Pilot Study of Asynchronous and Synchronous Telepsychiatry for Skilled Nursing Facilities
- Conditions
- DepressionAnxiety DisorderSubstance Use DisorderDementiaMood Disorder
- Registration Number
- NCT02537093
- Lead Sponsor
- University of California, Davis
- Brief Summary
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.
- Detailed Description
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 University of California (UC Davis)
Behavior Health Center of Excellence grant via the California Mental Health
Services Act (Prop 63). In a larger, future study, we intend to demonstrate that
ATP will be no different than STP in clinical outcomes but will be more
accessible and cost effective.
Aim 1: To assess whether ATP and STP models improve clinical outcomes:
Hypotheses: Compared to STP, the ATP arm will: H1: show similar clinical
outcome trajectory, reflected in improvement from baseline, as measured by
Clinical Global Impression (CGI), Patient Health Questionaire-9 (PHQ-9), Brief
Interview for Mental Status (BIMS), and overall behavioral symptoms; H2: have
similar use of health care resources: psychiatric medications, additional interval
psychiatric visits, number of emergency room visits and hospitalizations
(medical, psychiatric, and overall); And H3: produce shorter waiting times for
psychiatric consultation.
Aim 2: To assess the acceptability of ATP and STP by examining satisfaction
surveys from SNF residents (who are able to complete the surveys).
Hypothesis:
Compared to STP, ATP participants will show: H1: Similar levels of satisfaction
as measured by: Telemedicine Satisfaction Survey as completed by
participants.
Aim 3: To conduct preliminary healthcare economics analysis and feasibility of
producing estimates of cost-effectiveness of ATP vs. STP in SNFs. Hypotheses:
ATP, compared to STP, will: H1: be more cost effective as measured by cost
savings from reduced need for face-to-face psychiatrist time and similar use of
other medical and psychiatric services.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 40
- 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
- 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
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Clinical Global Impression 12 months Change in CGI will be measured from baseline to study endpoint of 12-month follow-up
Brief Interview for Mental Status (BIMS) 12 months Change in BIMS will be measured from baseline to 12-month
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (2)
Norwood Pines Care Center
🇺🇸Sacramento, California, United States
Cottonwood Post-Acute Rehabilitation Center
🇺🇸Woodland, California, United States
Norwood Pines Care Center🇺🇸Sacramento, California, United States