Comparison of Asynchronous Telepsychiatry vs. Synchronous Telepsychiatry in Skilled Nursing Facilities

This study aims to assess the acceptability of asynchronous telepsychiatry (ATP) and
synchronous (STP) in rural, Northern California Skilled Nursing Facility (SNF) population, in
a 12-month randomized controlled trial.

The study will be conducted at 5 SNFs in Northern California. SNF staff will place a formal
order for psychiatric consultation to the study so that the participants can receive
psychiatric care via ATP or STP. Research assistants will screen each referral by reviewing
inclusion and exclusion criteria based on the psychiatric referral question. To closely match
real-world practice settings, STP "clinic" will be pre-scheduled for 4 hours once per month
for each site. ATP participants will be interviewed by SNF staff (and videotaped with
assistance from research assistant within 5 days). The video will then by reviewed by
research psychiatrist and a consultation report will be send to the PCP in <5 days. Follow-up
will occur at 1-, 2-, 3-, 6- and 12-month time periods, in addition to the baseline (0-month)
visit for a total of 6 consults.

Aim 1: To assess whether ATP and STP models improve clinical outcomes: Hypotheses: Compared
to STP, the ATP arm will: H1: show non-inferior clinical outcome trajectory, reflected in
improvement from baseline, as measured by Clinical Global Impression (CGI).

Aim 2: To assess the acceptability of ATP and STP by examining satisfaction surveys from SNF
residents (who are able to complete the surveys). Hypothesis: Compared to STP, ATP
participants will show: H1: Similar levels of satisfaction as measured by the Telemedicine
Satisfaction Survey as completed by participants.

Aim 3: To conduct healthcare economics and net benefit analysis of cost-effectiveness of ATP
vs. STP in SNFs. H3: ATP, compared to STP, will be more cost effective with respect to SNF
resident satisfaction and reduced wait times.

Inclusion Criteria:

Participants must be residents of SNF that has been approved by University of California,
Davis IRB, and adults aged ≥18, with non-emergent psychiatric issues, including:

depression, schizophrenia, bipolar disorder, PTSD, dementia behavioral problems, management
of psychiatric medications, and others mental health problems. Chronic medical disorders
are not excluded. Study PI or co-PI will be available by phone to help with screening.

Exclusion Criteria:

1. Residents with imminent suicidal and/or violence risks that require emergency
psychiatric referrals or patients who cannot wait until the next ATP/STP evaluation,

2. Residents with imminent risks will be referred to the local emergency department as is
the current practice at both SNFs, and 3) Residents who are unable to consent to the
study and who do not have surrogate decisional makers to provide informed consent will
not be able to participate.