Thursday, January 27, 2022

Most Patients Considered Good Candidates for Telemedicine, Psychiatrists Report

Psychiatrists view telemedicine as a tool to facilitate engagement with care, encourage patients to keep appointments, and improve adherence with treatment, according to a report published yesterday in Psychiatric Services in Advance.

The pandemic has made telemedicine a permanent part of psychiatric practice, allowing psychiatrists to approach care through a hybrid model of in-person and virtual visits. “However, hybrid models add another layer of complexity, requiring clinicians to use their judgment to make individualized decisions about the appropriateness of different modalities,” wrote Lori Uscher-Pines, Ph.D., of the RAND Corporation and colleagues. “Understanding how clinicians make decisions about telemedicine versus in-person care is key to informing clinical practice guidelines and reimbursement policies that mandate in-person care with some frequency.”

From June 25 to August 4, 2021, Uscher-Pines and colleagues conducted semi-structured interviews with 20 psychiatrists treating adults in outpatient settings across the United States. Psychiatrists were eligible if they conducted both telemedicine and in-person visits in the previous month, with neither type of visit representing more than 90% of all visits (telemedicine was defined as the same as video visits).

Interviews involved the critical incident technique, which is a method that asks patients to reflect on real-life experiences, “to uncover unconscious factors that influence the decision to offer telemedicine,” the authors wrote. Participants were asked to describe an example of a telemedicine visit during which they thought the quality was equivalent to that of an in-person interaction, as well as an example in which they felt uncomfortable about the quality of the telemedicine visit. The researchers also provided the participants with four clinical vignettes and asked them to discuss their thoughts on the appropriateness of telemedicine in the cases the vignettes described.

On average, the participants reported providing 59% of their visits in the previous month via telemedicine. They also reported being able to make decisions about offering telemedicine to patients using their own clinical judgment, without constraints from their organizations or practice settings. Additional findings included the following:

  • Patient preference drove a significant percentage of in-person care, with psychiatrists repeatedly mentioning during interviews that they tried to accommodate patient preference when determining whether visits should be conducted via telemedicine or in-person.
  • Psychiatrists also reported that almost all patients are good candidates for telemedicine. Some psychiatrists felt telemedicine was less appropriate when treating patients with substance use disorders, suicidal ideation, psychotic disorders, eating disorders, intimate partner violence, or trauma. Other psychiatrists disagreed, however, and countered that telemedicine offered unique benefits even in these cases (for example, improved patient safety and reduced likelihood of escalation).
  • Some psychiatrists thought that some patients could be treated exclusively through telemedicine, while others believed that it is necessary to offer hybrid models that mix telemedicine with in-person visits to ensure high-quality care.
  • Psychiatrists used telemedicine as a tool “to meet patients where they are,” and they offered it as a way to facilitate keeping appointments and adhering to treatment.

“[O]ffering the option of telemedicine, with its added convenience and potential for privacy, could help individuals expressing ambivalence about treatment or behavior change overcome their personal activation barriers to engagement,” the authors wrote.

For related information, see the Psychiatric News article “Telemental Health Use Remains Robust, But What Does Future Hold?

(Image: iStock/gpointstudio)

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