Advancing telemedicine and task-sharing to improve access to psychotherapy for perinatal populations.

Abstract

Background: The Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial (ClinicalTrials.gov: NCT04153864) examined two solutions to improving access to psychotherapy for perinatal populations: telemedicine and task-sharing with non-specialist providers (individuals without prior specialized training or experience in delivering mental healthcare). The SUMMIT trial showed that telemedicine and non-specialist-delivered psychotherapy were non-inferior to treatment delivered in-person or by a specialist mental health provider. Our aim was to conduct an implementation assessment of task-sharing and telemedicine to inform best practices when providing access to psychotherapy treatment for perinatal patients in real world healthcare settings.

Methods: In this current study, we examined barriers and facilitators of task-sharing and telemedicine-delivered psychotherapy from a multistakeholder perspective (N = 105). We interviewed perinatal participants (n = 70) who received psychotherapy and specialist or non-specialist providers (n = 35) who delivered psychotherapy in the SUMMIT trial. We conducted an inductive thematic analysis.

Results: Our results show many facilitators of telemedicine across all stakeholder groups, including alleviating childcare needs through convenience, flexibly, and increased accessibility. Although perinatal participants and providers express that there are some benefits of in-person delivery (e.g., seeing physical cues and minimizing privacy concerns), we find that there are more barriers than facilitators of in-person psychotherapy. Regarding task-sharing, perinatal participants who received treatment from non-specialist and specialist providers report the same facilitators at similar rates, including capacity for active listening and empathy.

Conclusions: Our implementation assessment shows that telemedicine and task-sharing are acceptable, feasible, and patient-centred solutions to improve access to evidence-based psychotherapies across healthcare settings.