160 million Americans live in regions with… shortages of mental health professionals. Many of these areas are rural, where it is not realistic to drive to the nearest treatment option due to distance or personal and professional commitments. Cost and access are also barriers to care, with a prediction shortage of 21,000 adult psychiatrists in 2030 making things worse.
Telepsychiatry can be a lifeline in areas with few mental health options by increasing access to treatment. However, access does not equal quality, and substandard care can do more harm than good.
a new peer-reviewed research in the Journal of Medical Internet Research demonstrates the efficacy of telepsychiatry for anxiety and depression care in different regions. Rural areas with few mental health options showed similar clinical outcomes as urban areas with many options, demonstrating the power of virtual care to positively impact those who cannot travel to an in-person session.
After an average of five appointments spread over fifteen weeks, the study showed the following:
- 67% of patients no longer had clinically significant anxiety symptoms, and 62% no longer had clinically significant depression symptoms.
- 26% of patients with anxiety and 29% with depression achieved clinical remission of symptoms.
The study of 1,826 patients seeking treatment from Talkiatry, a national mental health practice offering in-network psychiatry and therapy, aimed to determine whether there was clinically meaningful change.
Healthcare IT news spoke to Dr. Georgia Gaveras, co-founder and chief medical officer of Talkiatry, to discuss the findings of this study.
Q: Please tell us about the telepsychiatry study you published in the Journal of Medical Internet Research.
A. Depression and anxiety are two of the most common mental health conditions across the country. Although there are a number of treatments available, many people struggle to access care when they need it.
Telepsychiatry has shown promise in increasing access to mental health care for depression and anxiety, but little was actually known about its actual impact beyond anecdotal feedback. Our team wanted to scientifically determine whether the telepsychiatry model was as successful as touted in the media, and if so, exactly how effective was it?
Our peer-reviewed study in the Journal of Medical Internet Research,”Evaluation of clinical outcomes in patients treated exclusively via telepsychiatry: retrospective data analysis‘, supported claims about the effectiveness of values-based telepsychiatry. By demonstrating that patients experienced robust and clinically significant improvement in depression and anxiety symptoms, the study demonstrated the potential to improve access to quality psychiatric care for the communities that need it.
The study evaluated 1,826 treatment-seeking patients in the US for clinically meaningful changes in one of two validated outcome measures of depression and anxiety: the Patient Health Questionnaire-8 (PHQ8) or the Generalized Anxiety Disorder Questionnaire-7 (GAD7). They were enrolled in a commercially available health insurance plan.
All patients analyzed completed the GAD-7 and PHQ-8 before their first appointment and at least once after eight weeks of outpatient telepsychiatry treatment at Talkiatry. The caregivers were all psychiatrists and treatment consisted of a comprehensive diagnostic evaluation, supportive psychotherapy, and medication management.
Q. What were the results discovered in the study? How has telepsychiatry helped?
A. After an average of five appointments over 15 weeks, our study showed that 67% of patients no longer had clinically significant anxiety symptoms, and 62% no longer had clinically significant depression symptoms. Furthermore, the data showed that 26% of patients with anxiety and 29% with depression achieved clinical remission of symptoms.
On average, the study showed a seven-point reduction in severity scores based on the GAD7 and PHQ8 questionnaires. For reference, a reduction of five points or 50% is clinically significant. Treatment efficacy also extended across geographic areas: data between rural and urban patients were comparable, highlighting the potential of telepsychiatry in overcoming treatment disparities arising from where a patient lives.
These results confirm the importance of building a trusting relationship between psychiatrists and patients in virtual care. A strong therapeutic alliance can absolutely be created virtually, and most importantly, telepsychiatry helps patients who are feeling the serious effects of a mental health problem get better quickly.
By delivering positive outcomes while reducing healthcare costs, this study demonstrates the effectiveness of a values-based approach in telepsychiatry. It also shows that telepsychiatry can be a powerful alternative to intensive, expensive care options that lead to similar outcomes.
Q. How does telepsychiatry promote the right outcomes for success in value-based care?
A. Thirty percent of patients do not have local access to mental health care. The problem is better pronounced within rural, low-income, and black or brown communities. Moreover, the country still faces a shortage of mental health providers. In fact, more than half of U.S. counties lack even one psychiatrist.
Fortunately, the rise of telehealth during the pandemic has been a boon for patients in need of care. It particularly benefited traditionally marginalized populations in medicine, including the LGBTQ community. It also opened up new care options for those who felt stigmatized by or reluctant to seek mental health care.
For many Americans, telehealth is also their only viable route to treatment. To ensure equal health care for patients in all regions and population groups, it is very important that mental health care is covered by as many insurers as possible. It is imperative that we continue to campaign to get more and more insurers to cover behavioral health care.
These two elements combined – expanding access and increasing insurance coverage – play a huge role in making our communities safer and our families and friends healthier. Economically, they also help reduce costs for providers and insurers because patients receive quality treatment before their mental health problems force them to visit the emergency room. It’s a win-win situation for everyone.
Q. Where do you see telepsychiatry going in 2024?
A. As the pandemic forced providers to immediately transition to virtual appointments, the initial focus in telepsychiatry care focused on increasing access for people living in rural areas and underserved minority populations. Although this has undeniably been a good development (which is long overdue), the quality of care has in many respects been pushed aside.
This year we will see a push across the sector to ensure that access is matched by excellence, using tools like measurement-based care, for the benefit of the patient.
I believe this will also be the year we see significant momentum in addressing the mental health physician shortage. Finding new ways to encourage aspiring psychiatrists from all demographics to join the field is the best path forward to increasing equity, access, and quality of care.
Just right now 10.4% of psychiatric practitioners come from underrepresented groups, and providers of color make up a very small portion of the behavioral health provider workforce. Industry organizations and educational institutions will do their part to promote the next generation of psychiatrists and therapists.
While it will be a few more years before we see a major impact on the physician shortage, we look back on this year as the tipping point.
We’re finally approaching one year since the DEA released its ill-advised guidelines for prescribing controlled substances through telehealth appointments. After receiving more than 38,000 public comments, the DEA granted approval an extension of one year allowing telehealth providers to continue offering controlled substances via telehealth.
While the expansion is appreciated, there is now more than enough information available to implement a permanent policy that provides responsible guardrails and ensures patients have access to safe, quality care. I believe that implementing a dedicated registry that does not impose unnecessary burdens on healthcare providers while requiring reasonable policies to maximize patient well-being is the best path forward.
This would streamline DEA registration and provide pharmacies with clarity on their roles and responsibilities in filling telemedicine prescriptions. Mandating regular virtual patient visits, allowing specific medications to be offered only to providers trained in prescribing controlled substances, and limiting the overall number of prescriptions for controlled substances benefits everyone: patients, providers, and regulators.
Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.