Using Telepsychiatry to Enrich Existing Integrated Primary Care

Telemed J E Health. 2019 Aug;25(8):762-768. doi: 10.1089/tmj.2018.0132. Epub 2018 Nov 9.


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.

MeSH terms

  • Comorbidity
  • Humans
  • Interdisciplinary Communication
  • Mental Disorders / therapy*
  • Mental Health Services / organization & administration
  • Patient Care Team
  • Primary Health Care / organization & administration*
  • Psychiatry / organization & administration*
  • Quality Improvement
  • Systems Integration*
  • Telemedicine / organization & administration*
  • Workflow