. 2017 Jul; 15(3):257-263.
doi: 10.1176/appi.focus.20170007.

Telepsychiatry in Integrated Care Settings

Akuh Adaji 1 John Fortney 1 
  • PMID: 31975855
  •     44 References
  •     9 citations


The objective of this article is to inform psychiatrists and other mental health professionals and primary care providers about the role of telepsychiatry in facilitating integrated care models, particularly in remote primary care practices. A narrative literature review was conducted to highlight the evidence and challenges of using telepsychiatry for integrated care. Telepsychiatry uses communication technologies to facilitate audiovisual interaction between patients and care teams to deliver services and expertise across distances and practice settings. It is particularly suited for integrated care settings, if business model innovations such as collaborative care models are implemented alongside to improve the access and delivery of care to patients. Telepsychiatry has been shown to be equivalent to face-to-face evaluations and, in certain instances, may lead to better outcomes in integrated care settings. Several challenges of adopting telepsychiatry in real practice are highlighted, including reimbursement and licensing across states, which continue to be an important barrier. It is critical to use an established framework to understand the potential users of telepsychiatry and develop and promote competency-based telepsychiatry training for novice, competent, and expert users. Psychiatrists who want to extend their expertise to distant sites, improve access to care, and partake in the new business models of collaborative care will need to consider these benefits and challenges.

Keywords: Integrated care; Primary care; Telepsychiatry.

Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders.
Miriam Komaromy, Dan Duhigg, +6 authors, Sanjeev Arora.
Subst Abus, 2016 Feb 06; 37(1). PMID: 26848803    Free PMC article.
Highly Cited.
Design and implementation of the telemedicine-enhanced antidepressant management study.
John C Fortney, Jeff M Pyne, +3 authors, Kathy L Henderson.
Gen Hosp Psychiatry, 2005 Dec 27; 28(1). PMID: 16377361
Use of an on-line patient portal in a depression collaborative care management program.
Jennifer Pecina, Frederick North, Mark D Williams, Kurt B Angstman.
J Affect Disord, 2016 Oct 14; 208. PMID: 27736688
Treatment outcomes in depression: comparison of remote treatment through telepsychiatry to in-person treatment.
Paul E Ruskin, Michele Silver-Aylaian, +6 authors, Peter Hauser.
Am J Psychiatry, 2004 Aug 03; 161(8). PMID: 15285975
Technical aspects of clinical videoconferencing: a large scale review of the literature.
Farhad Fatehi, Nigel R Armfield, Mila Dimitrijevic, Leonard C Gray.
J Telemed Telecare, 2015 Feb 24; 21(3). PMID: 25697489
Integrated care: the evolving role of psychiatry in the era of health care reform.
Lori Raney.
Psychiatr Serv, 2013 Nov 05; 64(11). PMID: 24185536
Organizing care for patients with chronic illness.
E H Wagner, B T Austin, M Von Korff.
Milbank Q, 1996 Jan 01; 74(4). PMID: 8941260
Highly Cited. Review.
Randomized trial of depression follow-up care by online messaging.
Gregory E Simon, James D Ralston, +3 authors, Belinda H Operskalski.
J Gen Intern Med, 2011 Mar 09; 26(7). PMID: 21384219    Free PMC article.
A re-conceptualization of access for 21st century healthcare.
John C Fortney, James F Burgess, +2 authors, Peter J Kaboli.
J Gen Intern Med, 2011 Oct 19; 26 Suppl 2. PMID: 21989616    Free PMC article.
Disruptive innovation in health care delivery: a framework for business-model innovation.
Jason Hwang, Clayton M Christensen.
Health Aff (Millwood), 2008 Sep 11; 27(5). PMID: 18780919
Cost analysis of store-and-forward telepsychiatry as a consultation model for primary care.
Thomas N Butler, Peter Yellowlees.
Telemed J E Health, 2011 Nov 17; 18(1). PMID: 22085113
Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression.
Jeffrey M Pyne, John C Fortney, +3 authors, D Keith Williams.
Arch Gen Psychiatry, 2010 Aug 04; 67(8). PMID: 20679589
Trends in office-based mental health care provided by psychiatrists and primary care physicians.
Mark Olfson, Kurt Kroenke, Shuai Wang, Carlos Blanco.
J Clin Psychiatry, 2014 Apr 11; 75(3). PMID: 24717378
A framework for telepsychiatric training and e-health: Competency-based education, evaluation and implications.
Donald M Hilty, Allison Crawford, +8 authors, Su-Ting Li.
Int Rev Psychiatry, 2015 Nov 06; 27(6). PMID: 26540642
Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial.
W Katon, M Von Korff, +6 authors, E Ludman.
Arch Gen Psychiatry, 1999 Dec 11; 56(12). PMID: 10591288
Highly Cited.
A budget impact analysis of telemedicine-based collaborative care for depression.
John C Fortney, Matthew L Maciejewski, +2 authors, Jeffrey M Pyne.
Med Care, 2011 May 31; 49(9). PMID: 21623240
Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system.
David Mechanic.
Health Aff (Millwood), 2012 Feb 11; 31(2). PMID: 22323168
Telepsychiatry: videoconferencing in the delivery of psychiatric care.
Jay H Shore.
Am J Psychiatry, 2013 Mar 02; 170(3). PMID: 23450286
Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.
John C Fortney, Jeffrey M Pyne, +7 authors, Paula P Schnurr.
JAMA Psychiatry, 2014 Nov 20; 72(1). PMID: 25409287
Disruptive innovation: the future of healthcare?
Peter Yellowlees, Alberto Odor, +4 authors, Donald Hilty.
Telemed J E Health, 2011 Mar 03; 17(3). PMID: 21361819
A feasibility study of the use of asynchronous telepsychiatry for psychiatric consultations.
Peter M Yellowlees, Alberto Odor, +3 authors, Donald Hilty.
Psychiatr Serv, 2010 Aug 03; 61(8). PMID: 20675845
Clinical and educational telepsychiatry applications: a review.
Donald M Hilty, Shayna L Marks, +2 authors, Thomas S Nesbitt.
Can J Psychiatry, 2004 Feb 07; 49(1). PMID: 14763673
The triple aim: care, health, and cost.
Donald M Berwick, Thomas W Nolan, John Whittington.
Health Aff (Millwood), 2008 May 14; 27(3). PMID: 18474969
Highly Cited.
Accelerating the use of electronic health records in physician practices.
Steven Shea, George Hripcsak.
N Engl J Med, 2010 Jan 22; 362(3). PMID: 20089969
Steps for implementing collaborative care programs for depression.
John C Fortney, Jeffrey M Pyne, +4 authors, Skye McDougall.
Popul Health Manag, 2009 Mar 27; 12(2). PMID: 19320606
Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial.
John C Fortney, Jeffrey M Pyne, +7 authors, Kathryn M Rost.
Am J Psychiatry, 2013 Feb 23; 170(4). PMID: 23429924    Free PMC article.
Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication.
Philip S Wang, Michael Lane, +3 authors, Ronald C Kessler.
Arch Gen Psychiatry, 2005 Jun 09; 62(6). PMID: 15939840
Highly Cited.
Resisting and promoting new technologies in clinical practice: the case of telepsychiatry.
C May, L Gask, +3 authors, A Esmail.
Soc Sci Med, 2001 May 16; 52(12). PMID: 11352414
A web-based data management system to improve care for depression in a multicenter clinical trial.
Jürgen Unützer, Youlim Choi, Ian A Cook, Sabine Oishi.
Psychiatr Serv, 2002 Jun 05; 53(6). PMID: 12045303
Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies.
Steven E Hyler, Dinu P Gangure, Sarai T Batchelder.
CNS Spectr, 2005 Apr 29; 10(5). PMID: 15858458
Transcultural psychiatry made simple--asynchronous telepsychiatry as an approach to providing culturally relevant care.
Peter M Yellowlees, Alberto Odor, +8 authors, Donald Hilty.
Telemed J E Health, 2013 Mar 05; 19(4). PMID: 23451812    Free PMC article.
Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial.
Richard O'Reilly, Joan Bishop, +3 authors, Jatinder Takhar.
Psychiatr Serv, 2007 May 31; 58(6). PMID: 17535945
Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review.
Caroline Lubick Goldzweig, Greg Orshansky, +5 authors, Paul G Shekelle.
Ann Intern Med, 2013 Nov 20; 159(10). PMID: 24247673
Highly Cited. Systematic Review.
Collaborative care for patients with depression and chronic illnesses.
Wayne J Katon, Elizabeth H B Lin, +7 authors, David McCulloch.
N Engl J Med, 2010 Dec 31; 363(27). PMID: 21190455    Free PMC article.
Highly Cited.
A Web-based clinical decision support system for depression care management.
John C Fortney, Jeffrey M Pyne, +8 authors, Jeffrey L Smith.
Am J Manag Care, 2011 Feb 26; 16(11). PMID: 21348556    Free PMC article.
Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.
Michael J Ackerman, Rosemarie Filart, +2 authors, Ronald K Poropatich.
Telemed J E Health, 2010 Jan 02; 16(1). PMID: 20043711    Free PMC article.
Defining competencies for the practice of telepsychiatry through an assessment of resident learning needs.
Allison Crawford, Nadiya Sunderji, Jenna López, Sophie Soklaridis.
BMC Med Educ, 2016 Jan 28; 16. PMID: 26813286    Free PMC article.
Large-Scale Dissemination of Collaborative Care and Implications for Psychiatry.
David J Katzelnick, Mark D Williams.
Psychiatr Serv, 2015 Jun 02; 66(9). PMID: 26030320
Predictors of Initiation and Engagement of Cognitive Processing Therapy Among Veterans With PTSD Enrolled in Collaborative Care.
Kathleen M Grubbs, John C Fortney, +5 authors, Paula P Schnurr.
J Trauma Stress, 2015 Dec 02; 28(6). PMID: 26625355
A randomized trial of telemedicine-based collaborative care for depression.
John C Fortney, Jeffrey M Pyne, +4 authors, Kathy L Henderson.
J Gen Intern Med, 2007 May 12; 22(8). PMID: 17492326    Free PMC article.
Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs.
Jeffrey M Pyne, John C Fortney, +3 authors, Dinesh Mittal.
Psychiatr Serv, 2015 Feb 18; 66(5). PMID: 25686811    Free PMC article.
Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.
Jürgen Unützer, Wayne Katon, +14 authors, IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment.
JAMA, 2002 Dec 11; 288(22). PMID: 12472325
Highly Cited.
Collaborative care for depression and anxiety problems.
Janine Archer, Peter Bower, +5 authors, Peter Coventry.
Cochrane Database Syst Rev, 2012 Oct 19; 10. PMID: 23076925
Highly Cited. Systematic Review.
A Tipping Point for Measurement-Based Care.
John C Fortney, Jürgen Unützer, +4 authors, Henry T Harbin.
Psychiatr Serv, 2016 Sep 02; 68(2). PMID: 27582237
Highly Cited. Review.
Advances in Collaborative Care.
Mark D Williams, David J Katzelnick.
Focus (Am Psychiatr Publ), 2017 Jul 01; 15(3). PMID: 31975853    Free PMC article.
Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States.
Francesca Mongelli, Penelope Georgakopoulos, Michele T Pato.
Focus (Am Psychiatr Publ), 2020 Feb 13; 18(1). PMID: 32047393    Free PMC article.
Telepsychiatry and integrated primary care: setting expectations and creating an effective process for success.
Jacqueline Calderone, Amy Lopez, +2 authors, Jay H Shore.
Mhealth, 2020 Jul 08; 6. PMID: 32632367    Free PMC article.
EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination.
W Gaebel, A Kerst, +7 authors, J Stricker.
Eur Psychiatry, 2020 Jul 25; 63(1). PMID: 32703326    Free PMC article.
Systematic Review.
Planning and Implementing Telepsychiatry in a Community Mental Health Setting: A Case Study Report.
Hossam Mahmoud, Hady Naal, Snezana Cerda.
Community Ment Health J, 2020 Sep 09; 57(1). PMID: 32897476    Free PMC article.
Telepsychiatry in the Arab World: A Viewpoint Before and During COVID-19.
Samer El Hayek, Marwa Nofal, +12 authors, Maya Bizri.
Neuropsychiatr Dis Treat, 2020 Nov 27; 16. PMID: 33239877    Free PMC article.
Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial.
Jennifer Severe, Paul N Pfeiffer, +5 authors, John Fortney.
J Gen Intern Med, 2022 Feb 03;. PMID: 35106719
Study of Impact of Telehealth Use on Clinic "No Show" Rates at an Academic Practice.
Kalyan Muppavarapu, Sy A Saeed, +2 authors, Vickie Haley.
Psychiatr Q, 2022 Apr 13; 93(2). PMID: 35412100    Free PMC article.
Association Between Virtual Care Use and Same-Day Primary Care Access in VA Primary Care-Mental Health Integration.
Taona P Haderlein, Aram Dobalian, Pushpa V Raja, Claudia Der-Martirosian.
J Prim Care Community Health, 2022 Apr 16; 13. PMID: 35426344    Free PMC article.