RAND Corporation, Arlington, Virginia (Uscher-Pines) and Santa Monica, California (Qureshi); U.S. Department of Veterans Affairs Greater Los Angeles Medical Center, Los Angeles (Raja, Mehrotra); Department of Health Care Policy, Harvard Medical School, Boston (Huskamp, Busch); McLean Hospital, Belmont, Massachusetts (Busch); Beth Israel Deaconess Medical Center, Boston (Mehrotra).
Psychiatr Serv. 2020 May 1;71(5):419-426. doi: 10.1176/appi.ps.201900386. Epub 2020 Jan 30.
Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed. This project aimed to describe how health centers use tele-mental health in conjunction with in-person care.
The 2018 Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator database was used to identify community mental health centers and federally qualified health centers with telehealth capabilities. Maximum diversity sampling was applied to recruit health center leaders to participate in semistructured interviews. Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes.
Twenty health centers in 14 states participated. All health centers used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth. Some health centers used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centers, tele-mental health was used as an adjunct to in-person care. In choosing between tele-mental health and in-person care, health centers often considered patient preference, patient acuity, and insurance status or payer. Although most health centers planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency.
Tele-mental health is generally used as an adjunct to in-person care. The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.
尽管远程心理健康服务的使用正在增加，但关于远程心理健康的部署方式的研究有限。本项目旨在描述健康中心如何将远程心理健康与面对面护理结合使用。
使用 2018 年物质滥用和心理健康服务管理局行为健康治疗服务定位器数据库来识别具有远程医疗能力的社区心理健康中心和联邦合格的健康中心。采用最大差异抽样招募健康中心负责人参与半结构化访谈。采用归纳和演绎方法来开发站点摘要，并进行矩阵分析以确定和完善主题。
来自 14 个州的 20 家健康中心参与了研究。所有健康中心都使用远程精神病学进行诊断评估和药物处方，其中 10 家还通过远程医疗提供治疗。一些健康中心使用自己的员工提供远程心理健康服务，而其他健康中心则与外部提供商签订合同。在大多数健康中心，远程心理健康是作为面对面护理的辅助手段。在选择远程心理健康和面对面护理时，健康中心通常会考虑患者偏好、患者病情严重程度以及保险状况或付款人。尽管大多数健康中心计划继续提供远程心理健康服务，但参与者指出存在一些缺点，包括患者参与度降低、在护理团队内共享信息的挑战以及效率降低。
远程心理健康通常作为面对面护理的辅助手段。本研究的结果可以为政策制定者和临床医生提供有关包含远程心理健康的各种交付模式的信息。
