Integrating Telehealth-Enabled Psychiatric Collaborative Care Management in Rural Primary Care: Facilitators and Barriers to Patient Enrollment

Background: Behavioral health (BH) disorders are common in the United States, although access to care is limited, especially in rural areas. This is due to a lack of knowledge about how to access services, insufficient funding, and stigma associated with this type of treatment. Collaborative care management (CoCM) is an integrated BH model designed to provide mental health treatment within the primary care setting. Partly due to the incorporation of telehealth technology, CoCM has expanded in recent years, demonstrating increased access to care and improved mental health outcomes. Prior research has identified organizational-level barriers to CoCM adoption. The goal of this study was to explore barriers and facilitators to enrollment in a telehealth-enabled CoCM program from a patient perspective after receiving a program referral. Methods: The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Semi-structured interviews were conducted with patients who enrolled in CoCM and those who did not, after receiving a program referral from their primary care provider (PCP) between July 2023 and June 2025. Themes from interviews were summarized based on RE-AIM domains and compared between program enrollees and non-enrollees. Results: All patients who enrolled in CoCM ( n = 8) expressed receiving sufficient clear information to understand the program and its goals. These patients appreciated the ease of initial enrollment and the ongoing convenient scheduling and appointment process. Three patients who enrolled in CoCM reported that the telehealth format fit well with their busy schedules, which was a factor in their long-term participation. They also appreciated ongoing communication between their PCP and BH care manager as well as mental health benefits gained from the program. Conversely, barriers to CoCM enrollment included patient preference for in-person health care visits ( n = 3) and stigma related to BH services ( n = 2). Lack of funds to pay for the visits ( n = 1) and lack of cell service/internet were also barriers to enrollment ( n = 1). Discussion: The CoCM program can provide beneficial mental health benefits to patients via telehealth. Providing clear information to referred patients, ensuring a smooth enrollment and ongoing appointment scheduling process, and maximizing communication between a PCP and a BH care manager are important for maintaining program benefits. The telehealth format of CoCM can be a barrier or a facilitator for patient participation; however, it can improve access to care in rural areas and help reduce the stigma of BH, thereby improving health outcomes.