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

Abstract

Background: Telemental health interventions have empirical support from clinical trials and structured demonstration projects. However, their implementation and sustainability under less structured clinical conditions are not well demonstrated. Introduction: We conducted a follow-up analysis of the implementation and sustainability of a clinical video teleconferencebased collaborative care model for individuals with bipolar disorder treated in the Department of Veterans Affairs to (a) characterize the extent of implementation and sustainability of the program after its establishment and (b) identify barriers and facilitators to implementation and sustainability. Materials and Methods: We conducted a mixed methods program evaluation, assessing quantitative aspects of implementation according to the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. We conducted qualitative analysis of semistructured interviews with 16 of the providers who submitted consults, utilizing the Integrated Promoting Action on Research Implementation in the Health Services implementation framework. Results: The program demonstrated linear growth in sites (n = 35) and consults (n = 915) from late 2011 through mid-

Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: a systematic review

“…[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The only study published prior to 2007 involved a telehealth digital intervention. 45 Most of the studies used mixed methods, 28,29,31,32,34,35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] four used quantitative methods 30,33,36,51 and two studies used qualitative methodology. 52,53 The majority of the studies were feasibility and acceptability trials (42%), 29, 35, 36, 38, 40, 42-44, 50, 53 eight were designed to look specifically at implementation (31%), 28, 30, 32, 45-47, 49, 52 five were pilot studies (19%), 31,39,…”

“…52,53 The majority of the studies were feasibility and acceptability trials (42%), 29, 35, 36, 38, 40, 42-44, 50, 53 eight were designed to look specifically at implementation (31%), 28, 30, 32, 45-47, 49, 52 five were pilot studies (19%), 31,39,41,48,51 and two were RCTs (8%). 33,34 Seven of the studies included participants with schizophreniform disorders (27%), 29,30,37,38,43,44,51 seven those with bipolar disorder (27%), 28,33,36,40,41,49,53 and the remaining were for both illnesses (46%). 31, 32, 34, 35, 45-48, 50, 52 None of the digital interventions targeted family or friends and most of the digital interventions (78%) utilised direct support from staff or peers in their delivery.…”

“…40,45,47,50,52 Only one study completed a formal cost analysis 50 but others reported on removing human facilitation to reduce cost, 40 and the impact of care providers agreeing to absorb the cost of implementation on uptake and sustainability within private healthcare systems. 28…”

“…Lack of a suitable infrastructure to support the delivery of digital interventions was reported as a major barrier to implementation across several studies. Infrastructure problems included lack of access to computers, printers 46,52,53 , space 28,34,52,53 , equipment 28,47,52 , or Wi-Fi/internet access. 42,47,52,53 Whilst cost was cited as a factor for this, there was a sense across these studies that there had been a failure in implementation planning across all types of interventions.…”

Practical lessons learned for assessing and treating bipolar disorder via telehealth modalities during the COVID‐19 pandemic

“…With the onset of the COVID-19 pandemic, distance care (including phone and TMH-V) is now becoming the default treatment modality for many mental health clinicians. Given our longstanding experience delivering TMH-V to patients with bipolar disorder in the US Department of Veterans Affairs, 2,3 we wanted to provide some practical guidance for clinicians who may be new to treating patients diagnosed with bipolar disorder virtually.…”