How COVID-19 transformed telepsychiatry from a backup modality to a mainstream necessity

Telepsychiatry is defined as the delivery of psychiatric assessment and care through telecommunications technology such as videoconferencing. Historically, telepsychiatry was reserved for patients in rural areas or underserved settings. The COVID-19 pandemic, however, has changed that.

During a February webinar hosted by Becker's Hospital Review and sponsored by TeleSpecialists, Kristina Bedynerman, MD, psychiatry medical director at TeleSpecialists, discussed how telepsychiatry has evolved into a mainstream treatment modality.

Five key takeaways were:

  1. Telepsychiatry has been used for more than 60 years. According to the presenters, the Nebraska Psychiatric Institute first used telepsychiatry in 1959 for group therapy, consultation-liaison psychiatry and medical student training at the Nebraska State Hospital in Norfolk. By the 2000s, telepsychiatry was validated as an equivalent modality to the in-person model in terms of diagnostic reliability, treatment effectiveness and patient satisfaction.
  2. COVID-19 expanded mainstream use of telepsychiatry. The pandemic has fueled demand for behavioral healthcare. The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children's Hospital Association have declared a national emergency in children's mental health. "Telepsychiatry has been beneficial during the pandemic for both patients and psychiatrists," Dr. Bedynerman said. "Not only does it minimize exposure to the virus, but the virtual care model works well in psychiatry because physical exams are limited and largely passive in most cases."
  3. Psychiatric services delivered via telehealth are comparable to traditional, in-person evaluation. This is true in terms of reliability and validity of clinical assessment, clinical outcomes and satisfaction. "Telepsychiatry has been used effectively for diagnoses ranging from anxiety disorders to depression, schizophrenia, substance use disorders, attention deficit hyperactivity disorder, eating disorders, cognitive disorders and children and adolescents with autistic spectrum disorders. It has also been used with special populations like children and adolescents, geriatric patients, immigrants and refugees, military professionals and forensics," Dr. Bedynerman said.
  4. Telepsychiatry offers clinical and economic benefits. Health systems that adopt telepsychiatry find it results in faster and improved care delivery, improved emergency department throughput, better integration of psychiatry into primary care, enhanced continuity of care and follow-up, fewer transportation barriers and less stigma for patients, and potential cost savings. "One study demonstrated a 10 percent cost savings in the outpatient setting," Dr. Bedynerman said. "Another showed that the 30-day inpatient costs were $2,336 lower for those who received a telepsychiatry consultation in the emergency department than those in the control group. Telepsychiatry consults are also associated with shorter inpatient lengths of stay, lower levels of hospital admissions and more appropriate outpatient follow-up within 30 and 90 days."
  5. TeleSpecialists' Emergent Telepsychiatry Service provides coverage for adults, adolescents and children. This offering is built on the strong foundation of TeleSpecialists' TeleStroke service. Board-certified psychiatrists respond to requests for a consultation within one hour and TeleSpecialists provides health systems with ongoing quality monitoring and data reporting. Feedback from emergency medicine physicians, parents and psychiatrists has been very positive.

Looking ahead, telepsychiatry is likely to grow. "We expect continued high demand. Patients appreciate the convenience and privacy of telepsychiatry consultations. Psychiatrists also like the convenience and recognize the positive outcomes associated with this care model. Given the strong validating data and our inability to meet mental healthcare demand with an in-person approach, reimbursements aren't likely to go away," Dr. Bedynerman said.

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