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Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.

Background: Mobile health applications have gained popularity in assisting high-risk, hard-to-reach groups in self-management of health conditions. One such population with high rates of health disparities comprises women under community supervision. In this review, we examine the literature on mHealth applications to address health disparities among women under community supervision., Methods: We searched CINAHL, PubMed, and PsycInfo for peer-reviewed research articles conducted in the U.S. After removal of duplicates, review of 231 article titles and abstracts and 36 articles for full-text review yielded five articles for analysis. Extracted data include author, year, design, sample, objectives, conclusions, measures, interventions and analytic approach., Results: Of the five studies that addressed health disparities of individuals under community supervision, one was done with participants on probation, four with participants on medication therapy for substance use disorder, and one with participants in a drug court program. Only one article was specific to women or controlled for ethnicity. No studies were done with those on parole. None done with populations outside the U.S., Conclusion: Few studies focused on health disparities of women under community supervision. mHealth applications that address substance use, reproductive and sexual health, and safety issues specific to women under community supervision are warranted.

Background: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic., Methods: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020., Results: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic., Conclusions: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

Background: Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement., Objective: This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers., Methods: A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout., Results: Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts., Conclusions: Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers' well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes., (©Donald M Hilty, Christina M Armstrong, Shelby A Smout, Allison Crawford, Marlene M Maheu, Kenneth P Drude, Steven Chan, Peter M Yellowlees, Elizabeth A Krupinski. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.05.2022.)

Introduction: Telepsychiatry can improve access to psychiatric services for those who otherwise cannot easily access care. Family physicians are gatekeepers to specialized care in Ontario, so it is essential to understand predictors relating to referrals to telepsychiatry to better plan services and increase telepsychiatry adoption., Methods: This study used an annual retrospective cross-sectional study design to compare physicians who referred their patients to telepsychiatry each year from fiscal year (FY) 2008 to FY 2016. A 1-year (FY 2016) comparison of family physicians who referred to telepsychiatry (FPTs) compared to family physicians who did not refer to telepsychiatry (FPNTs) matched (1:2) by region was also conducted. Finally, we used statistical modeling to understand the predictors of referring to telepsychiatry among physicians., Results: Between FY 2008 and FY 2016, the number of patients receiving telepsychiatry increased from 925 visits to 13,825 visits. Thirty-two percent of Ontario primary care physicians referred to telepsychiatry in 2016. Several characteristics were notably different between FPTs and FPNTs: FPTs were more likely to be from a residence with less than 10,000 people, to have more nurse practitioners in the practice, and to be from a family health team than FPNTs. Rostered patients of FPTs were more likely to reside in rural areas, have more clinical complexity, and to utilize more mental health services compared to FPNTs., Conclusions: There has been an increase in the use of telepsychiatry by patients and family physicians over the study period, although there remains opportunity for significant growth. Family physicians who live in rural areas, are part of an FHT, have more NPs, with more rural and complex patients were more likely to refer to telepsychiatry. As recent pro-telemedicine policies support the growth of telepsychiatry, this study will serve as an important baseline.

Introduction: Residents of Northern Ontario have limited access to local psychiatric care. To address this, three program models exist: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist. Evidence shows that telepsychiatry has comparable outcomes to in-person consultations. The objective of this study was to determine the cost difference between programs., Methods: A cost-minimization analysis estimating cost per visit from a public healthcare payer economic costing perspective was conducted. Data on fixed and variable costs were obtained. Evidence-based assumptions were made where relevant. Base-case scenarios and a break-even analysis were completed, as well as deterministic and probabilistic sensitivity analyses, to explore the effects of parameter variability on program costs., Results: Costs per visit were lowest in telepsychiatry (CAD$360) followed by traveling physicians (CAD$558) and patient reimbursement (CAD$620). Among the 100,000 Monte Carlo simulations, results showed telepsychiatry was the least costly program in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively. The break-even analysis found telepsychiatry was the least costly program after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients)., Discussion: Our analyses support telepsychiatry as the least costly program. These results have important implications for program planning, including the prioritization of telepsychiatry, increased integration of telepsychiatry with other modalities of outreach psychiatry, and limiting use of the patient remuneration program to where medically necessary, to reduce overall cost.

Background: Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable., Objective: This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry., Methods: The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit., Results: The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample., Conclusions: By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens., (©Eva Serhal, Anne Kirvan, Marcos Sanches, Allison Crawford. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.09.2020.)

Background: Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood., Objective: This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care., Methods: We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019., Results: Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues., Conclusions: Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care., (©Jessica Kemp, Timothy Zhang, Fiona Inglis, David Wiljer, Sanjeev Sockalingam, Allison Crawford, Brian Lo, Rebecca Charow, Mikayla Munnery, Shuranjeet Singh Takhar, Gillian Strudwick. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.03.2020.)

Introduction: The notion of compassion and compassionate care is playing an increasingly important role in health professional education and in the delivery of high-quality healthcare. Digital contexts, however, are not considered in the conceptualisation of compassionate care, nor is there guidance on how compassionate care is to be exercised while using digital health technologies. The widespread diffusion of digital health technologies provides new contexts for compassionate care, with both opportunities for new forms and instantiations of compassion as well as new challenges. How compassion is both understood and enacted within this evolving, digital realm has not been synthesised., Methods and Analysis: This scoping review protocol follows Arksey and O'Malley's methodology to examine dimensions of compassionate professional practice when digital technologies are integrated into clinical care. Relevant peer-reviewed literature will be identified using a search strategy developed by medical librarians, which applies to six databases of medical, computer and information systems disciplines. Eligibility of articles will be determined using the two-stage screening process consisting of (1) title and abstract scan, and (2) full-text review. Screening, abstracting and charting will be conducted by two independent reviewers, with a third reviewer available for resolution when consensus is not achieved. In order to look at the range of current research in this area, extracted data will be thematically analysed and validated by content experts. Descriptive statistics will be calculated where necessary., Ethics and Dissemination: Research ethics approval and consent to participate is not required for this scoping review. The results of the review will inform resource development and strategy for Associated Medical Services (AMS) Healthcare, a Canadian charitable organisation at the forefront of advancing research and leadership development in health and humanities, as part of the AMS Phoenix Project: A Call to Caring, particularly for digital professionalism frameworks so that they are inclusive of a compassion competency., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Rural areas in Ontario have fewer psychiatrists, making access to specialist mental health care challenging. Our objective was to characterise psychiatrists delivering and patients receiving telepsychiatry in Ontario and to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalisation., Method: We conducted a serial panel study to evaluate the characteristics of psychiatrists providing telepsychiatry from April 2007 to March 2013. In addition, we conducted a cross-sectional study for fiscal year 2012-2013 to examine telepsychiatry patient characteristics and create an in-need patient cohort of individuals with a recent psychiatric hospitalisation that assessed if they had follow-up with a psychiatrist in person or through telepsychiatry within 1 year of discharge., Results: In fiscal year 2012-2013, a total of 3801 people had 5635 telepsychiatry visits, and 7% ( n = 138) of Ontario psychiatrists provided telepsychiatry. Of the 48,381 people identified as in need of psychiatric care, 60% saw a local psychiatrist, 39% saw no psychiatrist, and less than 1% saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry within a year. Three northern regions had more than 50% of in-need patients fail to access psychiatry within 1 year., Conclusions: Currently, relatively few patients and psychiatrists use telepsychiatry. In addition, patients scarcely access telepsychiatry for posthospitalisation follow-up. This study, which serves as a preliminary baseline for telepsychiatry in Ontario, demonstrates that telepsychiatry has not evolved systematically to address need and highlights the importance of system-level planning when implementing telepsychiatry to optimise access to care.

Background: A foundational assessment of learning needs is missing from previous reports of telepsychiatry curricula. We used an in-depth needs assessment to identify specific skills required for the practice of effective telepsychiatry, and provide an evidence base to guide the development of telepsychiatry curricula in postgraduate psychiatry training. Many of these skills set telepsychiatry apart from practice in traditional face-to-face clinical settings, or result from adaptations to clinical practice to meet the needs of a telepsychiatry interface in patient care., Methods: We used a qualitative, modified grounded theory approach to gain insight into areas of importance for telepsychiatry training in postgraduate psychiatry residency. 16 interviews of faculty and residents (9 and 7 interviews, respectively), allowed participants to reflect on their experiences in telepsychiatry. Data were then thematically analyzed., Results: Interview respondents identified important aspects of the context for telepsychiatry training; the skills required to competently practice telepsychiatry; and the desired teaching and learning methods for acquiring these skills. Specific domains of competency were identified: technical skills; assessment skills; relational skills and communication; collaborative and interprofessional skills; administrative skills; medico-legal skills; community psychiatry and community-specific knowledge; cultural psychiatry skills, including knowledge of Indigenous cultures; and, knowledge of health systems. The skills identified in this study map well to competency- based medical education frameworks., Conclusions: Telepsychiatry is increasingly being adopted as a solution to health systems problems such as regional disparities in access to care, and it requires explicit competency development. Ensuring adequate and quality exposure to telepsychiatry during residency training could positively impact our health systems and health equity.

Objective: Telepsychiatry is an innovation that addresses disparities in access to care. Despite rigorous clinical research demonstrating its equivalence and effectiveness relative to face-to-face care, many providers are unfamiliar with this technology. Training residents in telepsychiatry is critical to building mental health care capacity in rural and underserviced communities. However, many questions remain regarding the competencies that future psychiatrists require with respect to telepsychiatry, and technology generally, and regarding pedagogical approaches that will promote their attainment. This literature review aims to elucidate evidence-based approaches to developing residents' competence to practice telepsychiatry., Methods: The authors conducted a literature search of telepsychiatry training for psychiatry residents. The authors searched MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, and ERIC using subject headings and keywords; and hand searched reference lists, forward citations of relevant articles, and tables of contents of relevant journals. Articles were included if they were in English, discussed teaching psychiatry residents to provide direct or indirect clinical care via real-time videoconferencing technology, and were published by January 2014., Results: In total, 215 unique references yielded 20 relevant publications. The literature on graduate training in telepsychiatry is sparse, heterogeneous, and primarily descriptive. Even brief learning experiences may increase the likelihood that residents will incorporate telepsychiatry into their future practice. Training should address competencies that are (1) technical, (2) collaborative/interprofessional, and (3) administrative. Training typically consists of supervised provision of clinical care to build modality-specific clinical skills and may also include didactic teaching to provide health systems and transcultural and medicolegal perspectives., Conclusions: A more evidence-based approach to telepsychiatry training is needed, including an assessment of residents' learning needs, use of multiple learning modalities, and evaluations of educational curricula. Pedagogically sound curriculum development and evaluation of postgraduate education in telepsychiatry could promote social accountability, cultural competence, interprofessional care, and, ultimately, improve clinical outcomes.

Telepsychiatry (TP; video; synchronous) is effective, well received and a standard way to practice. Best practices in TP education, but not its desired outcomes, have been published. This paper proposes competencies for trainees and clinicians, with TP situated within the broader landscape of e-mental health (e-MH) care. TP competencies are organized using the US Accreditation Council of Graduate Medical Education framework, with input from the CanMEDS framework. Teaching and assessment methods are aligned with target competencies, learning contexts, and evaluation options. Case examples help to apply concepts to clinical and institutional contexts. Competencies can be identified, measured and evaluated. Novice or advanced beginner, competent/proficient, and expert levels were outlined. Andragogical (i.e. pedagogical) methods are used in clinical care, seminar, and other educational contexts. Cross-sectional and longitudinal evaluation using quantitative and qualitative measures promotes skills development via iterative feedback from patients, trainees, and faculty staff. TP and e-MH care significantly overlap, such that institutional leaders may use a common approach for change management and an e-platform to prioritize resources. TP training and assessment methods need to be implemented and evaluated. Institutional approaches to patient care, education, faculty development, and funding also need to be studied.

BackgroundDuring the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.MethodsWe used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.ResultsThirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.ConclusionsOur results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost–benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost–benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis—such as effectiveness and implementation science approaches—contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses. [ABSTRACT FROM AUTHOR]

Introduction: Project Extension for Community Healthcare Outcomes (Project ECHO®) is a global-guided practice initiative aimed at building primary care capacity and improving health care quality for underserved populations. This tele-education model brings together primary care providers and subject-matter specialists in online communities of practice to share knowledge, discuss complexities in patient care, and collaborate to reduce health disparities. Methods: Using co-generated clinical care recommendations from ECHO Ontario Mental Health, a mental health focused ECHO program, we explored alignment of recommendations across the Institute of Medicine's (IOM) six domains of health care quality to characterize its impact. A total of 417 recommendations, made for 32 patient cases, were analyzed using a modified directed content analysis method. Each recommendation was coded with one or multiple codes, representing each of the six IOM domains. Key examples of recommendations within each domain are described. Results: An average of 13 recommendations were generated per patient case. The effective domain occurred at least once in each complete set of patient care recommendations. The next highest occurring domain was safe (71.9%), followed by patient-centered (68.8%), efficient (40.6%), equitable (18.8%), and timely (12.5%). Recommendation distribution across the entire data set was effective (97.8%), safe (15.6%), patient-centered (12.0%), efficient (3.6%), equitable (1.9%), and timely (1.4%). Discussion: As the first study to characterize ECHO's impact using health care quality domains, the study highlights ECHO's significant focus on effective, safe, and patient-centered care. These findings can inform ways for ECHO to target quality improvement and measure impact in additional health care quality domains, such as efficient, equitable, and timely. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic can cause significant mental health distress among health care professionals (HCPs). We describe the psychological needs of HCPs during COVID-19 and the implementation of Project Extension for Community Healthcare Outcomes (ECHO) Coping with COVID (ECHO-CWC) to help HCPs manage COVID-19 distress. Methods: We used an established rapid implementation approach to accelerate the development and delivery of ECHO-CWC to address the emerging needs of HCPs. Participants' needs were identified using a 10-question survey of participants' perceived risk of COVID-19 and a five-item self-efficacy measure. Implementation outcomes consisted of participant engagement and session satisfaction scores using a five-point Likert scale. Results: A total of 426 participants registered for ECHO-CWC. Needs assessment data (n = 129) showed that most participants reported feeling increased stress at work (84.5%), fear of infecting others (75.2%), and fear of falling ill (70.5%) from COVID-19, yet most participants accepted the risk associated with work during this time (59.7%). Participants were highly satisfied with the initial five sessions (mean = 4.26). Discussion: HCPs reported the greatest concern with fears of infection and infecting others during the acute phase of the pandemic. Using an iterative curriculum design approach and existing implementation frameworks, the ECHO tele-education model can be rapidly mobilized to address HCPs' mental health needs during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

While most patients with depression, anxiety, or at-risk drinking receive care exclusively in primary care settings, primary care providers experience challenges in diagnosing and treating these common problems. Over the past two decades, the collaborative care model has addressed these challenges. However, this model has been adopted very slowly due to the high costs of care managers; inability to sustain their role in small practices; and the perceived lack of relevance of interventions focused on a specific psychiatric diagnosis. Thus, we designed an innovative randomized clinical trial (RCT), the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs). This RCT compared the outcomes of enhanced usual care and a novel model of collaborative care in primary care patients with depressive disorders, generalized anxiety, social phobia, panic disorder, at-risk drinking, or alcohol use disorders. These conditions were selected because they are present in almost a third of patients seen in primary care settings. Innovations included assigning the care manager role to trained lay providers supported by computer-based tools; providing all care management centrally by phone - i.e., the intervention was delivered without any face-to-face contact between the patient and the care team; and basing patient eligibility and treatment selection on a transdiagnostic approach using the same eligibility criteria and the same treatment algorithms regardless of the participants' specific psychiatric diagnosis. This paper describes the design of this RCT and discusses the rationale for its main design features. [ABSTRACT FROM AUTHOR]