Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis
Abstract
BACKGROUND: Telemental health interventions have empirical support from clinical trials and structured demonstration projects. However, their implementation and sustainability under less structured clinical conditions are not well demonstrated. INTRODUCTION: We conducted a follow-up analysis of the implementation and sustainability of a clinical video teleconference-based collaborative care model for individuals with bipolar disorder treated in the Department of Veterans Affairs to (a) characterize the extent of implementation and sustainability of the program after its establishment and (b) identify barriers and facilitators to implementation and sustainability. MATERIALS AND METHODS: We conducted a mixed methods program evaluation, assessing quantitative aspects of implementation according to the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. We conducted qualitative analysis of semistructured interviews with 16 of the providers who submitted consults, utilizing the Integrated Promoting Action on Research Implementation in the Health Services implementation framework. RESULTS: The program demonstrated linear growth in sites (n = 35) and consults (n = 915) from late 2011 through mid-2016. Site-based analysis indicated statistically significant sustainability beyond the first year of operation. Qualitative analysis identified key facilitators, including consult content, ease of use via electronic health record, and national infrastructure. Barriers included availability of telehealth space, equipment, and staff at the sites, as well as the labor-intensive nature of scheduling. DISCUSSION: The program achieved continuous growth over almost 5 years due to (1) successfully filling a need perceived by providers, (2) developing in a supportive context, and (3) receiving effective facilitation by national and local infrastructure. CONCLUSION: Clinical video teleconference-based interventions, even multicomponent collaborative care interventions for individuals with complex mental health conditions, can grow vigorously under appropriate conditions.
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Authors reported that support and high-quality training were necessary to achieve widespread growth.
“Authors reported that support and high-quality training were necessary to achieve widespread growth [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [37]
Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 reviewed articles.
“Complexity in the organizational domain was managed more effectively when telehealth champions were available, as reported in 11 of the reviewed articles [2,33-37,39-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [37]
At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all 13 reviewed studies.
“At least one challenge or opportunity related to political, regulatory, cultural, contextual, or financial factors was reported in all studies (n=13) [2,32-43].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [37]
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- Authors
- Bauer, M. S., Krawczyk, L., Tuozzo, K., Frigand, C., Holmes, S., Miller, C. J., Abel, E., Osser, D. N., Franz, A., Brandt, C., Rooney, M., Fleming, J., Smith, E., & Godleski, L.
- Affiliations
- Harvard University (US)
- Yale University (US)
- Center for Health Optimization and Implementation Research (US)
- Hunter Holmes McGuire VA Medical Center (US)
- University of Massachusetts System (US)
- Corresponding author
- Bauer, Mark S.
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2018-01
- Volume
- 24
- Issue
- 1
- Pages
- 45-53
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- OpenAlex
- W2726729967
- Cited by
- 31
- References
- 35
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 3 · 2017: 1
- FWCI
- 3.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- bipolar disorder, telecare, collaborative care, implementation, sustainability, barriers and facilitators, telemental health, veterans, electronic health records, program growth
- MeSH terms
- Bipolar Disorder, Cooperative Behavior, Humans, Organizational Innovation, Patient Care Team, Quality of Health Care, Telecommunications, United States, United States Department of Veterans Affairs, Program Evaluation, Patient Satisfaction, Telemedicine, Qualitative Research, Electronic Health Records
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