Care managers' experiences in a collaborative care program for the treatment of bipolar disorder and PTSD in underserved communities

Anna LaRocco-Cockburn; Matthew Jakupcak; Amy M Bauer; Deborah J Bowen; Jared Bechtel; Natalie Koconis; John C Fortney

doi:10.1016/j.genhosppsych.2022.03.004

Care managers' experiences in a collaborative care program for the treatment of bipolar disorder and PTSD in underserved communities

Gen Hosp Psychiatry. 2022 May-Jun:76:16-24. doi: 10.1016/j.genhosppsych.2022.03.004. Epub 2022 Mar 7.

Authors

Anna LaRocco-Cockburn¹, Matthew Jakupcak², Amy M Bauer³, Deborah J Bowen⁴, Jared Bechtel⁵, Natalie Koconis⁶, John C Fortney⁷

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; LaRocco Counseling, PLLC, 2366 Eastlake Ave E, Suite 234, Seattle, WA 98102, United States of America. Electronic address: [email protected].
² Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, United States of America. Electronic address: [email protected].
³ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America. Electronic address: [email protected].
⁴ Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, United States of America. Electronic address: [email protected].
⁵ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America. Electronic address: [email protected].
⁶ University of Washington, Institute for Public Health Genetics, in association with the Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America. Electronic address: [email protected].
⁷ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195-6560, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Values-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America. Electronic address: [email protected].

PMID: 35313202
DOI: 10.1016/j.genhosppsych.2022.03.004

Abstract

Objectives: To understand care managers' experiences treating primary care patients with bipolar disorder and PTSD in a telepsychiatry collaborative care (TCC) program, as part of a large pragmatic trial.

Methods: We conducted individual qualitative interviews with 12 care managers to evaluate barriers and facilitators to implementation of a previously completed TCC intervention for patients with bipolar disorder and/or PTSD. We used directed and conventional content analysis and Consolidated Framework for Implementation Research (CFIR) constructs to organize care manager experiences.

Results: Participants described clinical and medication management support from telepsychiatrists and satisfaction with the TCC model as facilitators of success for patients with bipolar disorder and PTSD in underserved communities. Participants also described onboarding of primary care providers and clinic leadership as keys to successful team-care and credited satisfaction with providing Behavioral Activation as essential to sustained delivery of the psychotherapy component of TCC.

Conclusions: Participants described high satisfaction with TCC for patients with bipolar disorder and PTSD. Challenges included lack of clinic leadership and PCP engagement. Early and ongoing promotion of integrated care and prioritizing telepsychiatry consultation with patients, behavioral health professionals and PCPs, may improve patient care, provide ongoing training and improve workforce satisfaction.

Keywords: Behavioral activation; Collaborative care; Integrated care; Qualitative research; Telepsychiatry.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bipolar Disorder* / therapy
Humans
Primary Health Care
Psychiatry*
Qualitative Research
Stress Disorders, Post-Traumatic* / therapy
Telemedicine*