【文献Abstract】精神科遠隔診療：郡部におけるプライマリ・ケアトレーニング

〈要点〉

・郡部においては人材が不足しており、精神科領域における専門的なチームアプローチが困難である。うつ病のチームアプローチで、精神科遠隔診療の実現可能性を調査するために、2018年にワシントン州の3つの郡部の医療機関にて、継続的な共同ケアと精神科遠隔診療を利用したスタッフと半構造化面接を実施した。
・合計17人の臨床スタッフ、サポートスタッフ、管理スタッフが面接を実施。すべてのインタビュー対象者において、それぞれのスキル強化とチームアプローチが精神障害を特定および治療する能力を向上させることを認識した。
・精神科遠隔診療を使用した週1回の症例カンファレンスは、患者ケアのモデルとして、またチームアプローチを提供する郡部でのトレーニングの双方に役立つ。

〈雑感〉

・郡部における精神科遠隔診療ではなくとも、事例の共有やディスカッションはプライマリ・ケアの現場において患者ケアならびにスタッフの能力開発につながる。2020年9月現在でも新型コロナの影響でなかなか事例検討などできていないが、気軽に遠隔でも事例検討ができるとよいのかもしれない。

〈文献〉

Ann Fam Med. 2020 Sep;18(5):438-445. doi: 10.1370/afm.2561.
Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care
Morhaf Al Achkar , Ian M Bennett , Lydia Chwastiak , Theresa Hoeft , Tre Normoyle , Melinda Vredevoogd , Davis G Patterson 

Abstract
Purpose: There is a shortage of rural primary care personnel with expertise in team care for patients with common mental disorders. Building the workforce for this population is a national priority. We investigated the feasibility of regular systematic case reviews through telepsychiatric consultation, within collaborative care for depression, as a continuous training and workforce development strategy in rural clinics.

Methods: We developed and pilot-tested a qualitative interview guide based on a conceptual model of training and learning. We conducted individual semistructured interviews in 2018 with diverse clinical and nonclinical staff at 3 rural primary care sites in Washington state that used ongoing collaborative care and telepsychiatric consultation. Two qualitative researchers independently analyzed transcripts with iterative input from other research team members.

Results: A total of 17 clinical, support, and administrative staff completed interviews. Participants' feedback supported the view that telepsychiatric case review-based consultation enhanced skills of diverse clinical team members over time, even those who had not directly participated in case reviews. All interviewees identified specific ways in which the consultations improved their capacity to identify and treat psychiatric disorders. Perceived benefits in implementation and sustainability included fidelity of the care process, team resilience despite member turnover, and enhanced capacity to use quality improvement methods.

Conclusions: Weekly systematic case reviews using telepsychiatric consultation served both as a model for patient care and as a training and workforce development strategy in rural primary care sites delivering collaborative care. These are important benefits to consider in implementing the collaborative care model of behavioral health integration.

Keywords: collaborative care; consultation; depression; mental health; patient care team; primary care; remote consultation; rural health services; telemedicine; telepsychiatry; vulnerable populations.

© 2020 Annals of Family Medicine, Inc.