Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary CareA Pragmatic Randomized Comparative Effectiveness Trial

Accepted for Publication: June 29, 2021.

Published Online: August 25, 2021. doi:10.1001/jamapsychiatry.2021.2318

Corresponding Author: John C. Fortney, PhD, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA 98195 (fortneyj@uw.edu).

Author Contributions: Drs Fortney and Hawrilenko had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Fortney, Bauer, Cerimele, Pyne, Heagerty, Kaysen, Bowen, Moore, Metzger, Hafer, Unützer.

Acquisition, analysis, or interpretation of data: Fortney, Bauer, Cerimele, Pyne, Pfeiffer, Heagerty, Hawrilenko, Zielinski, Kaysen, Bowen, Moore, Ferro, Shushan, Nolan, Dalack, Unützer.

Drafting of the manuscript: Fortney, Hawrilenko, Bowen, Moore, Metzger, Hafer.

Critical revision of the manuscript for important intellectual content: Bauer, Cerimele, Pyne, Pfeiffer, Heagerty, Hawrilenko, Zielinski, Kaysen, Moore, Ferro, Shushan, Nolan, Dalack, Unützer.

Statistical analysis: Fortney, Heagerty, Hawrilenko.

Obtained funding: Fortney, Kaysen, Hafer.

Administrative, technical, or material support: Fortney, Bauer, Pfeiffer, Zielinski, Kaysen, Bowen, Moore, Ferro, Metzger, Shushan, Hafer, Nolan, Dalack, Unützer.

Study supervision: Fortney, Pyne, Kaysen, Unützer.

Conflict of Interest Disclosures: Drs Fortney, Bauer, Cerimele, Heagerty, Kaysen, Shushan, and Dalack have received grants from the Patient-Centered Outcomes Research Institute during the conduct of the study. Dr Bauer has received grants from the National Institutes of Health, Washington State Legislature Integrated Care Training Program, and Premera Blue Cross Rural Mental Health Integration Initiative outside the submitted work. Dr Pyne has received grants from the University of Arkansas for Medical Sciences during the conduct of the study. Dr Kaysen has received personal fees from Elsevier Publishing and honorarium for conducting trainings or workshops in cognitive processing therapy outside the submitted work. Dr Moore has received support from the University of Washington during the conduct of the study. No other disclosures were reported.

Funding/Support: This work was supported by a grant PCS-1406-19295 from the Patient-Centered Outcomes Research Institute to Drs Fortney and Unützer.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The statements in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its board of governors, or methodology committee.

Data Sharing Statement: See Supplement 3.

Additional Contributions: We thank the patients and staff of Family Health Centers, Omak, Washington; Moses Lake Community Health Center, Moses Lake, Washington; Sea Mar Community Health Centers, Seattle, Washington; Yakima Neighborhood Health Services, Yakima, Washington; Boston Mountain Rural Health Centers, Marshal, Arkansas; East Arkansas Family Health Center, West Memphis; Lee County Cooperative Clinic, Marianna, Arkansas; Cherry Health, Grand Rapids, Michigan; Family Medical Center, Temperance, Michigan; Great Lakes Bay Health Centers, Saginaw, Michigan; InterCare Community Health Network, Bangor, Michigan; and Upper Great Lakes Family Health Center, Calumet, Michigan. We thank the staff of the Community Health Plan of Washington, the Community Health Centers of Arkansas, and the Michigan Primary Care Association. We thank our policy advisory board: Donald Weaver, MD (National Association of Community Health Centers, Bethesda, Maryland); Ed Larkins, MHA (Family Medical Center); Jay Shore, MD (University of Colorado at Denver); LaShannon Spencer, MPA, MHSA (Community Health Centers of Arkansas, Little Rock); Nancy Speck, PhD (National Association for Rural Mental Health, Houston, Texas); Sara Coates, MA, MPH, and Dawne Velianoff, LMSW (Michigan Primary Care Association, Lansing); and Susan Ward-Jones, MD (East Arkansas Family Health Center). We thank our consumer advisor board: Bernadette McDonald, BS; Florence Fee, JD (No Health Without Mental Health, Arlington, Virginia); Ingrid Deetz, BS, Kevin Einbinder, BS, and Betsy O’Brien, BS (Depression and Bipolar Support Alliance, Chicago, Illinois); Kim Arnold, BS, Marquitta Magnini, BS, and Shawn McCown, BS (National Alliance on Mental Illness, Little Rock, Arkansas); Jode Freyholtz-London, AAS (Wellness in the Woods, Eagle Bend, Minnesota); and Tammy Heral and Jeremy Mullins. We thank the members of our external data safety monitoring board: Thomas Belin, PhD (University of California, Los Angeles); John Williams, MD (Duke University, Durham, North Carolina); and Mark Williams, MD (Mayo Clinic, Rochester, Minnesota). Also, thanks to our research staff Suzanne Hunter, BS, Jared Bechtel, BS, Diane Powers, MA, MBA, Shiyu Chen, MS, and Morgan Johnson, MS (Department of Psychiatry, University of Washington, Seattle); and Nick Ponomarev, PhD, and Dan Vakoch, MS (Social and Economic Sciences Research Center, Washington State University, Pullman). We thank the following electronic health record vendors for giving us substantial discounts on the user licenses for the telepsychiatrists and telepsychologists: NextGen Healthcare, eClinicalWorks, Centricity (GE Healthcare), Allscripts, and SuccessEHS, Inc. Members of the policy advisory board and consumer advisory board as well as our research staff were compensated for their work.