telepsychology Enhanced Referral where telepsychiatrists and telepsychologists assumed responsibility for treatment, or 2) Telepsychiatry Collaborative Care where telepsychiatrists provided consultation to the primary care team.  Patients in both groups experienced a substantial and statistically significant increase in perceived access, decreases in symptoms and medication side-effects, and improvements in quality of life.  There were no differences in outcomes with regard to age, gender, race or ethnicity, indicating that both approaches mitigated health disparities.  While practices should adopt whichever approach is the most feasible to implement, it is important to note that the referral model used three times more scarce telepsychiatrist time than did the collaborative care model.