Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care

• Published in: Annals of family medicine Vol. 18; no. 5; pp. 438 - 445
• Main Authors: Al Achkar, Morhaf, Bennett, Ian M, Chwastiak, Lydia, Hoeft, Theresa, Normoyle, Tre, Vredevoogd, Melinda, Patterson, Davis G
• Format: Journal Article
• Language: English
• Published: Annals of Family Medicine 01.09.2020; American Academy of Family Physicians
• Series: Annals Journal Club
• Subjects: Educational aspects; Human resource management; Medical personnel training; Methods; Original Research; Primary health care; Psychiatric consultation; Rural health services; Telemedicine; United States
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.2561

PURPOSE There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. We investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics. METHODS We developed and pilot-tested a qualitative interview guide based on a conceptual model of training and learning. We conducted individual semi-structured interviews in 2018 with diverse clinical and nonclinical staff at 3 rural primary care sites in Washington state that used ongoing collaborative care and telepsychiatric consultation. Two qualitative researchers independently analyzed transcripts with iterative input from other research team members. RESULTS A total of 17 clinical, support, and administrative staff completed interviews. Participants' feedback supported the view that telepsychiatric case review-based consultation enhanced skills of diverse clinical team members over time, even those who had not directly participated in case reviews. All interviewees identified specific ways in which the consultations improved their capacity to identify and treat psychiatric disorders. Perceived benefits in implementation and sustainability included fidelity of the care process, team resilience despite member turnover, and enhanced capacity to use quality improvement methods. CONCLUSIONS Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration. Key words: rural health services; mental health; telepsychiatry; remote consultation; telemedicine; consultation; collaborative care; primary care; depression; patient care team; vulnerable populations