Date of Completion

4-12-2021

Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Sun Kim, PhD, APRN, PMHCNS-BC

Site Advisor

Lisa Kelly, LICSW

Second Reader

Lingling Zhang, ScD

Abstract

BACKGROUND: Mental health access in rural areas is a national problem. Of strategies to increase access, telemental health has the highest level of evidence.

PURPOSE: This project aimed to implement a telemental health program in rural Vermont to: (a) increase the number of rural-dwelling patients who enter treatment for anxiety and depression, (b) evaluate the effectiveness of telemental health for depression, anxiety, and overall functioning, and (c) evaluate patient satisfaction with the accessibility, quality, and affordability of the service.

METHODS: Adult psychiatric diagnostic evaluation, medication management and psychotherapeutic interventions were delivered via telemental health. The service was marketed to Health Professional Shortage Areas (HPSA) in Vermont. Accessibility of patients residing in HSPA areas was compared between pre- and post-implementation. The Patient Health Questionnaire -9, Generalized Anxiety Disorder-7 and the Sheehan Disability Scale measured the efficacy of telehealth delivery. A patient survey assessed affordability, accessibility and quality. Descriptive statistics were utilized. IRB review was not required. Ethical and privacy protection were provided for telemental health patients using encryption.

RESULTS: Nineteen patients participated in the project. Four patients (21%) were from HPSAs. Aggregate measures for depression, anxiety and disability at 2nd follow up showed a decrease from baseline by 35.2%, 25.4%. and 45.1%, respectively. Patients reported satisfaction with accessibility, affordability, quality and overall experience with care.

CONCLUSIONS: Telemental health implementation in a small Vermont private practice setting resulted in improved access to mental health care for rural-dwelling adults and was clinically effective and satisfactory.

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