Optimization of Virtual and In-Person Care Coordination Between VA Primary Care and Mental Health Teams: A Qualitative Study.
In the Veterans Health Administration (VA), primary care teams include embedded specialists to facilitate timely access to effective mental health treatments, including same-day warm handoffs from primary care clinicians/staff to integrated mental health specialists.
Understand the impact of the post-COVID-19 shift to virtual care on depression assessment and treatment and explore clinician-identified ways to optimize hybrid (virtual/in-person) integrated care for primary care patients with depression.
Semi-structured interviews across three geographically diverse VA healthcare systems.
Forty-seven primary care clinicians/staff and integrated mental health specialists.
Interview questions were based on Fortney et al.'s Reconceptualized (Digital) Access Framework. Transcripts were coded using a qualitative descriptive approach with constant comparison.
Participants indicated that post-pandemic use of virtual care helped increase access to depression treatment. Particularly, they cited a model where integrated mental health clinicians/staff cover clinics across a healthcare system by offering telephone or video visits to patients at multiple sites. Primary care and mental health coordination appeared to work well; nevertheless, some primary care clinicians/staff preferred in-person warm handoffs. When asked about the optimal mix of in-person and virtual depression care, primary care clinicians/staff thought the initial assessment should be done in person, especially for patients presenting complicated cases. Ongoing care, namely cognitive behavioral therapy and medication management, was thought to be ideal for virtual delivery. Participants emphasized the need for offering Veteran-centric care, or care that "meets the Veterans where they are" and encourages them to continue engagement in mental healthcare.
Clinicians generally deferred to patients on their preferred care modality, but some indicated certain situations (e.g., initial assessment, complicated cases) may be better suited for in-person over virtual care. Further research should examine quality of virtual and in-person primary care-based mental healthcare, and patient satisfaction and experiences with these care modalities.
Understand the impact of the post-COVID-19 shift to virtual care on depression assessment and treatment and explore clinician-identified ways to optimize hybrid (virtual/in-person) integrated care for primary care patients with depression.
Semi-structured interviews across three geographically diverse VA healthcare systems.
Forty-seven primary care clinicians/staff and integrated mental health specialists.
Interview questions were based on Fortney et al.'s Reconceptualized (Digital) Access Framework. Transcripts were coded using a qualitative descriptive approach with constant comparison.
Participants indicated that post-pandemic use of virtual care helped increase access to depression treatment. Particularly, they cited a model where integrated mental health clinicians/staff cover clinics across a healthcare system by offering telephone or video visits to patients at multiple sites. Primary care and mental health coordination appeared to work well; nevertheless, some primary care clinicians/staff preferred in-person warm handoffs. When asked about the optimal mix of in-person and virtual depression care, primary care clinicians/staff thought the initial assessment should be done in person, especially for patients presenting complicated cases. Ongoing care, namely cognitive behavioral therapy and medication management, was thought to be ideal for virtual delivery. Participants emphasized the need for offering Veteran-centric care, or care that "meets the Veterans where they are" and encourages them to continue engagement in mental healthcare.
Clinicians generally deferred to patients on their preferred care modality, but some indicated certain situations (e.g., initial assessment, complicated cases) may be better suited for in-person over virtual care. Further research should examine quality of virtual and in-person primary care-based mental healthcare, and patient satisfaction and experiences with these care modalities.