(Click to enlarge.) The map depicts the shortage of mental-health providers in many U.S. counties.
University of Wisconsin Population Health Institute. County Health Rankings and Roadmaps. www.countyhealthrankings.org
[The third paragraph's reference to the shortage of mental-health care in Washington has been clarified.]
UW Medicine specialists in psychiatry and behavioral sciences will lead the largest clinical trial ever involving rural Americans with a psychiatric disorder.
One thousand primary-care patients with post-traumatic stress disorder (PTSD), bipolar disorder or both will be recruited from 15 Federally Qualified Health Centers in three states (Arkansas, Michigan and Washington) to study how best to treat these complex mental health conditions in rural areas.
Rural health centers face substantial challenges to care for such patients – namely the lack of mental-health specialists. Many counties in Washington face mental-health workforce shortages – a situation that, as recently as 2007, was mirrored in counties nationwide, according to the U.S. Department of Health and Human Services.
Drs. John Fortney, left, and Jürgen Unützer will co-lead the three-state clinical trial.
pictures of Drs. John Fortney and Jürgen Unützer
“Many rural primary-care providers feel obligated, yet unprepared, to manage PTSD and bipolar disorder,” said Dr. John Fortney, professor of psychiatry and behavioral sciences. He directs research in UW's Division of Population Health, and will lead the study.
“We want to know the most effective approach for managing PTSD and bipolar disorder for the millions of patients in rural America who are unable to seek specialty mental healthcare,” he said.
The study will examine which of two models is more effective for providing mental health care. In one model, primary-care providers will refer patients to offsite psychiatrists and psychologists, who will work directly with the patient through web- and phone-based encounters and prescribe medication and/or deliver psychotherapy as clinically appropriate.
In the other model, offsite mental-health specialists will support and guide an onsite care manager (a nurse or clinical social worker) and the patients’ primary-care providers.
Both are promising approaches, but there have been no comparative-effectiveness trials to determine whether either approach yields a better experience for patients.
Patients and providers helped design the interventions and research methods, Fortney said, and they will be key stakeholders throughout the study.
“Engaged patients oftentimes have a better healthcare experience and improved outcomes. We will look at many factors to assess which model works best, including satisfaction with care, adherence to treatment, improvement in symptoms and progress toward life goals,” he said.
UW psychiatrist Mark Avery counsels a remotely located patient in a secure web conference. The patient's face is obscured intentionally.
picture of UW psychiatrist Mark Avery
Fortney and his collaborators aim to reduce health disparities and improve health-related quality of life among rural Americans. This is good news for Washington, whose mental-health care was ranked 48th in the nation in a 2014 report because of poor access to specialists, especially in rural and otherwise underserved areas.
“This new study will help us take an important step towards realizing our department’s vision: to make sure that all Americans have access to effective mental health care,” said Dr. Jürgen Unützer, UW professor and chair of Psychiatry and Behavioral Sciences and a co-leader of the trial.
The study was funded Aug. 18 by the Patient-Centered Outcomes Research Institute, an independent nonprofit organization authorized by Congress. One of its initiatives is to produce results applicable to diverse patients and care situations that can be translated quickly into clinical practice.
Collaborating institutions include Community Health Centers of Arkansas, Michigan Primary Care Associates, Community Health Plan of Washington, Group Health Research Institute, HealthPartners Institute for Education and Research, Oregon Health & Science University, University of Arkansas for Medical Sciences, University of Michigan, and Washington State University.