A Controlled Trial of Patient Centered Telepsychiatry Interventions

This project addresses a critical public mental health problem: the need to improve access to
high quality, mental health services for diverse populations through improving the flow of
clinical work across care settings (primary care and specialty care) by implementing an
efficient, provider compatible, administratively simple health IT solution: Asynchronous
Telepsychiatry. To assess the impact of this novel approach, this two-year randomized
controlled trial of clinical outcomes seeks to evaluate the superiority of the asynchronous
telepsychiatry (ATP) consultation model on access, quality, cost and outcomes of care over
the usual care for adults referred from primary care clinics for psychiatric evaluation and
treatment.

Aim 1: To assess whether the ATP delivery model improves clinical OUTCOMES in adult patients
referred for psychiatric treatment by their PCPs; Hypotheses: Compared to the participants in
the 'usual care" arm, participants in the ATP arm will show:

H1: Higher scores over the course of treatment (better clinical trajectory) on the
Short-Form-12 Health Survey (SF12- the primary outcome measure), the Clinical Global
Impressions scale (CGI), the Who Disability Schedule (WHODAS) and the Global Assessment of
Functioning (GAF) score.

H2 (Exploratory): Improved clinical trajectories on specific disorder scales, such as the
PSQ9, the Hamilton Anxiety Scale (HAMA), the GAD7 and the AUDIT substance abuse scale over
the those in the "usual care" arm.

Aim 2: To assess whether ATP improves the QUALITY of care for adult patients referred for
psychiatric treatment by their PCPs and for PCP providers; Hypotheses: Compared to the
participants in the 'usual care" arm, participants in the ATP arm will show:

H1: higher levels of satisfaction (as measured by the patient rated Patient Telemedicine
Satisfaction Survey which includes a general care satisfaction measure to be used across TAU
and ATP groups and by the provider rated Telemedicine Provider Satisfaction Questionnaire) H2
(Exploratory- Spanish only speaking participants): will report more positive ratings of their
provider on the Interpersonal Processes of Care Survey short form. Hypothesis: PCP's will be
highly satisfied with the quality of ATP H3: PCPs with patients referred to the ATP arm will
report high satisfaction ratings on the Telemedicine Provider Satisfaction Questionnaire. Aim
3: To assess whether ATP improves EFFICIENCY and REACH through reducing COSTS and increasing
ACCESS for adult patients referred for psychiatric treatment by their PCPs; Hypotheses:
Compared to care in the 'usual care" arm, care in the ATP arm will: H1: be more cost
effective than "usual care" arm as measured by comprehensive economic data that will be
collected from patient, provider, and payor perspectives.

H2: produce shorter wait-times for appointment and consultation feedback as measured by
comprehensive efficiency data that will be collected from patient, provider, and payor
perspectives.

Inclusion Criteria:

- aged 18 or older

- diagnosis of a mood disorder, anxiety disorder, or substance/alcohol abuse disorder(s)

- referred by PCP at participating site.

Exclusion Criteria:

- less than 18 years

- imminent suicidal ideation and/or plans

- immediate violent intentions or plans

- incarceration

- significant cognitive deficits

- patient who's PCP recommends not participating.

- PCP not at participating site