Abstract

Background:

Asynchronous Telepsychiatry (ATP) consultations (delayed time) can extend psychiatric expertise into primary care, and across languages.

Objective:

This is the first clinical outcomes study of ATP compared with Synchronous (real time) Telepsychiatry (STP), the current gold standard telepsychiatry “usual care” method. We hypothesized that patients in the ATP arm would show a better clinical trajectory than those in the STP arm as measured by clinician and patient self-reported ratings of depression, global functioning and health outcomes.

Methods:

In this randomized clinical trial 36 Primary Care Physicians (PCP) referred a heterogeneous sample of 401 treatment seeking adult depressed or anxious patients over a 5- year period from 3 primary care clinics. 184 English and Spanish speaking participants were enrolled and randomized, of whom 160 (80 ATP, 80 STP) completed baseline evaluations and were entered into the 2-year follow up study. Patients were treated by their PCPs in consultation with University of California Davis Health (UCDH) psychiatrists who consulted with the patients every 6 months for up to 2 years using ATP or STP and then made treatment recommendations to the PCP’s. Patients’ depression, clinical global functioning and health outcomes were assessed every 6 months using both clinician (primary outcomes) and patient (secondary outcomes) self-reported ratings.

Results:

Patients in both ATP and STP groups had significant improvements at 6- and 12-month follow-up on both clinician-rated outcomes. There were no significant differences in improvement between ATP and STP on any clinician or patient self-reported ratings at any follow-up. Drop-out rates at 1 year were 63/160, and at 2 years were 114/143, all somewhat higher for STP than ATP. 19% of the

Conclusions:

This trial provides evidence of the clinical validity of ATP in English and Spanish speaking primary care patients and may be a key part of a stepped series of mental health interventions available within the primary care treatment setting. ATP presents a possible solution to the workforce shortage of psychiatrists and to the provision of mental healthcare in the home. Clinical Trial: NCT02084979