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The asynchronous telepsychiatry model of collaborative care virtual visits supporting the patient-centered medical home
LK 101
The asynchronous telepsychiatry model of collaborative care virtual visits supporting the patient-centered medical home
Background: Health information technologies — such as telemedicine — have been identified as important tools in advancing the patient-centered medical home (PCMH) by streamlining communication, boosting... Read more

Description

Background: Health information technologies — such as telemedicine — have been identified as important tools in advancing the patient-centered medical home (PCMH) by streamlining communication, boosting access, and decreasing time delays in seeing a specialist from months to minutes. Within mental health, studies show that telepsychiatry can help patients gain better access to specialists. However, telepsychiatry (STP), which traditionally uses synchronous, live two-way videoconferencing, has scheduling issues, cost limitations, and administrative barriers — similar to in-person care — that have prevented wide-scale use of this technology. A novel method, asynchronous telepsychiatry (ATP), a virtual mental health visit, is a more rapid, efficient, and administratively simple way for primary care providers to gain access to psychiatric expertise —supporting a collaborative model of care.

ATP is an emerging technology in the field of mental health that supports PCMH and in particular helps PCP's better manage patients with comorbid physical conditions and mental illness. ATP also encourages patient involvement in their own mental health care by creating a patient-provider-specialist communication triangulation and paves the way to utilize patient-generated data in routine mental health care. Following successful pilots, feasibility trials, and preliminary cost-benefit analysis, we are conducting a randomized clinical trial of clinical outcomes, funded by the Agency for Healthcare Research and Quality (AHRQ), evaluating the clinical effectiveness of ATP compared with STP.

Methods: English- and Spanish-speaking adult patients referred by their PCP for evaluation for a non-urgent mental health issue — mood, anxiety, substance abuse or posttraumatic stress disorder (PTSD) — were recruited from rural and urban primary care clinics, screened and randomized into one of two treatment arms: (1) STP — in which the patient speaks through live, real-time videoconferencing to a psychiatrist, or (2) ATP — in which a local clinician interviews the patient, and a video of the encounter and clinical progress note is recorded and sent to a psychiatrist for consultation. Consultation and patient- provider- specialist communication is fully integrated into the secure electronic medical record and clinical communications infrastructure of the University of California Davis Health System. A total of five appointments over 2 years of follow up are planned for each of over 200 enrolled patients.

Results: Data from the first 50 patients enrolled from rural and urban primary care clinics will be presented. Preliminary qualitative analyses from participating psychiatrists and PCP's indicate wide acceptance of the ATP consultation model. Advantages noted by the psychiatrists include the ability for consultants to rewind videos and compare changes over time, to observe the interaction between the interviewer and interviewee, to multitask during consultations and to easily fit ATP consults into their schedules. Advantages noted by PCPs and patients are shorter wait times for appointments and quicker access to the psychiatrist’s recommendations. 

Conclusions: ATP is clinically acceptable to providers and specialists. We are collecting satisfaction and clinical outcome metrics from the primary care providers and the patients as well as conducting a wide scale cost-benefit analysis of the two models of care.

Michelle Burke Parish is a project manager in clinical research at the University of California, Davis in the Department of Psychiatry and Behavioral Sciences. Mrs. Burke Parish has a Masters Degree in Psychology and is a candidate for a Doctor of Philosophy in Nursing Science and Healthcare Leadership at the University of California, Davis. She has participated in research in clinical psychology, neuroscience and telepsychiatry and e-health. She is a contributing author in the area of telemedicine, e-health and applications of social media in healthcare. She is currently working with Dr. Peter Yellowlees on research to validate asynchronous telepsychiatry.

Dr Yellowlees is Vice Chair for Faculty Development and Professor of Psychiatry at UC Davis, where he also is Chair of the Medical Staff Wellbeing Committee. He is a member of the Institute of Medicines review committee evaluating the national VA mental health services for veterans, Vice President of the American Telemedicine Association, and Chair of the Board of HealthLinkNow Inc. He is an experienced speaker and media commentator who writes and produces regular video editorials for Medscape. He has a number of research interests and is presently working on projects involving physician health and wellness, Internet e-mail and video consultation services and the development and validation of asynchronous telepsychiatry. Dr. Yellowlees has worked in public and private sectors in the USA, Australia and the UK, in academia, and in rural settings. He has published five books and over 200 scientific articles and book chapters.

Steven Chan (@StevenChanMDwww.stevenchanMD.com) is regarded as an accomplished top thinker in the intersection of healthcare, behavior, medicine, business, and technology. Steve not only reports on the latest technology trends as contributor to iMedicalApps.com — a leading news site written by physicians for physicians on mobile health — but also develops cutting-edge research in the areas of asynchronous telepsychiatry, smartphones and mobile wearable devices for mental health, and applications for cultural psychiatry and underserved minority health.
 
Steve's ideas, thoughts, and research have been featured in JAMA, Healthcare, and JMIR (Journal of Medical Internet Research). He has designed and developed interactive voice user interfaces at Microsoft. With the support of the U.S. Department of Health & Human Services, Steve serves as current American Psychiatric Association (APA) & SAMHSA MFP Fellow to the APA Council of Communications and Workgroup on Mental Health & Psychiatric Apps.
 
Dr. Chan draws from his extensive training at the University of California’s leading institutes — with computer science & engineering at UC Berkeley and informatics coursework at Stanford University; medical training at UCLA, UC San Francisco, UC Davis, UC Irvine, and Icahn School of Medicine at Mt. Sinai in New York City; and business & healthcare administration at UC Irvine. As a current resident physician in psychiatry & behavioral sciences at UC Davis School of Medicine, Dr. Chan treats a variety of patients, including veterans, felons, and the homeless.
 
Steve has an established reputation for business strategy and creativity. He has presented inspiring, well-researched talks at the national Health 2.0 conference in Silicon Valley, Institute for Psychiatric Services, the American Telemedicine Association, and for the California Healthcare Foundation Design-a-thon. Steve has also led winning collaborative teams at numerous health tech competitions, including the UC Berkeley-Genentech Hacking Health competition and the Health 2.0 San Francisco code-a-thon twice.
 
Giving back is important to Steve. He currently volunteers as preceptor at a UC Davis free clinic for the medically underserved. He mentors over 200 students for the Edge Interns program, designed to empower undergraduates and graduate students from around the United States. He has also trained future physicians in topics ranging from organic chemistry to computer science to topics in psychopharmacology and cultural and linguistic diversity in medicine. He has made healthcare technology accessible to his local community as co-founder of Health 2.0 Sacramento. And, he volunteers as third-in-command at the Kraken Con semi-annual pop culture convention for families and fans.
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