Comparison Of Two Telehealth Models for Primary Care Patients Screening Positive for Bipolar Disorder and/or PTSD: Translating Clinical Trial Results into Action

Abstract: Bipolar disorder and PTSD are prevalent among patients in primary care settings, yet individuals with these conditions rarely receive adequate mental health care in primary care settings. Scalable primary care approaches to providing mental health treatment to patients living with these conditions are sorely needed.

This first half of this interactive workshop will present the rationale, study, design, and key quantitative and qualitative findings from the Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT), the largest mental health treatment trial among rural Americans (n=1,004). In the second half, we will engage the audience in a series of conversations and activities designed to stimulate translation of the findings into actionable steps in clinical practice.

Dr. Unutzer will serve as moderator and will introduce the rationale and study design and provide an overview of the context and relevance for CL psychiatrists. SPIRIT was a randomized pragmatic effectiveness trial that compared two telehealth approaches to delivering evidence-based mental health treatments to patients who screened positive for PTSD and/or bipolar disorder. It was conducted in 24 primary care clinics from 12 Federally Qualified Health Centers in three states.

Dr. Bauer and Dr. Cerimele will provide details for each of the clinical models and discuss the study’s quantitative findings. Characteristics of patients screening positive for PTSD and bipolar disorder will be described and the screening false positive rate will be reviewed. The two models were: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly. Patients in both groups experienced large and clinically meaningful improvements in mental health functioning from baseline to 12-months and there were minimal between-group differences.

Dr. Howland will discuss qualitative findings that focus on individual-level experiences of care, including the perspectives from patients and providers (care managers, primary care providers, telepsychologists, and telepsychiatrists). She will pose questions and use case-based approaches to explore effective interprofessional communication strategies for increasing provider satisfaction with telehealth models. Finally, she will identify methods for addressing workflow-related barriers to provider satisfaction.

The workshop will stimulate audience engagement around the topic of translation of SPIRIT findings into attendees’ practice settings. We will poll the audience about their current practice experience treating patients with bipolar disorder and/or PTSD in ambulatory medical settings. We will pose questions to reflect on current practices including screening, structured assessment, symptom monitoring, and clinic workflows. Using a case-based approach and common scenarios in implementation, we will identify opportunities for practice improvement. We will discuss sustainment strategies relevant to supporting and retaining clinicians in their roles. The workshop will conclude with time for open questions and answers from participants.