By Imran S. Khawaja, MD, CEO of MD TruCare PA
As a psychiatrist, I have always thought of telepsychiatry as a niche field that will eventually catch on. A few months before the COVID-19 pandemic began, I had a conversation with several psychiatrists and some of them believed that telehealth for psychiatry would never take off in the industry. However, I continued to believe that it could have substantial benefits for patient care, and it was just a matter of time.
When COVID-19 suddenly hit and patient care became contactless, we realized that telepsychiatry was the best option to continue care. At my practice, it took us just one day to switch to a telehealth platform in 2020, with the help of eClinicalWorks. The process was efficient and straightforward, which made me wonder why we had not implemented the technology sooner. (One of the main roadblocks was a lack of understanding and the lack of reimbursement. Today, this is not a significant issue as most insurance carriers cover telepsychiatric care.)
COVID-19 has not only changed how we provide psychiatric care but also the need for it. A recent meta-analysis on mental health problems in the Journal of Affective Disorders found that the prevalence of depression, anxiety, distress, and insomnia worldwide during the pandemic was 31.4%, 32%, 41%, and 38%, respectively. Another study from the Journal of Public Health looked at the mental health impact of the pandemic after the initial lockdown, highlighting that the prevalence of depression in the United States was 39%, anxiety 42%, and psychological distress 39.3%. (Males were more likely to have depression, and females were more likely to have anxiety.)
To help meet this growing need, providers are turning to telehealth services to make psychiatric care more accessible, and patients are experiencing positive results.
Improved Emergency Room Care
Currently, the number of inpatient psychiatric beds in emergency rooms (ERs) remains the same even though the need for care continues to rise. As a result, many patients must wait to transfer from the ER to an open bed, which causes significant crowding in already busy ERs. However, according to studies from Psychiatric Services, approximately 20% of ER psychiatric care is now administered through virtual services, resulting in decreased wait times and increased ER capacity.
Even prior to the pandemic, ERs had already experienced a 44% increase in patients with psychiatric or substance use disorders between 2006 and 2014. With many ERs and departments lacking the capacity to adequately care for psychiatric patients in the midst of these challenging times, these visits are more likely to result in inpatient admissionsthan non-psychiatric visits.
Thus, telepsychiatry for ERs is one of the fastest growing segments in telehealth due to patient satisfaction. In a recent study from Psychiatric Quarterly, authors compared the outcomes for patients receiving telepsychiatric care in the ER department versus receiving in-person ER care in New York. They used unadjusted analysis and multivariable logistic regression models to evaluate associations between an emergency telepsychiatric services status and the two clinical outcomes: use of observational services and ED visit disposition. (Telepsychiatric care status was identified from the 2016 National ED inventory/USA and then linked to psychiatric visits from the 2016 New York State emergency department database/state inpatient databases.)
Most visits were in urban ER settings. In multivariate logistic regression models, psychiatric visits in ERs with telepsychiatric services had a lower chance of using observation services than visits in emergency rooms without telepsychiatric services. The study showed that patients who received telepsychiatry services in the ER had low usage of observation services for psychiatric visits, which reduces the amount of time spent in the ER, thus reducing ER overcrowding. Therefore, the study emphasizes that increased use of telepsychiatry in ERs can reduce overcrowding.
Better Access, Care and Patient Privacy
Some preliminary studies suggest that telehealth is comparable in both effectiveness and patient satisfaction to face-to-face mental health services outside of the ER as well.
According to a recent poll from the American Psychiatric Association (APA), many patients want telehealth services to remain a permanent part of health care, and more specifically mental health care. The poll reports that 82% of survey respondents have used telehealth, and 43% want to continue virtual health care even after the pandemic is over. Further emphasizing the shift to telehealth in the mental health space, 38% of the respondents had used telehealth to meet with a medical or mental health professional, an increase from 31% in a similar poll by the APA conducted in October 2020. About 45% of survey respondents also reported that the quality of care from a telehealth session was comparable to that of an in-person office visit, a rate that was 40% back in 2020. Overall, the percentage of respondents who preferred telehealth to in-person doctor visits rose from 31% in 2020 to 34% in 2021.
These results are not at all surprising and are influencing providers to adopt telepsychiatric practices. Another poll from APA in mid-2020 showed a dramatic increase in the use of telepsychiatric services among its physician members. Before the pandemic, 62% of physician respondents did not see any patients via virtual psychiatry services. In contrast, after the onset of the COVID-19 pandemic, 86% physicians saw nearly all their patients using technology.
Increased Provider Flexibility
Most respondents have accessed telehealth through an online app such as Zoom, FaceTime or Skype, while others report using phone calls only. However, some EHR providers, such as eClinicalWorks, provide secure, HIPAA-compliant telehealth options, like healow TeleVisits, which make it easy to ensure patient information remains confidential. With more of our lives online than ever before, it’s important to make sure that telehealth remains a safe space for patient care, especially when it comes to mental health.
The privacy and flexibility of virtual mental health services are greatly influencing provider adoption as well as patience preference. Since psychiatric care does not require physical examinations, many experts suggest that psychiatry is one of the easier specialties to transfer to a telehealth platform. For example, I’ve seen patients during their work breaks, while they are on vacation and from many other remote locations.
Additionally, a recent study by Accenture indicated that younger adults (born in or after 1997) are four times more likely to prefer virtual mental health services than baby boomers (born between 1946 to 1964). These findings reveal that adopting telepsychiatric services could allow providers to see more patients than in-person visits alone.
What’s Next for Virtual Psychiatric Care?
In conclusion, virtual psychiatric care is here to stay as it has helped eliminate many barriers to mental health care, including transportation costs and taking time off work. Numerous studies confirm telehealth services have proved advantageous for psychiatry in both emergency and traditional care situations, and patients continue to express their desire for increased privacy and flexibility. People can be seen in rural areas, and providers from out of state can see patients as long as they have licenses to practice in other states.
While virtual psychiatric care may not be the best fit for every patient – younger teens, elderly patients and those at risk of suicide should prioritize in-person care – telepsychiatry is rapidly evolving. As more providers implement the technology, regulatory bodies will need to implement new guidelines to ensure the transition remains positive and beneficial for all patients and providers. I’m confident that the future of telepsychiatry is bright and will continue to revolutionize patient care.
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