A Comparison of the Effectiveness of Telepsychiatry with a Randomized Waitlist Using Patient Reported Outcomes

Overall Objective: Hybrid psychiatric treatment, defined as the delivery of care through a combination of phone, video, and in-person visits, has little empirical support for its effectiveness. This study investigated patient outcomes in hybrid psychiatric care compared to outpatient waitlist control groups measured via Patient-Reported Outcome Measures (PROMs).

Detail: The utilization of patient reported outcome measures (PROMs) during in-person care allows for on-going assessment of the severity of mental illness and patient outcomes across treatment (Lewis, et al., 2019; Douglas, et al., 2020). Additionally, it provides immediate feedback on the patient’s psychiatric status to both the patient and practitioner (Lambert, et al., 2018). Carilion Clinic - Psychiatry & Behavioral Medicine (CC-P&BM) ambulatory clinic implemented PROMs prior to the start of the COVID-19 pandemic and continues to utilize them as part of patient care. All new patients are asked to complete an initial PROM bundle of assessments twenty-four hours before their initial appointment, including the Brief Adjustment Scale (BASE-6), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), US Alcohol Use Disorder Identification Test (USAUDIT), and Drug Assessment Screening Test (DAST-10). Automatic monthly reminders to complete the BASE-6, PHQ-9 and GAD-7 continue after the first visit with the clinician.
The COVID-19 pandemic necessitated a rapid transition nationally from in-person to telehealth psychiatry (Augusterfer, Mollica, & Lavelle, 2018; Torous & Wykes, 2020; Kalin, et al., 2020), a change that occurred in our clinic as well. Over the last 2 years, research members of Carilion Clinic Psychiatry and Virginia Tech Psychology departments have been actively using PROM data to assess psychiatric health outcomes before and after the outbreak of COVID-19 in the United States. Initial results indicate that patients who received care via telepsychiatry not only did not experience worsening symptoms, but showed improvements in depression, anxiety and psychological functioning. However,
without a control group of untreated patients to compare, the impact of telepsychiatry plus PROMs remains unclear. A waitlist control group design would allow us to compare patients receiving telepsychiatry and repeated completion of PROMs (current practice) to patients referred to psychiatry, but not receiving telepsychiatry treatment or completing PROMs during the same time period. We proposed randomizing waitlist individuals to one of two groups to
assess the influence of time alone awaiting initial psychiatric clinician assessment (no intervention) versus minimal intervention using repeated PROMs and microlearning patient education videos while awaiting initial psychiatric clinician assessment. This kind of design allowed for assessment of the influence of time and the type of health service contact that replicated the basics of measurement-based psychiatric services (measurement of symptomology and
well-being), but with none of the benefits of psychiatric supports, interventions, and techniques.