Rural areas of the US are currently experiencing a shortage of primary care providers who specialize in the treatment of patients with psychiatric and mental health disorders. To help bridge that gap, researchers examined the feasibility of implementing a telepsychiatric consultation model in rural primary care settings, according to a study published in Annals of Family Medicine

To evaluate the effectiveness of telepsychiatric consultation model, the research team interviewed clinicians and staff who had received formal training in a collaborative care model at 3 rural setting in Washington State. “Although formal training of the collaborative care model team was necessary for successful implementation, after the initial program launch, all team members continued learning from each other through their interactions. Learning went beyond just-in-time information, coaching, and support from the consulting psychiatrist,” noted the authors.

To get to that point, the researchers developed a conceptual model of training based on team expertise and educational learning models. To evaluate the effectiveness of the program, interviews were completed with 17 people and averaged 56 minutes in duration. A total of 17 themes were identified related to team members’ training and learning in the collaborative care model. Four themes emerged for primary care clinicians:

  • Clinicians taking jobs in rural health settings often felt unprepared for consulting patients with behavioral health conditions
  • Primary care clinicians became more confident in diagnosing mental illnesses and recognizing the importance of mental health through the collaborative model
  • Primary care clinicians developed adequate language to engage patients and competency to formulate treatment plans
  • Primary care clinicians became more proficient in managing behavioral health disorders following implementation of the model.

Care managers also felt unprepared for the collaborative care model, but training allowed them to learn the biopsychosocial model of patient care within an integrative framework. They developed new competencies in building relationships and working effectively on a care team and increased their proficiency in diagnosing and managing mental illnesses. Care managers were able to apply this learning during patient visits and therefore improved the quality of their care.


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Consulting psychiatrists learned how the collaborative care model differed from traditional psychiatry consultations. They became lead educators in the clinic and amongst the team, and they also learned that team learning is two-fold. These clinicians also learned the requirements for psychiatric programs that are sustainable and that clinicians on the team may need continuous retraining in order to ensure continuity of practice.

Ancillary staff learned screening tools for patients with mental illness.  Interpreters learned how to work in a medical setting using this collaborative care model. Receptionists learned how to schedule appointments for behavioral health consultations, allowing for necessary duration, and billers learned how to properly bill for these types of consultations.

“We identified consistent evidence that informal learning occurred regularly through interaction of diverse clinical team members and was associated with the case review process,” concluded the researchers. “Policy makers interested in rural mental health and development of a chronic illness workforce should consider this specialist consultation model of team care a promising framework for rapidly building existing primary care capacity to improve care outcomes.”

Reference

Achkar MA, Bennett IM, Chwastiak L, et al. Telepsychiatric consultation as a training and workforce development strategy for rural primary care. Ann Fam Med. 2020;18(5):438-445.