Specific Aims: This study aims to assess the acceptability of asynchronous~telepsychiatry (ATP) and synchronous (STP) in rural Skilled Nursing Facility~(SNF) population, in a 12-month randomized controlled trial. ATP relies on~video recording of a psychiatric interview, where the video is later reviewed by~a psychiatrist to make a psychiatric diagnosis and treatment recommendation~to the primary treatment team.~STP is real-time, face-to-face psychiatric assessment using video conferencing~to come up with a psychiatric recommendation. People residing in SNFs~generally rely on primary and consultant physicians to visit them and rarely~have outpatient psychiatrist follow-up. SNFs offer more services than what is~available to primary care office, and include 24-hours skilled nursing services,~physical therapy, nutritional consultation, occupational therapy, social services,~wound care, and psychiatric consultation when available. SNF residents are~unable to live independently due to their multiple medical comorbidities and are~therefore more medically ill than patients who are typically seen in primary care~settings. The present study aims to demonstrate feasibility and to collect pilot~data in SNFs. This study is funded by the University of California (UC Davis)~Behavior Health Center of Excellence grant via the California Mental Health~Services Act (Prop 63). In a larger, future study, we intend to demonstrate that~ATP will be no different than STP in clinical outcomes but will be more~accessible and cost effective.~Aim 1: To assess whether ATP and STP models improve clinical outcomes:~Hypotheses: Compared to STP, the ATP arm will: H1: show similar clinical~outcome trajectory, reflected in improvement from baseline, as measured by~Clinical Global Impression (CGI), Patient Health Questionaire-9 (PHQ-9), Brief~Interview for Mental Status (BIMS), and overall behavioral symptoms; H2: have~similar use of health care resources: psychiatric medications, additional interval~psychiatric visits, number of emergency room visits and hospitalizations~(medical, psychiatric, and overall); And H3: produce shorter waiting times for~psychiatric consultation.~Aim 2: To assess the acceptability of ATP and STP by examining satisfaction~surveys from SNF residents (who are able to complete the surveys).~Hypothesis:~Compared to STP, ATP participants will show: H1: Similar levels of satisfaction~as measured by: Telemedicine Satisfaction Survey as completed by~participants.~Aim 3: To conduct preliminary healthcare economics analysis and feasibility of~producing estimates of cost-effectiveness of ATP vs. STP in SNFs. Hypotheses:~ATP, compared to STP, will: H1: be more cost effective as measured by cost~savings from reduced need for face-to-face psychiatrist time and similar use of~other medical and psychiatric services.
Specific Aims: This study aims to assess the acceptability of asynchronous~telepsychiatry (ATP) and synchronous (STP) in rural Skilled Nursing Facility (SNF)~population, in a 12-month randomized controlled trial. ATP relies on video recording of a~psychiatric interview, where the video is later reviewed by a psychiatrist to make a~psychiatric diagnosis and treatment recommendation to the primary treatment team.~STP is real-time, face-to-face psychiatric assessment using video conferencing to come~up with a psychiatric recommendation. People residing in SNFs generally rely on primary~and consultant physicians to visit them and rarely have outpatient psychiatrist follow-up.~SNFs offer more services than what is available to primary care office, and include 24-~hours skilled nursing services, physical therapy, nutritional consultation, occupational~therapy, social services, wound care, and psychiatric consultation when available. SNF~residents are unable to live independently due to their multiple medical comorbidities~and are therefore more medically ill than patients who are typically seen in primary care~settings. The present study aims to demonstrate feasibility and to collect pilot data in~SNFs. This study is funded by the UC Davis Behavior Health Center of Excellence grant~via the California Mental Health Services Act (Prop 63). In a larger, future study, the investigators~intend to demonstrate that ATP will be no different than STP in clinical outcomes but will~be more accessible and cost effective.