Skip to main content
Patient-Centered Outcomes Research Institute
Patient-Centered Outcomes Research Institute
  • Blog
  • Newsroom
  • Find It Fast
  • Help Center
  • Subscribe
  • Careers
  • Contact Us

PCORI

Patient-Centered Outcomes Research Institute

Search form

  • About Us
    Close mega-menu

    About Us

    • Our Programs
    • Governance
    • Financials and Reports
    • Procurement Opportunities
    • Our Staff
    • Our Vision & Mission
    • Contact Us

    Fact Sheets: Learn More About PCORI

    Download fact sheets about out work, the research we fund, and our programs and initiatives.

    Find It Fast

    Browse through an alphabetical list of frequently accessed and searched terms for information and resources.

    Subscribe to PCORI Email Alerts

    Sign up for weekly emails to stay current on the latest results of our funded projects, and more.

  • Research & Results
    Close mega-menu

    Research & Results

    • Explore Our Portfolio
    • Research Fundamentals
    • Research Results Highlights
    • Putting Evidence to Work
    • Peer Review
    • Evidence Synthesis
    • About Our Research

    Evidence Updates from PCORI-Funded Studies

    These updates capture highlights of findings from systematic reviews and our funded research studies.

    Journal Articles About Our Funded Research

    Browse through a collection of journal publications that provides insights into PCORI-funded work.

    Explore Our Portfolio of Funded Projects

    Find out about projects based on the health conditions they focus on, the state they are in, and if they have results.

  • Topics
    Close mega-menu

    Topics

    • Addressing Disparities
    • Arthritis
    • Asthma
    • Cancer
    • Cardiovascular Disease
    • Children's Health
    • Community Health Workers
    • COVID-19
    • Dementia and Cognitive Impairment
    • Diabetes
    • Kidney Disease
    • Medicaid
    • Men's Health
    • Mental and Behavioral Health
    • Minority Mental Health
    • Multiple Chronic Conditions
    • Multiple Sclerosis
    • Obesity
    • Older Adults' Health
    • Pain Care and Opioids
    • Rare Diseases
    • Rural Health
    • Shared Decision Making
    • Telehealth
    • Transitional Care
    • Veterans Health
    • Women's Health

    Featured Topic: Women's Health

    Learn more about the projects we support on conditions that specifically or more often affect women.

  • Engagement
    Close mega-menu

    Engagement

    • The Value of Engagement
    • Engagement in Health Research Literature Explorer
    • Influencing the Culture of Research
    • Engagement Awards
    • Engagement Resources
    • Engage with Us

    Engagement Tools and Resources for Research

    This searchable peer-to-peer repository includes resources that can inform future work in patient-centered outcomes research.

    Explore Engagement in Health Literature

    This tool enables searching for published articles about engagement in health research.

    Research Fundamentals: A New On-Demand Training

    It enables those new to health research or patient-centered research to learn more about the research process.

  • Funding Opportunities
    Close mega-menu

    Funding Opportunities

    • What & Who We Fund
    • What You Need to Know to Apply
    • Applicant Training
    • Merit Review
    • Awardee Resources
    • Help Center

    PCORI Funding Opportunities

    View and learn about the newly opened funding announcements and the upcoming PFAs in 2021.

    Tips for Submitting a Responsive LOI

    Find out what PCORI looks for in a letter of intent (LOI) along with other helpful tips.

    PCORI Awardee Resources

    These resources can help awardees in complying with the terms and conditions of their contract.

  • Meetings & Events
    Close mega-menu

    Meetings & Events

    • Upcoming
    • Past Events

    January 2021 Board of Governors Meeting

    The Board approved funding for a new research study relating to kidney health and a new funding allocation for PCORnet. Learn more

    Confronting COVID-19: A Webinar Series

    Learn more about the series and access recordings and summary reports of all six sessions.

    2020 PCORI Annual Meeting

    Watch recordings of all sessions, and view titles and descriptions of the posters presented at the virtual meeting.

You are here

  • Research & Results
  • Explore Our Portfolio
  • Comparing Two Approaches to Provide C...

Comparing Two Approaches to Provide Complex Mental Health Care for Patients in Rural Areas -- The SPIRIT Study

Sign Up for Updates to This Study  

Project Summary  

PCORI has identified the need for large studies that look at real-life questions faced by diverse patients, caregivers, and clinicians. To address this need, PCORI launched the Pragmatic Clinical Studies initiative in 2014. Pragmatic clinical studies allow for larger-scale studies with longer timelines to compare the benefits and harms of two or more approaches known to be effective for preventing, diagnosing, treating, or managing a disease or symptom. They focus on everyday care for a wide range of patients. This research project is one of the studies PCORI awarded as part of this program.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

More than 20 million Americans get care at community health centers every year. Almost half of these people live in rural areas. Community health centers often see patients with complex mental health conditions. These include post-traumatic stress disorder (PTSD) and bipolar disorder. These conditions need treatment from a health professional with special training in mental health care. Patients who do not receive adequate treatment for PTSD or bipolar disorder may have serious physical and emotional consequences. Primary care providers in community health centers—such as doctors, physician assistants, and nurse practitioners—may not have training to treat these conditions. Not enough mental health doctors live in rural areas to treat these health conditions there.

One way to address these challenges is through telemedicine. Telemedicine involves doctors using technology, such as videoconferencing, to treat patients remotely. This study compares two telemedicine options, called telepsychiatry-collaborative care and telepsychiatry-enhanced referral, for patients with PTSD and bipolar disorder at rural community health centers.

Who can this research help?

This research can help rural community health centers make decisions about how to provide mental health services to patients with PTSD or bipolar disorder.

What is the research team doing?

The study is taking place at 15 rural community health centers in Arkansas, Michigan, and Washington. The research team is enrolling 1,000 people. This includes 500 people who have PTSD and 500 people who have bipolar disorder, according to screening tests. The patients aren’t getting treatment from a mental health doctor when they join the study. The team is assigning patients by chance to receive either telepsychiatry-collaborative care or telepsychiatry-enhanced referral.

Each patient in the collaborative-care group first has a one-on-one video appointment with a mental health doctor. The doctor confirms the patient’s diagnosis and recommends medicines for treatment. A primary care provider then carries out the treatment plan and writes prescriptions for medicine. A care manager at the community center meets regularly in person or by phone with the patient to provide behavioral therapy. The care manager makes sure the patient takes medicines correctly and that the treatment is working. The care manager talks to the mental health doctor each week about any patient whose condition is not responding to treatment. The mental health doctor can then recommend a different treatment.

Each patient in the enhanced referral group also first has a one-on-one video appointment with a mental health doctor to come up with a treatment plan. This plan can include medicines and/or counseling. A patient who gets counseling has regular video appointments at the community health center with a mental health doctor.

All patients take surveys by phone when they begin the study. They take another survey after 6 and 12 months. The surveys ask patients about topics related to their care, health condition, and quality of life. The research team interviews the primary care providers to learn about their experiences giving treatment. They also interview some of the patients to learn about their experiences getting treatment.

The research team came up with this research topic by talking to patients and healthcare professionals who took part in previous studies. Two advisory groups are helping design the treatment approaches and study methods. The consumer advisory board includes patients with PTSD and bipolar disorder. It also includes members of patient advocacy groups. The policy advisory board includes primary care providers at community health centers and members of professional associations.

Research methods at a glance

Design Element Description
Study Design Randomized controlled trial
Population Patients at community health centers who are 18 years or older, screen positive for PTSD and/or bipolar disorder, and are not currently taking medicines for their condition(s)
Interventions/
Comparators
  • Telepsychiatry-collaborative care
  • Telepsychiatry-enhanced referral
Outcomes

Primary: self-rating of mental health-related quality of life

Secondary: satisfaction and engagement with care, medication adherence, number of counseling sessions that participant attended illness severity

Timeframe 12-month follow-up for primary outcome

Journal Articles

Related Articles

Journal of Rural Health

Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study

General Hospital Psychiatry

Care manager perspectives on integrating an mHealth app system into clinical workflows: A mixed methods study

General Hospital Psychiatry

Bipolar disorder and PTSD screening and telepsychiatry diagnoses in primary care

Journal of Traumatic Stress

Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic

Contemporary Clinical Trials

Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT): Rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics

Bipolar Disorders

Bipolar disorder and posttraumatic stress disorder in rural primary care: Extending specialty care reach

The Journal of Rural Health

Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations

Journal of Medical Internet Research

Applying the Principles for Digital Development: Case Study of a Smartphone App to Support Collaborative Care for Rural Patients With Posttraumatic Stress Disorder or Bipolar Disorder

Project Details

Principal Investigator
John C. Fortney, PhD
Project Status
In progress; Recruiting
Project Title
Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT)
Board Approval Date
August 2015
Project End Date
June 2021
Organization
University of Washington
Year Awarded
2015
State
Washington
Project Type
Research Project
Health Conditions  
Mental/Behavioral Health
Post Traumatic Stress Disorder
Bipolar Disorder
Intervention Strategies
Behavioral Interventions
Care Coordination
Other Clinical Interventions
Other Health Services Interventions
Technology Interventions
Telemedicine
Training and Education Interventions
Populations
Racial/Ethnic Minorities
Low Income
Older Adults
Rural
Funding Announcement
Pragmatic Clinical Studies to Evaluate Patient-Centered Outcomes
Project Budget
$12,024,172
Study Registration Information
HSRP20162193
NCT02738944
Page Last Updated: 
February 20, 2020

Research & Results

  • Explore Our Portfolio
  • Research Fundamentals
  • Research Results Highlights
  • Putting Evidence to Work
  • Peer Review
  • Evidence Synthesis
  • About Our Research

About Us

  • Our Programs
  • Governance
  • Financials and Reports
  • Procurement Opportunities
  • Our Staff
  • Our Vision & Mission
  • Contact Us

Research & Results

  • Explore Our Portfolio
  • Research Fundamentals
  • Research Results Highlights
  • Putting Evidence to Work
  • Peer Review
  • Evidence Synthesis
  • About Our Research

Engagement

  • The Value of Engagement
  • Engagement in Health Research Literature Explorer
  • Influencing the Culture of Research
  • Engagement Awards
  • Engagement Resources
  • Engage with Us

Funding Opportunities

  • What & Who We Fund
  • What You Need to Know to Apply
  • Applicant Training
  • Merit Review
  • Awardee Resources
  • Help Center

Meetings & Events

February 2
PCORI 2021 and Beyond: Opportunities for Funding and Involvement in Patient-Centered Research
February 9
Board of Governors Meeting: February 9, 2021
February 11
Advisory Panel on Patient Engagement Winter 2021 Meeting

PCORI

Footer contact address

Patient-Centered Outcomes
Research Institute

1828 L Street, NW, Suite 900
Washington, DC 20036
Phone: (202) 827-7700 | Fax: (202) 355-9558
[email protected]

Subscribe to Newsletter

Twitter Facebook LinkedIn Vimeo

© 2011-2021 Patient-Centered Outcomes Research Institute. All Rights Reserved.

Privacy Policy | Terms of Use | Trademark Usage Guidelines | Credits | Help Center