Journal Article Annotations
2022, 1st Quarter

Integrated Care

Annotations by Jai Gandhi, MD
January, 2022

Remote Collaborative Care With Off-Site Behavioral Health Care Managers: A Systematic Review of Clinical Trials.

PUBLICATION #1 — Integrated Care

Remote Collaborative Care With Off-Site Behavioral Health Care Managers: A Systematic Review of Clinical Trials.

Jessica Whitfield, Erin LePoire, Brenna Stanczyk, Anna Ratzliff, Joseph M Cerimele

Abstract: J Acad Consult Liaison Psychiatry. Jan-Feb 2022;63(1):71-85. doi: 10.1016/j.jaclp.2021.07.012. Epub 2021 Aug 10.

Background:
In the United States, most patients who require behavioral health care do not receive it owing to an overall shortage of behavioral health specialists. The Collaborative Care Model (CoCM) is a team-based, highly-coordinated approach to treating common mental health conditions in primary care that has a robust evidence base. Several recent randomized controlled trials have demonstrated the effectiveness of remote CoCM teams. As telehealth technology advances and uptake expands, understanding the evidence for remote CoCM becomes increasingly crucial to inform CoCM practice and implementation.

Objective:
The objective of this study was to systematically review randomized controlled trials regarding the effectiveness of remote CoCM teams in treating common psychiatric conditions in primary care and medical settings.

Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to structure our review. Our search strategy and development of search terms was informed by knowledge and review of the CoCM literature. Articles were reviewed by 3 authors, and once selected, they were sent to 2 authors for further data extraction to describe various study characteristics and process measures relating to remote CoCM.

Results:
The literature search identified 13,211 articles, 9 of which met inclusion criteria. The 9 studies collectively demonstrate effectiveness of remote CoCM in treating a range of behavioral health conditions (depression [n = 7], anxiety [n = 2], and PTSD [n = 1]), across various populations and settings. Sample sizes ranged from 191 patients to 704 patients, publication dates from 2004 to 2018, and studies were conducted from 2000 to 2014. Various process measures were also reported.

Conclusions:
As the 9 studies included in our systematic review demonstrate, remote CoCM can be effective in treating a range of behavioral health conditions in various primary care and specialty medical settings. These findings suggest organizations may have more flexibility in building their CoCM team and drawing upon wider workforces than previously recognized. As recent shifts in telehealth policy and practice continue to motivate telehealth approaches, further research that can inform best practices for remote CoCM will be useful and valuable to those making organizational decisions when implementing integrated care models.

Keywords:
behavioral health care manager; collaborative care; integrated care; psychiatric consultant; remote; telehealth.

Annotation

The finding:
This comprehensive systematic review, which included 9 studies of remote collaborative care (CoCM) finds that a few behavioral health conditions (depression, anxiety, and posttraumatic stress disorder) and a range of health outcomes (e.g. quality of life, medication prescriptions, medication adherence) can be effectively managed via remote CoCM. The CoCM model includes a team of a PCP, behavioral health case manager, and psychiatric consultant. The remote CoCM interventions were found statistically significantly more effective than usual care (for seven trials), more effective than CoCM without psychiatric supervision (for one trial), and partially more effective than usual HIV care (for one trial).

Strength and weaknesses:
The authors took an inclusive and thorough approach to identifying articles. Remote CoCM was defined broadly which suggests that if the disparate interventions of these various studies can be effective then various approaches to remote CoCM that include core principles can help promote access to effective mental health care. One of the included studies focused on an African American population helping to promote the overall generalizability of the findings of the systematic review. A limiting factor in assessing feasibility and utility of implementing remote CoCM after the start of the COVID-19 pandemic is that none of the included studies employed televideo technologies for the behavioral health care managers (BHCMs), with little commentary on whether the ease of telephone use may have contributed to the improved outcomes for the remote CoCM studies included in this review. This warrants further study and evaluation.

Relevance:
As disparities to access in the aftermath of the COVID-19 pandemic are addressed with telehealth technologies, this systematic review adds to our confidence of the effectiveness of remote CoCM interventions to address mental health needs, especially in rural areas where remote CoCM could have the potential for a large impact. C-L psychiatrists play an important role with their affiliated health care systems to promote institutional implementation of remote CoCM to rural and surrounding primary care clinics.