telehealth in rural areas, rural telehealth

Telehealth in Rural Areas: Treating PTSD & Bipolar Disorder


December 20, 2021 | Reading Time: 3 Minutes

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Telehealth has recently shown triumphs within the medical field by reaching those living in rural areas who were less likely to access mental health services than those residing in bigger cities. Researchers at the University of Washington compared the effects of a rural telehealth referral approach versus an integrated approach using clinic-to-clinic interactive video conferencing for treating patients diagnosed with bipolar or post-traumatic stress disorder. The four-year rural telehealth study was published in JAMA Network on December 1, 2021. It was called SPIRIT (Study to Promote Innovation in Rural Integrated Telepsychiatry). Clinicians in the study saw over 1000 participants and concluded that 32% saw improvements in their mental health when using telehealth in rural areas.

The study started in 2016, and providers used Zoom as the video platform. This comparative analysis was designed to identify the best approach to conducting telehealth and telemedicine in rural areas. The program offered professional training to all clinicians to improve outcomes by standardizing the approach. For decades collaborative care has been rendered as an effective way to tend to those with depression and anxiety. Still, SPIRIT has depicted a modern way to use collaborative care for bipolar disorder and PTSD while using telehealth in rural areas. Persons who received telehealth regarding PTSD were seen to have “significantly larger decreases in Posttraumatic Diagnostic Scale scores.”

As part of the program, practitioners were required to track their patients’ progress. Unlike PTSD, bipolar disorder does not have a trackable scale. Therefore, a new scale was implemented by researchers called the mania scale

Researchers John Fortney and colleagues concluded that both approaches were equally effective in their report. The article states:

Findings  In this pragmatic randomized comparative effectiveness trial, including 1004 adult participants, both approaches significantly improved clinical outcomes significantly. The referral approach used substantially more mental health specialist time than the integrated approach.

Meaning  Based on findings from this trial, from a health care system perspective, clinical leadership should implement whichever approach is most sustainable; from a societal perspective, policymakers should incentivize the integrated approach because it requires less scarce mental health specialist time.

Despite limited financial resources, SPIRIT was a success.

School-Based Telehealth in Rural Areas

Schools are also benefiting from the movement toward telemedicine and telehealth in rural areas. School-Based Telehealth Network Grant Program conducted research that found that telehealth utilized in school boards was beneficial in aiding clinician shortages. It proved to be widely accepted by faculty, students, and parents alike. However, similar to SPIRIT, telehealth in rural schools needs more funding for better execution. These services need more reimbursement from private insurers and Medicaid. 

This study sought to identify facilitators and barriers to the implementation of telehealth in rural area schools and identified strategies for successful implementation. Interviews were conducted with 50 key informants working with telehealth programs funded through the School-Based Telehealth Network Grant Program. A thematic analysis of interview transcripts identified vital barriers and effective strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. The researchers conclude that school-based telehealth in rural areas can augment clinical capacity in areas with clinician shortages.

Funding for Research of Telehealth in Rural Areas

 As with the SPIRIT program discussed above, the future of these effective rural telehealth programs rests on funding from private insurers and Medicaid. John Fortney and other colleagues have also written a policy paper of potential use to readers interested in developing telehealth services in rural areas. It was written to help stakeholders predict financial steps and hurdles that needed to be addressed to maintain rural telehealth.

Resources & References

  1. (2018.) Serving Vulnerable and Underserved Populations.
  2. Can telehealth for PTSD and bipolar disorder in rural areas be scaled up?
  3. Fortney JC, Bauer AM, Cerimele JM, et al. Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care: A Pragmatic Randomized Comparative Effectiveness Trial. JAMA Psychiatry. 2021;78(11):1189–1199. doi:10.1001/jamapsychiatry.2021.2318
  4. Fox K, Burgess A, Williamson ME, Massey J, Shaler G, Pearson K, Mackenzie JK, Merchant K, Zhu X, Ward M. Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment. J Sch Health. 2021 Nov 21. doi: 10.1111/josh.13104. Epub ahead of print. PMID: 34806199.
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