Literature Collection
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References
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Articles
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Grey Literature
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Opioids & SU
The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
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BACKGROUND: Frequent attenders in primary care (FAs) consume a disproportionate amount of healthcare resources and often have depression, anxiety, chronic health issues, and interpersonal problems. Despite extensive medical care, they remain dissatisfied with the care and report no improvement in quality of life. OBJECTIVE: To pilot a Telephone-based Interpersonal Counseling intervention for Frequent Attenders (TIPC-FA) and assess its feasibility and efficacy in reducing symptoms and healthcare utilization. METHOD: Top 10% of primary care visitors were randomly assigned to TIPC-FA, Telephone Supportive Contact (Support), or Treatment as Usual (TAU). TIPC-FA and Support groups received six telephone sessions over twelve weeks, while the TAU group was interviewed twice. Multilevel regression tested for changes over time, considering patient and counselor variance. RESULTS: TIPC-FA and Support groups demonstrated reduced depressive symptoms, and the TIPC-FA group showed decreased somatization and anxiety. The TIPC-FA group demonstrated a trend towards less healthcare utilization than the TAU group. CONCLUSION: This pilot study suggests that IPC via telephone outreach is a feasible approach to treating FAs, achieving a reduction in symptoms not seen in other groups. Promising reduction in healthcare utilization in the TIPC-FA group warrants further exploration in larger-scale trials.





Telepsychiatry, especially in the form of live interactive videoconferencing, has greatly advanced the availability and use of specialist psychiatric consultations in primary care settings. Nevertheless, reliance on telepsychiatry, with corresponding decreases in direct face-to-face interaction between primary care providers and psychiatrists, can create unique challenges such as reducing the availability of non-verbal cues, and preventing the informal interactions that are so necessary for clarifying clinical and process details and for building essential team-based trust and rapport. Written from the perspective of an integrated psychiatrist, this article offers recommendations for a formal process to optimize virtual care coordination by setting clear expectations and providing communication tools for an effective and efficient telepsychiatry enabled integrated service.

