Journal Article Annotations
2022, 1st Quarter
Annotations by Jai Gandhi, MD
This comprehensive systematic review, which included 9 studies of remote collaborative care (CoCM) finds that a few behavioral health conditions (depression, anxiety, and posttraumatic stress disorder) and a range of health outcomes (e.g. quality of life, medication prescriptions, medication adherence) can be effectively managed via remote CoCM. The CoCM model includes a team of a PCP, behavioral health case manager, and psychiatric consultant. The remote CoCM interventions were found statistically significantly more effective than usual care (for seven trials), more effective than CoCM without psychiatric supervision (for one trial), and partially more effective than usual HIV care (for one trial).
Strength and weaknesses:
The authors took an inclusive and thorough approach to identifying articles. Remote CoCM was defined broadly which suggests that if the disparate interventions of these various studies can be effective then various approaches to remote CoCM that include core principles can help promote access to effective mental health care. One of the included studies focused on an African American population helping to promote the overall generalizability of the findings of the systematic review. A limiting factor in assessing feasibility and utility of implementing remote CoCM after the start of the COVID-19 pandemic is that none of the included studies employed televideo technologies for the behavioral health care managers (BHCMs), with little commentary on whether the ease of telephone use may have contributed to the improved outcomes for the remote CoCM studies included in this review. This warrants further study and evaluation.
As disparities to access in the aftermath of the COVID-19 pandemic are addressed with telehealth technologies, this systematic review adds to our confidence of the effectiveness of remote CoCM interventions to address mental health needs, especially in rural areas where remote CoCM could have the potential for a large impact. C-L psychiatrists play an important role with their affiliated health care systems to promote institutional implementation of remote CoCM to rural and surrounding primary care clinics.