TY - JOUR
AU - M. Waugh
AU - J. Calderone
AU - Brown Levey
AU - C. Lyon
AU - M. Thomas
AU - F. DeGruy
AU - J. H. Shore
A1 - 
AB - Background: Integrated care is characterized by evolving heterogeneity in models. Using telepsychiatry to enhance these models can increase access, quality, and efficiencies in care. Introduction: The purpose of this report is to describe the process and outcomes of adapting telepsychiatry into an existing integrated care service. Materials and Methods: Telepsychiatry was implemented into an existing integrated care model in a high-volume, urban, primary care clinic in Colorado serving patients with complex physical and behavioral needs. Consultative, direct care, educational/training encounters, provider-to-provider communication, process changes, and patient-level descriptive measures were tracked as part of ongoing quality improvement. Results: Telepsychiatry was adapted into the existing behavioral health services using an iterative team meeting process within a stepped care model. Over 35% of the requests for psychiatry services were medication related-and medication changes (type/dose) were the most frequent referral outcome of psychiatric consultation. Forty percent of patients in the service had multiple behavioral health diagnoses, in addition to physical health diagnoses. Discussion: Telehealth will become an increasingly necessary component in building hybrid/blended integrated care teams. Examples of flexible model implementation will support clinics in tailoring effective applications for their unique patient panels. Conclusions: An adapted integrated care model leveraging telepsychiatry is successfully serving the complex deep end of a primary care patient population in Colorado. Lessons learned in implementing this model include the importance of team attitudes.
AD - 1Evaluation and Research Department, Colorado Access, Denver, Colorado.; 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 1Evaluation and Research Department, Colorado Access, Denver, Colorado.; 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 1Evaluation and Research Department, Colorado Access, Denver, Colorado.; 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.; 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
BT - Telemedicine journal and e-health : the official journal of the American Telemedicine Association
C5 - HIT & Telehealth
CP - 8
CY - United States
DO - 10.1089/tmj.2018.0132
IS - 8
JF - Telemedicine journal and e-health : the official journal of the American Telemedicine Association
M1 - Journal Article
N2 - Background: Integrated care is characterized by evolving heterogeneity in models. Using telepsychiatry to enhance these models can increase access, quality, and efficiencies in care. Introduction: The purpose of this report is to describe the process and outcomes of adapting telepsychiatry into an existing integrated care service. Materials and Methods: Telepsychiatry was implemented into an existing integrated care model in a high-volume, urban, primary care clinic in Colorado serving patients with complex physical and behavioral needs. Consultative, direct care, educational/training encounters, provider-to-provider communication, process changes, and patient-level descriptive measures were tracked as part of ongoing quality improvement. Results: Telepsychiatry was adapted into the existing behavioral health services using an iterative team meeting process within a stepped care model. Over 35% of the requests for psychiatry services were medication related-and medication changes (type/dose) were the most frequent referral outcome of psychiatric consultation. Forty percent of patients in the service had multiple behavioral health diagnoses, in addition to physical health diagnoses. Discussion: Telehealth will become an increasingly necessary component in building hybrid/blended integrated care teams. Examples of flexible model implementation will support clinics in tailoring effective applications for their unique patient panels. Conclusions: An adapted integrated care model leveraging telepsychiatry is successfully serving the complex deep end of a primary care patient population in Colorado. Lessons learned in implementing this model include the importance of team attitudes.
PP - United States
PY - 2019
SN - 1556-3669; 1530-5627
SP - 762
EP - 768
EP - 
T1 - Using Telepsychiatry to Enrich Existing Integrated Primary Care
T2 - Telemedicine journal and e-health : the official journal of the American Telemedicine Association
TI - Using Telepsychiatry to Enrich Existing Integrated Primary Care
U1 - HIT & Telehealth
U2 - 30394851
U3 - 10.1089/tmj.2018.0132
VL - 25
VO - 1556-3669; 1530-5627
Y1 - 2019
Y2 - Aug
ER -