Background: Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. Objective: This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. Methods: Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients’ self-reported physical and mental health and depression) outcomes were assessed every 6 months. Results: For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI −0.2 to 0.6; P=.28; and GAF: −0.6, 95% CI −3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI −0.04 to 0.8; P=.07; and GAF: −0.5, 95% CI −3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. Conclusions: This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. Trial Registration: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.

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中文翻译：

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初级保健中异步与同步远程精神病学的临床结果：随机对照试验


背景：异步远程精神病学（ATP；延迟时间）咨询是初级保健机构中精神病学咨询的一种新型形式。缺乏比较 ATP 与同步远程精神病学 (STP) 临床结果的纵向研究。目的：本研究旨在确定与 STP（远程精神病学常规护理方法）相比，ATP 在改善英语和西班牙语初级保健患者临床结果方面的有效性。方法：总体而言，来自 3 个初级保健诊所的 36 名初级保健医生转诊了 401 名寻求治疗的患有非紧急精神疾病的成年患者的异质样本。共有 184 名（94 ATP 和 90 STP）英语和西班牙语参与者（36/184，19.6% 西班牙裔）被纳入并随机分组，其中 160 名（80 ATP 和 80 STP）完成了基线评估。患者由初级保健医生与加州大学戴维斯分校健康中心的远程精神病学家协商，使用协作护理模式进行治疗，后者使用 ATP 或 STP 每 6 个月与患者进行一次咨询，持续长达 2 年。每 6 个月评估一次主要结局（临床医生评定的临床总体印象 [CGI] 量表和总体功能评估 [GAF]）和次要结局（患者自我报告的身心健康状况和抑郁症）。结果：对于临床医生评定的主要结局，6 个月随访时 ATP 并未比 STP 带来更大的改善（ATP 与 STP，6 个月随访调整差异与 CGI 基线差异：0.2，95% CI - 0.2 至 0.6；GAF：-0.6，95% CI -3.1 至 1.9；P=.66）或 12 个月随访（ATP 与 STP，12 个月与CGI 的基线差异：0.4，95% CI -0.04 至 0.8；并且 GAF：-0。5，95% CI -3.3 至 2.2； P=.70），但两组患者的两种结果均在统计学和临床​​上都有显着改善。在任何随访中，任何患者自我报告的评分中，ATP 和 STP 相对于基线的改善均无显着差异（所有 P 值均在 0.17 至 0.96 之间）。辍学率高于预期，但两组之间相似。在进行基线访视的患者中，46.8% (75/160) 在 1 年时未进行随访，72.7% (107/147) 在 2 年时未进行随访。没有与干预相关的严重不良事件。结论：这是第一项证明 ATP 可以改善讲英语和西班牙语的初级保健患者的临床结果的纵向研究。尽管我们没有发现证据表明 ATP 在改善临床结果方面优于 STP，但它可能是初级保健中阶梯式心理健康干预措施的关键部分。 ATP 提出了解决精神科医生劳动力短缺问题的可能解决方案以及改善现有护理系统的策略。试验注册：ClinicalTrials.gov NCT02084979； https://clinicaltrials.gov/ct2/show/NCT02084979。


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