Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care

Abstract

PURPOSE There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. We investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics. METHODS We developed and pilot-tested a qualitative interview guide based on a conceptual model of training and learning. We conducted individual semistructured interviews in 2018 with diverse clinical and nonclinical staff at 3 rural primary care sites in Washington state that used ongoing collaborative care and telepsychiatric consultation. Two qualitative researchers independently analyzed transcripts with iterative input from other research team members. RESULTS A total of 17 clinical, support, and administrative staff completed interviews. Participants' feedback supported the view that telepsychiatric case reviewbased consultation enhanced skills of diverse clinical team members over time, even those who had not directly participated in case reviews. All interviewees identified specific ways in which the consultations improved their capacity to identify and treat psychiatric disorders. Perceived benefits in implementation and sustainability included fidelity of the care process, team resilience despite member turnover, and enhanced capacity to use quality improvement methods. CONCLUSIONS Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration.

The Attitudes and Perceptions of Israeli Psychiatrists Toward Telepsychiatry and Their Behavioral Intention to Use Telepsychiatry

“…The global median number of psychiatrists is ~1:100,000 people, making them a rare resource in mental health systems around the world ( 2 ). In an attempt to mitigate the shortage in human medical resources, to increase access to mental health services, and to reduce psychiatrists' burnout without compromising quality and satisfaction, there is a recommendation to use telemedicine in mental health ( 3 , 4 ). Telemedicine is defined as “the delivery of health care and the exchange of health-care information across distances” ( 5 ).…”

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“…Recently, with the aim of improving compatibility with small and/or remote primary care practices, integrated care has been expanded by introducing video-based integrated mental health care [20][21][22][23][24][25][26][27]. Leveraging expertise at a distance, MHS located off-site provide video consultations to patients presenting with mental health conditions in primary care practices [28]. PCPs and their patients have increasingly used video consultations as an alternative to face-to-face consultations in recent years.…”

Community Health Outside the Exam Room

“…In addition to the changes described earlier, we implemented FNP/PMHNP Consultation Units (CUs) 12 at the beginning of the next seminar series. The CUs were small groups of FNP and PMHNP students who met several times online through the semester to review and discuss case studies.…”