A Pilot Study Examining Use of Asynchronous and Synchronous Telepsychiatry Consultation for Skilled Nursing Facility Residents
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 40
- 试验地点
- 2
- 主要终点
- Clinical Global Impression
研究概览
简要总结
Specific Aims: This study aims to assess the acceptability of asynchronous
telepsychiatry (ATP) and synchronous (STP) in rural Skilled Nursing Facility (SNF)
population, in a 12-month randomized controlled trial. ATP relies on video recording of a
psychiatric interview, where the video is later reviewed by a psychiatrist to make a
psychiatric diagnosis and treatment recommendation to the primary treatment team.
STP is real-time, face-to-face psychiatric assessment using video conferencing to come
up with a psychiatric recommendation. People residing in SNFs generally rely on primary
and consultant physicians to visit them and rarely have outpatient psychiatrist follow-up.
SNFs offer more services than what is available to primary care office, and include 24-
hours skilled nursing services, physical therapy, nutritional consultation, occupational
therapy, social services, wound care, and psychiatric consultation when available. SNF
residents are unable to live independently due to their multiple medical comorbidities
and are therefore more medically ill than patients who are typically seen in primary care
settings. The present study aims to demonstrate feasibility and to collect pilot data in
SNFs. This study is funded by the UC Davis Behavior Health Center of Excellence grant
via the California Mental Health Services Act (Prop 63). In a larger, future study, the investigators
intend to demonstrate that ATP will be no different than STP in clinical outcomes but will
be more accessible and cost effective.
详细描述
Specific Aims: This study aims to assess the acceptability of asynchronous
telepsychiatry (ATP) and synchronous (STP) in rural Skilled Nursing Facility
(SNF) population, in a 12-month randomized controlled trial. ATP relies on
video recording of a psychiatric interview, where the video is later reviewed by
a psychiatrist to make a psychiatric diagnosis and treatment recommendation
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Aged ≥18, with non-emergent psychiatric symptoms: depression, schizophrenia, bipolar disorder, Post-Traumatic Stress Disorder (PTSD), dementia-related behavioral problems, management of psychiatric medications, and other mental health problems that the Skilled Nursing Facility (SNF) Primary Care Provider (PCP) and team deems necessary to obtain psychiatric consultation.
- •referred by SNF staff and PCP at participating site
排除标准
- •Residents with imminent suicide and/or violence risks that require emergency psychiatric referrals or residents who cannot wait until the next ATP/STP evaluation
- •Residents with other psychiatric emergencies will be referred to the local emergency department as is the current practice at both SNFs.
- •less than 18 years
- •immediate violent intentions or plans
- •incarceration
- •patient whose PCP recommends not participating.
- •PCP not at participating site
研究组 & 干预措施
Synchronous telepsychiatry (STP)
Control Arm/Synchronous telepsychiatry (STP): After baseline assessment, subjects will be assessed by a psychiatrist using live interactive videoconferencing every 6 months for a 1 year follow up (3 STP assessments: baseline plus 2 assessments). A report with treatment recommendations following American Psychiatric Association guidelines will be sent to the PCP who will be able to have adlib telephone or email consultations with the telepsychiatrist. The telepsychiatrist will have access to all previous clinical information about the patients.
干预措施: Psychiatric Consultation (Behavioral)
Asynchronous telepsychiatry (ATP)
Intervention Arm (ATP): All ATP assessments at 6 monthly intervals post baseline will be conducted by an ATP trained clinician. This interview will be video recorded.The ATP clinicians will then fill out a standardized medical template that will be reviewed by a psychiatrist who will provide a written assessment and psychiatric treatment plan. He will have access to any previous assessments and the PCP will also have continuing access to this psychiatrist by phone or email between the 3 consultations.
干预措施: Psychiatric Consultation (Behavioral)
结局指标
主要结局
Clinical Global Impression
时间窗: 12 months
Change in CGI will be measured from baseline to study endpoint of 12-month follow-up
Brief Interview for Mental Status (BIMS)
时间窗: 12 months
Change in BIMS will be measured from baseline to 12-month
次要结局
未报告次要终点