An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care

Hilty, Donald M.; Rabinowitz, Terry; McCarron, Robert M.; Katzelnick, David J.; Chang, Trina; Bauer, Amy M.; Fortney, John C.

doi:10.1016/j.psym.2017.12.005

Cited by 80 publications

(42 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TMH can be delivered with a range of intensities, from curbside consultation to referral for ongoing care . The 2 most effective models of TMH are collaborative care and referral care .…”

mentioning

confidence: 99%

“…[6][7][8] TMH can be delivered with a range of intensities, from curbside consultation to referral for ongoing care. 9,10 The 2 most effective models of TMH are collaborative care and referral care. 9 The TMH Collaborative Care model involves off-site mental health providers collaborating and consulting with the primary care team to manage patients without providing treatment directly.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

Fortney

Veith

Bauer

et al. 2018

The Journal of Rural Health

Self Cite

View full text Add to dashboard Cite

Background Federally Qualified Health Centers (FQHCs) deliver care to 26 million Americans living in underserved areas, but few offer telemental health (TMH) services. The social missions of FQHCs and publicly funded state medical schools create a compelling argument for the development of TMH partnerships. In this paper, we share our experience and recommendations from launching TMH partnerships between 12 rural FQHCs and 3 state medical schools. Experience There was consensus that medical school TMH providers should practice as part of the FQHC team to promote integration, enhance quality and safety, and ensure financial sustainability. For TMH providers to practice and bill as FQHC providers, the following issues must be addressed: (1) credentialing and privileging the TMH providers at the FQHC, (2) expanding FQHC Scope of Project to include telepsychiatry, (3) remote access to medical records, (4) insurance credentialing/paneling, billing, and supplemental payments, (5) contracting with the medical school, and (6) indemnity coverage for TMH. Recommendations We make recommendations to both state medical schools and FQHCs about how to overcome existing barriers to TMH partnerships. We also make recommendations about changes to policy that would mitigate the impact of these barriers. Specifically, we make recommendations to the Centers for Medicare and Medicaid about insurance credentialing, facility fees, eligibility of TMH encounters for supplemental payments, and Medicare eligibility rules for TMH billing by FQHCs. We also make recommendations to the Health Resources and Services Administration about restrictions on adding telepsychiatry to the FQHCs’ Scope of Project and the eligibility of TMH providers for indemnity coverage under the Federal Tort Claims Act.

show abstract

“…TMH can be delivered with a range of intensities, from curbside consultation to referral for ongoing care . The 2 most effective models of TMH are collaborative care and referral care .…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

Fortney

Veith

Bauer

et al. 2018

The Journal of Rural Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…The most influential papers about TBH over the past two decades are on the following themes: (1) effectiveness [14], (2) guidelines by the American Telemedicine Association (ATA) [15,16], (3) summary of outcomes including randomized controlled trials [17], (4) models of service delivery [18], (5) hybrid models of care [19], and (6) interventions with population-level impact [20]. Evaluation of TBH has gone through three phases related to effectiveness: ability to increase access to care, validity and reliability compared to inperson services, and delivery models for complex populations [14][15][16][20][21][22].…”

Section: The Telebehavioral Health Evidence-basementioning

confidence: 99%

The Need to Implement and Evaluate Telehealth Competency Frameworks to Ensure Quality Care across Behavioral Health Professions

Hilty

Maheu²,

Drude

et al. 2018

Acad Psychiatry

Self Cite

View full text Add to dashboard Cite

Technology is rapidly becoming a key player in care delivery, lifelong learning, and education/training. The American Psychiatric Association Practice-Based Learning and Improvement Core Competencies include the use information technology and lifelong learning [1]. Current competencybased education (CBE) focuses on skills rather than on what is taught [2,3]. Competency may be defined as a measurable human capability required for effective performance [4]. The Institute of Medicine (IOM) [5] suggested three key elements for patient-centered care: skills-focused education, interdisciplinary team-based care, and a technology/informaticsoriented administrative approach.A key premise of telepsychiatric competencies published in 2015 [6] is that faculty clinicians and educators have to first improve their care via clinical and technological competence, in order to then oversee trainees' use of technologies in clinical care. Fundamental steps to this work are the alignment of clinical outcomes with teaching/supervisory methods, evaluation, and feedback [6,7]. Professional association standards and guidelines typically do not focus on competencies, are complex, and are frequently incomplete (e.g., diverse populations and settings) [6][7][8], and comparisons across professions are rare [7].Telebehavioral health (TBH) is a broad term inclusive across behavioral health professions and technically includes both mental health and substance use care; in this paper, it will also include TP. Each BH discipline and field has its own nomenclature for telehealth (e.g., telepsychiatry, telepsychology, distance counseling) [9], though competencies related to technological standards were suggested years ago [10,11]. A TBH competency set arrived in [12] and a specific one for use of social media arrived in 2018 [13]. Care delivered by TBH may require additional skills-or adjusted behaviors-compared to in-person care [6,7,[11][12][13].The current paper will:1. Review TBH evidence relevant to competencies, guidelines, and standards and compare similarities and differences across professions related to integrating technology in practice 2. Highlight TBH competency sets to date 3. Discuss implications of implementing TBH competencies across professions. The Telebehavioral Health Evidence-BaseClinical Services, Outcomes, and EvaluationThe most influential papers about TBH over the past two decades are on the following themes: (1) effectiveness [14], (2) guidelines by the American Telemedicine Association (ATA) [15, 16], (3) summary of outcomes including randomized controlled trials [17], (4) models of service delivery [18], (5) hybrid models of care [19], and (6) interventions with population-level impact [20]. Evaluation of TBH has gone through three phases related to effectiveness: ability to increase access to care, validity and reliability compared to inperson services, and delivery models for complex populations [14][15][16][20][21][22]. TBH clinical assessment, psychological and cognitive testing, triage, and management/treatment serv...

show abstract

“…As an innovative, technology-supported approach to integrated care, real-time video consultations conducted by MHS are increasingly considered to be an alternative to in-person settings. Systematic reviews point to the general effectiveness of telemedicine interventions for mental health conditions 14–16. Concerning the integration of telepsychiatry services in primary care as such, several observational and interventional studies demonstrate that mental health specialist video consultations (MHSVCs) contribute to overcoming geographical barriers and to treating the increasing number of multimorbid patients often cut off from specialised care 17–20.…”

Section: Introductionmentioning

confidence: 99%

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

et al. 2019

View full text Add to dashboard Cite

IntroductionMost people suffering from depression and anxiety disorders are entirely treated in primary care. Due to growing challenges in ageing societies, for example, patients’ immobility and multimorbidity, the transition to specialised care becomes increasingly difficult. Although the co-location of general practitioners and mental health specialists improves the access to psychosocial care, integrated in-person approaches are not practical for rural and single-doctor practices with limited personnel and financial resources. Treating primary care patients via internet-based video consultations by remotely located mental health specialists bears the potential to overcome structural barriers and provide low-threshold care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing of mental health specialist video consultations in primary care practices.Methods and analysisFifty primary care patients with significant depression and/or anxiety symptomatology will be randomised in two groups receiving either the treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. The video consultations focus on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices’ workflows, feasibility of the data collection and clinical parameters.Ethics and disseminationThis trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-634/2018). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial.Trial registration numberDRKS00015812.

show abstract

An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care

Cited by 80 publications

References 53 publications

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

The Need to Implement and Evaluate Telehealth Competency Frameworks to Ensure Quality Care across Behavioral Health Professions

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

Contact Info

Product

Resources

About