A pilot telepsychiatry program for children significantly improved symptoms and cut emergency department visits in half, based on data from more than 8,000 patients over 2 years.
Health care costs will continue to rise, so new mechanisms are needed to combat the shortfalls in primary care medicine – including the limited number of child psychiatrists, said Alexander Vo, Ph.D., who presented the results in a webinar June 12.
"Telemedicine is the use of technology to deliver health care from a distance," said Dr. Vo of the University of Texas Medical Branch at Galveston. Faced with a shortage of pediatric psychiatrists in Texas and given a mandate to provide access to quality mental health and medical care, the University of Texas received a grant to develop pediatric psychiatry clinics for telemedicine.
"The goal of the project was to increase access to mental health care," Dr. Vo said. "Over a 2-year period we served approximately 8,000 patients with approximately 12,000 clinical appointments."
Then after the 2-year period, Dr. Vo and his colleagues surveyed 530 parents whose children were involved in the telemedicine program. Overall, 89% of the parents said the program made it easier for their children to receive services from a specialist, and more than 60% of parents reported dramatic improvements in their children’s functional behavior or symptoms.
One of the most striking findings was a 51% reduction in emergency department visits from baseline to the end of year 2, said Dr. Vo. "We effectively diverted these individuals from the [ED], and probably indicated that a lot of the [ED] use by this population was inappropriate," he said. "This is a very big finding for us."
In addition, 89% of the families said they would use telepsychiatry again in the future if it was available to them. "This speaks to the potential that using technology to deliver health care has; people want this kind of service if they are not able to go in person," he said.
Several factors crucial to the success of the project included establishing partnerships with existing community mental health centers where patients could go for their telemedicine visits. The project also involved establishing broadband internet access where needed. "That allowed us to have the ability to deliver quality care by providing expert guidance via real time consultation and monitoring," Dr. Vo said.
The program also involved the creation of a secure portal to share patient information among the different clinics, which had varying levels of technology for medical records, he said.
The take-home messages for clinicians are that telemedicine is a very viable medium for delivering care in psychiatry, it is accepted by patients, and it is effective for controlling costs, increasing access to care, and improving clinical outcomes, according to Dr. Vo.
"One of the hot topics is the use of in-home telemedicine," he added. Telemedicine from a patient’s home has the added advantages of convenience, privacy, and the avoidance of stigma, he said.
For providers who want to get into telemedicine, "this is an emerging market," he said. Potential barriers to expanding telepsychiatry include licensure and reimbursement issues. Specifically, providers may want to know whether they can still be paid at the same rate as an in-person visit, said Dr. Vo. Lack of broadband connectivity in some areas is a problem as well, he noted.
However, the findings from the University of Texas program suggest that telemedicine is here to stay. "Telemedicine transcends rural or geographic barriers," said Dr. Vo. In the future, telemedicine could expand to include telemonitoring of patients, especially those in urban areas who have mobile devices, he said.
The webinar was hosted by Internet Innovation Alliance (IIA) and Colorado Access, a nonprofit health plan that provides access to behavioral and physical health services. Dr. Vo had no financial conflicts to disclose.