title: Evolution of telepsychiatry to rural sites: changes over time in types of referral and in primary care providers' knowledge, skills and satisfaction.
abstract: BACKGROUND
  Rural populations remain underserved in terms of psychiatric services. This study assesses changes over time in the utilization of telepsychiatric services by individual primary care providers (PCPs) and clinics in rural areas, specifically: (a) types of referrals for telepsychiatry service; (b) PCPs' knowledge and skills related to medication dosing; and (c) PCPs' satisfaction with telepsychiatry.
  
  
  METHODS
  Data with regard to patient demographics, diagnoses, reason for consultation, medication dosing and satisfaction were prospectively collected on the first 200 and the subsequent 200 telepsychiatric initial consultations. A number of educational interventions were implemented during the project.
  
  
  RESULTS
  Adult patients were primarily referred for mood and anxiety disorders, particularly for diagnosis and medication treatment planning. Over time, PCPs significantly improved medication dosing and asked for more treatment planning help. PCPs' satisfaction also improved over time.
  
  
  CONCLUSIONS
  Telepsychiatric consultation, in combination with specific educational interventions, appears to facilitate the enhancement of skills and knowledge of PCPs. "Developmental" steps in provider and clinic evolution, along with interventions specific to a given provider's and a given site's needs, ought to be further elucidated.
authors.affiliation: Telepsychiatric Services, University of California-Davis, Sacramento, CA 95817, USA. dmhilty@ucdavis.edu <dmhilty@ucdavis.edu>
authors.forename: Donald M
authors.initials: DM
authors.lastname: Hilty
authors.forename: Peter M
authors.initials: PM
authors.lastname: Yellowlees
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002140:California; D002648:Child; D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000639:trends; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004502:Education, Medical, Continuing / Q000639:trends; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007406:Interview, Psychological; D008297:Male; D008507:Medically Underserved Area; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D011320:Primary Health Care / Q000639:trends*; D011570:Psychiatry / Q000193:education* / Q000639:trends*; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D012017:Referral and Consultation / Q000639:trends*; D019114:Remote Consultation / Q000639:trends*; D012423:Rural Health / Q000639:trends*
chemical_list: D011619:Psychotropic Drugs