Evaluation of Telehealth Videoconferencing Psychotherapy in Rural Primary Care: A Mixed-Methods Research Study

Abstract

The effectiveness of telehealth videoconferencing psychotherapy (TVCP) for a rural sample obtaining services through a primary care setting in Texas was examined by combining single-case and group research methods. Treatment-as-usual was delivered via TVCP to 41 patients for an average of 11 sessions (SD = 7.79) by doctoral level psychology students under supervision of licensed psychologists. Patients were assessed periodically over the course of treatment with the Clinical Outcomes in Routine Evaluation – Short Form B (CORE-B), Patient Health Questionnaire – 9 (PHQ-9), and SF-12 health survey. Group analyses included bootstrapped paired-samples t tests of pre-and post-treatment mean scores for all outcome variables. Reliable improvement (Improved) and clinically significant change (Recovered) was assessed for all patients on the CORE-B scales and the PHQ-9. Single-case analyses of four female patients included visual ratings of graphed CORE-B Global Distress scores and simple mean shift regressions of all CORE-B scales. Results of single-case analyses were compared with group results to uncover clinical insights.

TVCP produced statistically significant results on all mental health outcomes for the group despite declines in perceived physical health quality. On the CORE-B Global Distress scale, 27% of patients Improved and 32% Recovered. On the CORE-B subscales, a large percentage of patients made reliable improvements and clinically significant change in Risk (58% Improved, 8% Recovered), Well-Being (13% Improved, 52% Recovered), Symptoms (33% Improved, 29% Recovered), and Functioning (24% Improved, 33% Recovered). On the PHQ-9, 46% of patients Improved and 23% Recovered. Single-case analyses of four female patients provided a more differentiated representation of treatment response and context for group results. Comparison of single-case and group results suggested treatment response was dependent upon type and severity of diagnoses, severity of physical health issues, and situational context. Clinical and methodological conclusions of the study were discussed with implications for scientists and practitioners.