Abstract
Purpose of Review
Widespread implementation of integrated primary care and behavioral health is possible, but workforce shortages, competencies to deliver evidence-based approaches, and sufficient reimbursement are lacking. There are numerous telehealth solutions that could be utilized to assist with integration efforts that have the potential to be successfully used alone or in combination. This will require that the developers of such technologies understand the current evidence base for effective integration efforts and apply this knowledge to new solutions.
Recent Findings
Evidence-based models of integrated care such as the collaborative care model have a robust evidence base including studies that demonstrate effective delivery from remote locations. Technology solutions that can serve as practice extenders by performing some of the tasks, and can expand the competency of primary care providers to treat mild to moderate mental illness, have an emerging literature in the behavioral health arena that shows promise for integrating care.
Summary
More widespread implementation of effective integrated primary care and behavioral health can be accomplished with the help of technology solutions that can address the problems of workforce shortages and competencies. Use of these technologies alone or in combination is a growing area of research and development and an untapped frontier that warrants further investigation.
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References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Thomas K, Ellis A, Konrad T, et al. County level estimates of mental health professional shortage in the United States. Psych Serv. 2009: (60)10, 1323–1328.
Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting. J Am Med Assoc. 2002;288(22):2836–45.
Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012;10:CD006525.
•• Bao Y, Druss B, Jung H, Chan Y, Unutzer J. Unpacking collaborative care for depression: examining two essential tasks for implemention. Psychiatr Serv. 2016;67(4):418–24. https://doi.org/10.1176/appi.ps.201400577. This article begins dissecting the collaborative care model to see what tasks are outcome changing and to what degree. This can inform our work in model design.
Scott, C and Mendez-Shannon E. Behavioral health provider essentials. In: Raney L, Lasky G, Scott C, editors. Integrated care: a guide for effective implementation. American Psychiatric Publishing; 2017, pp 104.
Whitebird R, Solberg L, Jaeckels N, et al. Effective implementation of collaborative care for depression: what is needed? Am J Manag Care. 2014;20(9):699–707.
Appendix, Performance and outcome measures for integrated care. In: Raney L, Lasky G, Scott C, editors. Integrated care: a guide for effective implementation. American Psychiatric Publishing; 2017, pp 243–256.
Fortney J, Unutzer J, Wrenn G et al. A tipping point for measurement-based care. Psych Serv Ahead of Print. 2016. https://doi.org/10.1176/appi.ps.201500439.
•• Torous J, Roberts L. Needed innovation in digital health and smartphone applications for mental health: transparency and trust. JAMA Psych. 2017;74(5):437–8. It is important for new technologies to be adequately tested and reviewed to ensure quality and safety.
Berrouiquet S, Baca-Garcia E, Brandt S, Walter M, Courtet P. Fundamentals for future mobile-health (mHealth): a systematic review of mobile phone and web-based text messaging in mental health. J Med Internet Res. 2016;18(6):e135. https://doi.org/10.2196/jmir.5066.
Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32:329–42.
Mohr D, Weingardt K, Reddy M, Schueller S. Three problems with current digital mental health research…and three things we can do about them. Psych Serv. 2017;68(5):427–9.
Torous J, Roux S. Patient driven innovation in mobile technology: a case report of symptom tracking in schizophrenia. JMIR Ment Health. 2017;4(3):e27. https://doi.org/10.2196/mental.7911.
Bloss C, Wineinger N, Peters M, et al. A prospective randomized trial examining healthcare utilization in individuals using multiple smartphone-enabled biosensors. PeerJ. 2016;4:e1554. https://doi.org/10.7717/peerj.1554.
DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.
Vimalananda V, Gupte G, Seraj S, Orlander J, et al. Electronic consultations (eConsults) to improve access to specialty care: a systematic review and narrative synthesis. J Telemed Telecare. 2015;21(6):323–30.
•• Olayiwola J, Anderson D, Jepeal N, Aseltine R, et al. Electronic consultation to improve to improve the primary care-specialty care interface for cardiology in the medically underserved: a cluster randomized controlled trial. Ann Fam Med. 2016;14:133–40. https://doi.org/10.1370/afm.1869. A trial replicating the findings in cardiology would be a welcomed addition to the psychiatric workforce shortage, and this study provides encouragement that this is possible for psychiatric eConsult.
Komaromy M, Duhigg D, Metcalf A, Carlson C, Kalishman S, Hayes L. Project ECHO: a new model for educating primary care providers about treatment of substance use disorders. Subst Abus. 2016;37(1):20–4.
•• Fisher E, Hasselberg M, Conwell Y, et al. Telementoring primary care clinicians to improve geriatric mental health care. Popul Health Manag. This is the first study in the field of mental health that demonstrated outcomes with a psychiatric focused ECHO project.
•• Fortney JC, Pyne JM, Mouden SB, et al. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013;170:414–25. This study is instrumental in understanding there are good outcomes in providing integrated care from a remote hub location.
Hilt R, Romaire M, McDonnell M, et al. Partnership Access Line: evaluating a consult program in Washington State. JAMA Pediatr. 2013;167(2):162–8.
Sarvet B, Gold H, Bostic J, et al. Improving access to mental health care for children: the Massachusetts Child Psychiatry Access Project. Pediatrics. 2010;126:1191–200.
Shore J. Telepsychiatry: videoconferencing in the delivery of psychiatric care. Amer J Psychiatr. 2013;170:256–62.
Yellowlees P, Odor A, Parish M, et al. A feasibility study of using asynchronous telepsychiatry for psychiatric consultation. Psychiatr Serv. 2010;61(8):836–40. https://doi.org/10.1176/ps.2010.61.8.838.
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Conflict of Interest
John Torous and Michael Hasselberg declare no conflict of interest.
Lori Raney has received royalties for two textbooks on Integrated Care from American Psychiatric Publishing, Inc.
David Bergman is a stockholder in Valera Health, Inc., a digital behavioral health start-up.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Psychiatry in the Digital Age
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Raney, L., Bergman, D., Torous, J. et al. Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment. Curr Psychiatry Rep 19, 86 (2017). https://doi.org/10.1007/s11920-017-0838-y
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DOI: https://doi.org/10.1007/s11920-017-0838-y