Study Touts FQHC Success at Integrating Telehealth, Mental Health Services

With only about 10 percent of the nation’s federally qualified health centers having psychiatrists or licensed clinical psychologists on staff, a telehealth platform could improve access for millions of patients in need of mental health or substance abuse care.

A new study conducted at several rural FQHCs supports that point, finding that a telemental health platform connecting the clinics to specialists helped improve outcomes for patients living with bipolar disorder and/or post traumatic stress disorder.

“The results of our trial showed that if you give access to high-quality care for patients who are underserved, they improve their quality of life,” John Fortney, PhD, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and lead researcher in the project, said in a University of Michigan news release.

The five-year study, funded by the Patient-Centered Outcomes Research Institute (PCORI), brought together several health systems and the Department of Veterans Affairs to test the value of virtual care for psychiatric services at 24 rural FQHCs in Washington, Michigan and Arkansas. Called the Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT), it used a connected health model piloted by the University of Washington that connected these rural health centers to specialists at state medical schools for telepsychiatry and telepsychology services.

The study, recently published in JAMA Psychiatry, focused on two models of care, one linking the patient directly to specialists at the state medical school via telemedicine, and the other integrating telehealth with primary care services at an FQHC. Researchers found that a vast majority of the 1,004 patients treated “reported substantially and statistically significant improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life.” Those improvements were seen equally in both groups.

The research points not only to the value of telehealth in treating patients in remote locations, but in the value of a telehealth platform housed in an FQHC, which serves primarily underserved populations. According to the Centers for Medicare & Medicaid Services, there are roughly 1,400 FQHCs and similar health centers in the US, serving more than 25 million Americans.

With the pandemic reducing access to in-person care, many FQHCs are embracing telehealth to keep in touch with their patient populations and provide virtual access to needed services. They’ve been aided by emergency federal and state measures aimed at boosting access to and coverage for telehealth, and both Congress and the Centers for Medicare & Medicaid Services have expressed interest in extending those policies after the pandemic.

In this particular case, researchers pointed out that many of the patients in the study would likely go without care due to a lack of access to specialists. Only about a third of patients with bipolar disorder and PTSD receive specialty care in a year, they pointed out, and only about 10 percent receive adequate care in a primary care setting.

“One of the major contributions of this study is what we knew to be effective for depression and anxiety we now know also achieves good outcomes for patients with PTSD and bipolar disorder,” Paul Pfeiffer, MD, MS, an associate professor of psychiatry at the University of Michigan Medical School and member of the U-M Institute for Healthcare Policy and Innovation who led the Michigan-based part of the study, said in the press release.