• Jennifer D Hall, Maria N Danna, Theresa J Hoeft, Leif I Solberg, Linda H Takamine, John C Fortney, John Paul Nolan, and Deborah J Cohen.
• From Oregon Health and Science University, Portland, OR (JDH, MD, DJC); Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA (TJH, JCF); HealthPartners Institute, Bloomington, MN (LIS); University of Michigan, Ann Arbor, MI (LHT); Department of Veteran Affairs, Ann Arbor, MI (LHT); Department of Veteran Affairs, Seattle, WA (JCF). haljenni@ohsu.edu.
• J Am Board Fam Med. 2022 May 1; 35 (3): 465-474.

BackgroundPrimary care practices in underserved and/or rural areas have limited access to mental health specialty resources for their patients. Telemedicine can help address this issue, but little is known about how patients and clinicians experience telemental health care.MethodsThis pragmatic randomized effectiveness trial compared telepsychiatry collaborative care, where telepsychiatrists provided consultation to primary care teams, to a referral approach, where telepsychiatrists and telepsychologists assumed responsibility for treatment. Twelve Federally Qualified Health Centers in rural and/or underserved areas in 3 states participated.ResultsPatients and clinicians reported that both interventions alleviated barriers to accessing mental health care, provided quality treatment, and offered improvements over usual care. Telepsychiatry collaborative care was identified as better for patients with difficulty developing trust with new providers. This approach also required more primary care involvement than referral care, creating more opportunities for clinician learning related to mental health diagnosis and treatment. The referral approach was identified as better suited for patients with higher complexity or desiring specific psychotherapies.ConclusionsBoth approaches addressed patient needs and provided access to specialty mental health care. Each approach better aligned with different patients' needs, suggesting that having both approaches available to practices is optimal for supporting patient-centered care.© Copyright 2022 by the American Board of Family Medicine.

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