Jennifer Severe, MD

Credit: University of Michigan

Both Telehealth Collaborative Care and Telehealth Enhanced Referral programs enable psychiatrists and psychologists to treat patients effectively over a virtual setting.¹

A team, led by Jennifer Severe, MD, Clinical Assistant Professor Department of Psychiatry, University of Michigan, assessed the clinical predictors of treatment engagement for complex psychiatric conditions in Telehealth Collaborative Care and Telehealth Enhanced Referral.

Telehealth

Both Telehealth Collaborative Care and Telehealth Enhanced Referral are tools that could expand the reach of specialty mental health services to better serve underserved communities and populations.

Telehealth Collaborative Care is a system where remote psychiatrists consult with primary care teams through an onsite care manager who also provide brief psychotherapy, while Telehealth Enhanced Referral is where remote psychiatrists and psychologists provide telehealth treatment as usual.

The Trial

In the randomized pragmatic trial, presented during the 2023 American Psychiatric Association (APA) Annual Meeting in San Francisco, the investigators examined 1004 adult patients who screened positive for posttraumatic stress disorder (PTSD) and/or bipolar disorderfrom 24 primary care clinics without onsite psychiatrists or psychologists.

Each patient was randomized to receive either Telehealth Collaborative Care or Telehealth Enhanced Referral for 1 year.

The investigators sought main measures of psychotherapy engagement, measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ).

The results show engagement in the Telehealth Collaborative Care program visits was greater compared to the Telehealth Enhanced Referral group.

In addition, there was no association between the PTSD symptom severity and treatment engagement.

However, the internal state scale (ISS) activation subscale, which is often an indicator of mania, was linked to reduced odds of initiating psychotherapy (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.59-0.84), but not the number of sessions attended once psychotherapy began.

The investigators also found that the Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR], 0.88; 95% CI, 0.81-0.95), while the number of physical health comorbidities was linked to a greater engagement in both psychotherapy (IRR, 1.11, 95% CI, 1.03 -1.19) and pharmacotherapy (OR, 1.54; 95% CI, 1.27-1.87).

The findings did not vary by intervention group.

“Both telehealth integrated care and telehealth as usual offer an opportunity to treat patients with complex psychiatric conditions with otherwise limited access to mental health specialists,” the authors wrote. “While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions in Collaborative Care than remote telepsychologists.”