Table 2.

Task Sharing Interventions Primarily Leveraging Primary Care Providers and Specialist Support

Program Description	Task Shared or New Task	Control / Comparison Group	Primary Process and /or Health Outcome Measures Reported	Author (Yr) and Countrya
Telemedicine-based collaborative care mental health support located off- site to enable outreach to small rural clinics that may not be able to support an on-site psychiatrist	Primary care depression treatment shared between local clinic and remote expert team	Usual care + educational materials to providers and patients, and depression screening result in electronic medical record	↑ adherence, mental health status, quality of life and satisfaction and ↓ depression	Fortney 2007 U.S.
Telemedicine-based collaborative care off-site mental health support to clinics including nurse care manager, pharmacist, psychologist, and psychiatrist	Primary care depression treatment shared between local clinic and remote expert team	On-site PCP and nurse care manager	↓ depression which appeared to be attributed to higher fidelity in the telemedicine intervention	Fortney 2013 U.S.
Rural clinics were included in a large effectiveness study of collaborative care but not separated from urban clinics in analysis of effectiveness	Primary care depression treatment shared between PCPs, care manager and consulting psychiatrist	NA	NA	Unutzer 2002 U.S.
Shared care / collaborative care in a rural clinic setting worked to improve communication between general practitioners (GP) and psychiatric consultants	Psychiatrist consults with GPs through regular meetings and videoconference while also travels to 1 rural clinic a day, 3 days a week	NA	↑ GP satisfaction with mental health services over 5 years of program	Samy 2007 Australia
Consultation models and collaborative models which both involve primary care providers are described as a means to leverage specialists in child and adolescent psychiatry	Psychiatrist consults with PCPs	NA	NA	Szeftel 2011 U.S.
Therapists trained in cognitive behavioral therapy (high- intensity) and computerized CBT guided self-care and psychoeducation groups (low-intensity therapists) integrated into primary care clinics to offer stepped care for depression and anxiety	High-intensity face-to-face CBT therapists and low- intensity therapists called psychological wellbeing practitioners work with primary care	NA	Gyani 2013: Among patients with 2 sessions, 40.3% recovered, 63.7% improved, and 6.6% deteriorated. Compliance with IAPT model appeared to enhance recovery rates.	Clark 2011; Gyani 2013 U.K.
Specialist-guided videoconferencing consults with rural primary care providers offer mental health and substance abuse consultation while also creating a community of practice among rural providers for continued learning and support	Psychiatrist consults with PCPs, and PCPs support one another through building a community of practice	NA	On topics of addiction and psychiatry, 16 clinics, 239 clinicians and 105 patients were reached through this program	Scott 2012 U.S.
Consult service using telephone contact for PCPs who want to consult a child psychiatrist	Psychiatrist consults with PCPs	NA	PCPs consulted on medication and psychosocial treatment; satisfaction was high	Hilt 2013 U.S.
Televideoconferencing to support psychiatrist in the care team for children with special health care needs in rural areas which can include direct care with the child / family and/or consultation and supervision of community mental health providers	Psychiatrist consults with PCPs	NA	Three urban psychiatrists saw 159 patients via telepsychiatry and 210 face-to-face	Sulzbacher 2006 U.S.
Telepsychiatry with team (eg, parent, teacher, social worker, nurse, principal) supporting students at rural K - 12 schools	Psychiatrist consults with team at the schools	NA	NA	Knopf 2013; Saeed 2011 U.S.
Telepsychiatry with team supporting students at more rural universities (eg, local psychologist)	Psychiatrist consults with team in mental health at the university	NA	Khasanshina 2008: Those referred to consult were more distressed and needing psychotropic medication; satisfaction lower at first as they worked out technology challenges	Saeed 2011; Khasanshina 2008 U.S.
Multidisciplinary rural mental health care delivery program involving a psychiatric nurse, social worker, occupational therapist, Maori mental health worker, alcohol and drug counselor, psychologist, and forensic psychiatry nurse utilizes telepsychiatry consults in primary care and home visits and an off- hours on- call services for emergencies	Multidisciplinary program providers shared care. Psychiatrist visits weekly and a child and adolescent psychiatrist and psychogeriatrician visit monthly to work with GPs. Tele-psychiatry also used for case review.	NA	NA	Mahmood 2001 New Zealand
Group psychotherapy for PTSD treatment trial offered via televideoconferencing from a doctoral-level mental health specialist and included an on-site clinical observer to safeguard against undue emotional escalations	On-site support person helps with technology difficulties and helps safeguard participants	NA	NA	Moreland 2009 U.S.

^aAll articles were peer reviewed.