©2024 Stanford Medicine
Study to Promote Innovation in Rural Integrated Telepsychiatry
Not Recruiting
Trial ID: NCT02738944
Purpose
Background: Community Health Centers care for over 20 million rural, low income and minority
Americans every year. Patients often have complex mental health problems such as
Posttraumatic Stress Disorder (PTSD) and Bipolar Disorder. However, Community Health Centers
located in rural areas face substantial challenges to managing these patients due to lack of
onsite mental health specialists, stigma and poor geographic access to specialty mental
health services in the community. As a consequence, many rural primary care providers feel
obligated, yet unprepared, to manage these disorders, and many patients receive inadequate
treatment and continue to struggle with their symptoms. While integrated care models and
telepsychiatry referral models are both promising approaches to managing patients with
complex mental health problems in rural primary care settings, there have been no studies
comparing which approach is more effective for which types of patients. Objectives: The
central question examined by this study is whether it is better for offsite mental health
specialists to support primary care providers' treatment of patients with PTSD and Bipolar
Disorder through an integrated care model or to use telemedicine technology to facilitate
referrals to offsite mental health specialists. We hypothesize that patients randomized to
integrated care will have better outcomes than patients randomized to referral care. Methods:
1,000 primary care patients screening positive for PTSD or Bipolar Disorder will be recruited
from Community Health Centers in three states (Arkansas, Michigan and Washington) and
randomized to the integrated care model or the referral model. Patient Outcomes: Telephone
surveys will be administered to patients at enrollment and at 6 and 12 month follow-ups.
Telephone surveys will measure access to care, therapeutic alliance with providers,
patient-centeredness, patient activation, satisfaction with care, appointment attendance,
medication adherence, self-reported clinical symptoms, medication side-effects, health
related quality of life, and progress towards life goals. A sub-sample of patients will be
invited to participate in qualitative interviews to describe their treatment experience using
their own words. Likewise, primary care providers will be invited to participate in
qualitative interviews to voice their perspective.
Official Title
Integrated vs. Referral Care for Complex Psychiatric Disorders in Rural FQHCs
Stanford Investigator(s)
Debra Lee Kaysen
Professor of Psychiatry and Behavioral Sciences (Public Mental Health & Population Sciences)
Eligibility
Inclusion Criteria:
- Enrolled as a patient at a participating Federally Qualified Health Center
- Screen positive for Bipolar Disorder on the Composite International Diagnostic
Interview (CIDI) AND/OR screen positive for PTSD on the PTSD Check List (PCL)-6
Exclusion Criteria:
- Currently prescribed a psychotropic medication by a mental health specialist.
- Lacks capacity to provide informed consent
- Does not speak English or Spanish
Intervention(s):
behavioral: Telepsychiatry Collaborative Care
behavioral: Telepsychiatry Enhanced Referral
Not Recruiting
Contact Information
Stanford University
School of Medicine
300 Pasteur Drive
Stanford,
CA
94305