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Pilot Study of Asynchronous and Synchronous Telepsychiatry for Skilled Nursing Facilities

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT02537093
Recruitment Status : Completed
First Posted : September 1, 2015
Last Update Posted : July 11, 2017
Sponsor:
Information provided by (Responsible Party):

Study Description
Brief Summary:

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.


Condition or disease Intervention/treatment
Dementia Depression Mood Disorder Anxiety Disorder Substance Use Disorder Behavioral: Psychiatric Consultation

  Show Detailed Description

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: A Pilot Study Examining Use of Asynchronous and Synchronous Telepsychiatry Consultation for Skilled Nursing Facility Residents
Study Start Date : August 2015
Primary Completion Date : May 2017
Study Completion Date : May 2017
Arms and Interventions

Arm Intervention/treatment
Active Comparator: Synchronous telepsychiatry (STP)
Control Arm/Synchronous telepsychiatry (STP): After baseline assessment, subjects will be assessed by a psychiatrist using live interactive videoconferencing every 6 months for a 1 year follow up (3 STP assessments: baseline plus 2 assessments). A report with treatment recommendations following American Psychiatric Association guidelines will be sent to the PCP who will be able to have adlib telephone or email consultations with the telepsychiatrist. The telepsychiatrist will have access to all previous clinical information about the patients.
Behavioral: Psychiatric Consultation
Experimental: Asynchronous telepsychiatry (ATP)
Intervention Arm (ATP): All ATP assessments at 6 monthly intervals post baseline will be conducted by an ATP trained clinician. This interview will be video recorded.The ATP clinicians will then fill out a standardized medical template that will be reviewed by a psychiatrist who will provide a written assessment and psychiatric treatment plan. He will have access to any previous assessments and the PCP will also have continuing access to this psychiatrist by phone or email between the 3 consultations.
Behavioral: Psychiatric Consultation


Outcome Measures

Primary Outcome Measures :
  1. Clinical Global Impression [ Time Frame: 12 months ]
    Change in CGI will be measured from baseline to study endpoint of 12-month follow-up

  2. Brief Interview for Mental Status (BIMS) [ Time Frame: 12 months ]
    Change in BIMS will be measured from baseline to 12-month


Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Aged ≥18, with non-emergent psychiatric symptoms: depression, schizophrenia, bipolar disorder, Post-Traumatic Stress Disorder (PTSD), dementia-related behavioral problems, management of psychiatric medications, and other mental health problems that the Skilled Nursing Facility (SNF) Primary Care Provider (PCP) and team deems necessary to obtain psychiatric consultation.
  • referred by SNF staff and PCP at participating site

Exclusion Criteria:

  • Residents with imminent suicide and/or violence risks that require emergency psychiatric referrals or residents who cannot wait until the next ATP/STP evaluation
  • Residents with other psychiatric emergencies will be referred to the local emergency department as is the current practice at both SNFs.
  • less than 18 years
  • immediate violent intentions or plans
  • incarceration
  • patient whose PCP recommends not participating.
  • PCP not at participating site
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02537093


Locations
United States, California
Norwood Pines Care Center
Sacramento, California, United States, 95838
Cottonwood Post-Acute Rehabilitation Center
Woodland, California, United States, 95695
Sponsors and Collaborators
University of California, Davis
More Information

Responsible Party: University of California, Davis
ClinicalTrials.gov Identifier: NCT02537093     History of Changes
Other Study ID Numbers: 741223
First Posted: September 1, 2015    Key Record Dates
Last Update Posted: July 11, 2017
Last Verified: July 2017

Additional relevant MeSH terms:
Disease
Dementia
Anxiety Disorders
Mood Disorders
Substance-Related Disorders
Pathologic Processes
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Neurocognitive Disorders
Mental Disorders
Chemically-Induced Disorders