Abstract
Purpose of Review
This article discusses recent applications in telemedicine to promote the goals of population health and population management for people suffering psychiatric disorders.
Recent Findings
The use of telemedicine to promote collaborative care, self-monitoring and chronic disease management, and population screening has demonstrated broad applicability and effectiveness. Collaborative care using videoconferencing to facilitate mental health specialty consults has demonstrated effectiveness in the treatment of depression, PTSD, and also ADHD in pediatric populations. Mobile health is currently being harnessed to monitor patient symptom trajectories with the goal of using machine learning algorithms to predict illness relapse. Patient portals serve as a bridge between patients and providers. They provide an electronically secure shared space for providers and patients to collaborate and optimize care.
Summary
To date, research has supported the effectiveness of telemedicine in promoting population health. Future endeavors should focus on developing the most effective clinical protocols for using these technologies to ensure long-term use and maximum effectiveness in reducing population burden of mental health.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Kindig D, Stoddart G. What is population health? Am J Public Health. 2003;93(3):380–3.
Kindig DA. Understanding population health terminology. Milbank Q. 2007;85(1):139–61.
Bao YH, Casalino LP, Pincus HA. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. J Behav Health Serv Res. 2013;40(1):121–32.
Katon W, Von Korff M, Lin E, Simon G, Walker E, Unutzer J, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry. 1999;56(12):1109–15.
Unutzer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836–45.
Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.
Bower P, Gilbody S, Richards D, Fletcher J, Sutton A. Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta-regression. Br J Psychiatry. 2006;189:484–93.
Fortney JC, Maciejewski ML, Tripathi SP, Deen TL, Pyne JM. A budget impact analysis of telemedicine-based collaborative care for depression. Med Care. 2011;49(9):872–80.
Unutzer J, Katon WJ, Fan MY, Schoenbaum MC, Lin EH, Della Penna RD, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care. 2008;14(2):95–100.
Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006;166(21):2314–21.
Peek C. Lexicon for behavioral health and primary care integrations: concepts and definitions developed by expert consensus. Rockville, MD: The National Integration Council, Agency for Healthcare Research and Quality. 2013. AHRQ Publication No. 12-IP0001.
•• Fortney JC, Pyne JM, Kimbrell TA, Hudson TJ, Robinson DE, Schneider R, et al. Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiat. 2015;72(1):58–67. This is one of the strongest randomized controlled trials testing the use of telemedicine for collaborative care.
Fortney JC, Pyne JM, Edlund MJ, Williams DK, Robinson DE, Mittal D, et al. A randomized trial of telemedicine-based collaborative care for depression. J Gen Intern Med. 2007;22(8):1086–93.
Fortney JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, et al. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013;170(4):414–25.
Fortney JC, Pyne JM, Turner EE, Farris KM, Normoyle TM, Avery MD, et al. Telepsychiatry integration of mental health services into rural primary care settings. Int Rev Psychiatry. 2015;27(6):525–39.
•• Myers K, Vander Stoep A, Zhou C, McCarty CA, Katon W. Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2015;54(4):263–74. This study demonstrates the effectiveness of telemedicine for collaborative care in children.
•• Hilty DM, Yellowlees PM, Nesbitt TS. Evolution of telepsychiatry to rural sites: changes over time in types of referral and in primary care providers’ knowledge, skills and satisfaction. Gen Hosp Psychiatry. 2006;28(5):367–73. This article demonstrates how telemedicine can increase capacity of mental health services.
Rollman BL, Belnap BH, Mazumdar S, Abebe KZ, Karp JF, Lenze EJ, et al. Telephone-delivered stepped collaborative care for treating anxiety in primary care: a randomized controlled trial. J Gen Intern Med. 2017;32(3):245–55.
Katon W, Unutzer J. Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med. 2006;166(21):2304–6.
Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP. County-level estimates of mental health professional shortage in the United States. Psychiatr Serv. 2009;60(10):1323–8.
Calear AL, Christensen H, Mackinnon A, Griffiths KM. Adherence to the MoodGYM program: outcomes and predictors for an adolescent school-based population. J Affect Disord. 2013;147(1–3):338–44.
Neil A, Christensen H, Griffiths K. Evaluation of MoodGYM with an adolescent population. Acta Neuropsychiatr. 2006;18(6):263.
Schneider J, Sarrami Foroushani P, Grime P, Thornicroft G. Acceptability of online self-help to people with depression: users’ views of MoodGYM versus informational websites. J Med Internet Res. 2014;16(3):e90.
Twomey C, O’Reilly G. Meta-analysis looks at effectiveness of MoodGYM programme in computerised cognitive behavioural therapy. BMJ. 2016;354:i4221.
Twomey C, O’Reilly G. Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: meta-analysis. Aust N Z J Psychiatry. 2017;51(3):260–9.
Twomey C, O’Reilly G, Byrne M, Bury M, White A, Kissane S, et al. A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions. Br J Clin Psychol. 2014;53(4):433–50.
•• Andersson G, Carlbring P, Berger T, Almlov J, Cuijpers P. What makes Internet therapy work? Cogn Behav Ther. 2009;38(Suppl 1):55–60. This paper provides insights into best practices in Internet therapies.
• Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196–205. This is an excellent review of Internet-based therapies.
Gilbody S, Brabyn S, Lovell K, Kessler D, Devlin T, Smith L, et al. Telephone-supported computerised cognitive-behavioural therapy: REEACT-2 large-scale pragmatic randomised controlled trial. Br J Psychiatry. 2017;210(5):362–7.
Mohr DC, Stiles-Shields C, Brenner C, Palac H, Montague E, Kaiser SM, et al. MedLink: a mobile intervention to address failure points in the treatment of depression in general medicine. Int Conf Pervasive Comput Technol Healthc. 2015;2015:100–7.
Burns MN, Begale M, Duffecy J, Gergle D, Karr CJ, Giangrande E, et al. Harnessing context sensing to develop a mobile intervention for depression. J Med Internet Res. 2011;13(3):e55.
Saeb S, Cybulski TR, Schueller SM, Kording KP, Mohr DC. Scalable passive sleep monitoring using mobile phones: opportunities and obstacles. J Med Internet Res. 2017;19(4):e118.
Saeb S, Lattie EG, Schueller SM, Kording KP, Mohr DC. The relationship between mobile phone location sensor data and depressive symptom severity. PeerJ. 2016;4:e2537.
Saeb S, Zhang M, Karr CJ, Schueller SM, Corden ME, Kording KP, et al. Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: an exploratory study. J Med Internet Res. 2015;17(7):e175.
Ben-Zeev D, Brian R, Wang R, Wang W, Campbell AT, Aung MS, et al. CrossCheck: Integrating self-report, behavioral sensing, and smartphone use to identify digital indicators of psychotic relapse. Psychiatr Rehabil J. 2017;
Bardram J, Frost M, Szanto K, Faurholt-Jepsen M, Vinberg M, Kessing L, editors. Designing mobile health technology for bipolar disorder: a field trial of the MONARCA system. SIGCHI Conference on Human Factors in Computing Systems; 2013; Paris, France.
Fortney JC, Unutzer J, Wrenn G, Pyne JM, Smith GR, Schoenbaum M, et al. A tipping point for measurement-based care. Psychiatr Serv. 2017;68(2):179–88.
Mohr DC, Cheung K, Schueller SM, Hendricks Brown C, Duan N. Continuous evaluation of evolving behavioral intervention technologies. Am J Prev Med. 2013;45(4):517–23.
Luxton DD, McCann RA, Bush NE, Mishkind MC, Reger GM. mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Prof Psychol-Res Pr. 2011;42(6):505–12.
Meyer J, Schnauber J, Heuten W, Wienbergen H, Hambrecht R, Appelrath HJ, et al. Exploring longitudinal use of activity trackers. 2016 Ieee International Conference on Healthcare Informatics (Ichi). 2016. p. 198–2e06.
Scherer EA, Ben-Zeev D, Li ZG, Kane JM. Analyzing mHealth engagement: joint models for intensively collected user engagement data. J Med Internet Res. 2017;5(1)
Ben-Zeev D, Scherer EA, Gottlieb JD, Rotondi AJ, Brunette MF, Achtyes ED, et al. mHealth for schizophrenia: patient engagement with a mobile phone intervention following hospital discharge. J Med Internet Res. 2016;3(3):e34.
Klein AA, Slaymaker VJ, Dugosh KL, Mckay JR. Computerized continuing care support for alcohol and drug dependence: a preliminary analysis of usage and outcomes. J Subst Abus Treat. 2012;42(1):25–34.
Klein DM, Pham K, Samy L, Bluth A, Nazi KM, Witry M, et al. The veteran-initiated electronic care coordination: a multisite initiative to promote and evaluate consumer-mediated health information exchange. Telemed J E Health. 2017;23(4):264–72.
•• Turvey C, Klein D, Fix G, Hogan TP, Woods S, Simon SR, et al. Blue Button use by patients to access and share health record information using the Department of Veterans Affairs’ online patient portal. J Am Med Inform Assoc. 2014;21(4):657–63. This article demonstrates how patients can use portals to improve managing their health and communicating with caregivers.
Turvey CL, Zulman DM, Nazi KM, Wakefield BJ, Woods SS, Hogan TP, et al. Transfer of information from personal health records: a survey of veterans using My HealtheVet. Telemed J E Health. 2012;18(2):109–14.
Wolff JL, Darer JD, Berger A, Clarke D, Green JA, Stametz RA, et al. Inviting patients and care partners to read doctors’ notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc. 2017;24(e1):e166–e72.
Dobscha SK, Denneson LM, Jacobson LE, Williams HB, Cromer R, Woods S. VA mental health clinician experiences and attitudes toward OpenNotes. Gen Hosp Psychiatry. 2016;38:89–93.
Nazi KM, Turvey CL, Klein DM, Hogan TP, Woods SS. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc. 2015;22(2):380–9.
Funding
This work was supported by the Department of Veterans Affairs, Quality Enhancement Research Initiative program (QUE 15-282). The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the USA government.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Psychiatry in the Digital Age
Rights and permissions
About this article
Cite this article
Turvey, C., Fortney, J. The Use of Telemedicine and Mobile Technology to Promote Population Health and Population Management for Psychiatric Disorders. Curr Psychiatry Rep 19, 88 (2017). https://doi.org/10.1007/s11920-017-0844-0
Published:
DOI: https://doi.org/10.1007/s11920-017-0844-0