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Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed

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Telemental health collaborative care for bipolar disorder showed strong growth and sustainability over five years. Key facilitators included perceived need and supportive infrastructure, while barriers involved resources and scheduling.

Keywords:
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Area of Science:

  • Mental Health
  • Telehealth
  • Healthcare Implementation Science

Background:

  • Telemental health interventions show promise in clinical trials but lack demonstrated real-world implementation and sustainability.
  • Less is known about the long-term viability of these programs in less structured clinical settings.

Purpose of the Study:

  • To evaluate the implementation and sustainability of a video teleconference-based collaborative care model for bipolar disorder patients within the Department of Veterans Affairs.
  • To identify factors that facilitated or hindered the program's adoption and long-term use.

Main Methods:

  • A mixed-methods program evaluation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework for quantitative data.
  • Qualitative analysis of semistructured interviews with 16 providers using the Integrated Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework.

Main Results:

  • The program experienced continuous growth, expanding to 35 sites and handling 915 consults between 2011 and 2016.
  • Sustainability was statistically significant beyond the first year. Facilitators included consult content, EHR integration, and national infrastructure; barriers involved space, equipment, staff availability, and scheduling.

Conclusions:

  • Clinical video teleconference interventions, including collaborative care for complex mental health conditions, can achieve robust growth under supportive conditions.
  • Successful implementation hinges on meeting provider needs, a supportive environment, and effective infrastructure facilitation.