看護とケアのジャーナル

Mental Healthcare in Rural and Underserved Primary Care Settings: Benefits of Telemental Health, Integrated Care, Stepped Care and Interdisciplinary Team Models

Abstract

Donald M Hilty, Jennifer Green, Sarah E Nasatir-Hilty, Barb Johnston, James A Bourgeois

Contemporary healthcare has a patient-centered approach, integrates health/mental health care, emphasizes interdisciplinary teamwork, and adopts innovations such as communications technology. Telemedicine (including telepsychiatry) adds versatility to service delivery by improving access to care, leveraging expertise of key disciplines to the point-of-service, and tele-education. Key disciplines in integrated care, wherein psychiatric and other mental health services are provided in a primary care platform, are the psychiatrist, other mental health professionals (i.e., psychologists, social workers, marriage and family therapists), mid-level professionals, and nurses. These clinicians provide clinical, administrative, and care coordination expertise or oversight. Overall, telemedicine, cross-training, stepped care roles, and use of clinically “versatile” clinicians help to fill “holes” in services for patients. Evidence-based treatment becomes more accessible, better disseminated, and in “real-time” with use of technology.