Journal of Rural Mental Health, January 2019
Analytics, Behavioral Health
Evaluating the Impact of Telepsychiatry
To evaluate the impact of telepsychiatry services by comparing study participants receiving telepsychiatry interventions versus study participants receiving no such intervention.
There is a lack of access to mental health care for many individuals in the U.S. One strategy for reaching individuals for psychiatric care is using telepsychiatry. Telepsychiatry uses two-way real-time interactive video and audio communication between a patient and a psychiatrist who are in different locations. Potential reasons that the patient and psychiatrist may be in different locations may be that they live in different areas or that one of them has a contagious illness, to name a couple. This study examines a variety of medical outcomes to determine the effectiveness of delivering telepsychiatry to Medicaid-covered patients in Missouri.
The study was an analysis of Medicaid-covered patients in rural Missouri whose healthcare is managed by Genoa Healthcare, a large provider of pharmacy, outpatient telepsychiatry, and medication management services in the U.S. Patients between the ages of 18 to 64 at the point of a first psychiatry outpatient visit were included in the study. Intervention group patients had at least one telepsychiatry appointment and face-to-face mental health visits following either a behavioral health (BH) or substance use disorder (SUD) hospitalization, or a BH/SUD emergency department (ED) visit. Control group patients consisted of Medicaid-covered patients from the same program population who only had face-to-face psychiatry visits instead of telepsychiatry and face-to-face visits. Measures examined for the 11 months before and after the first outpatient visit included timeliness of care, outpatient encounters, ED visits, medication adherence, and readmissions.
Data from 242 patients showed that the group with telepsychiatry and in-person visits had improved timeliness of care with the intervention group having their first follow up first over a week sooner than those in the who had only in-person visits. Additionally, the group with telepsychiatry visits and in-person visits had significantly more total outpatient encounters compared to those with in-person visits only. For patients in the intervention group, 67% had at least one outpatient encounter per month compared to 50.3% of patients in the in-person only group. Finally, patients in the intervention group were 2.13 times more likely to have a psychiatry outpatient visit than those in the control group.
Our results suggest that a hybrid of telepsychiatry and in-person visits may be more effective than in-person visits alone. This hybrid approach delivered in a rural area may increase a patient’s willingness and ability to engage in outpatient follow up care. Telepsychiatry may help close the gap between rural and urban populations in access to mental health care, particularly in the time after an inpatient admission or visit to an emergency department. With the high prevalence of severe mental illness in the United States and lack of access to mental health care in rural areas, utilizing technology to connect providers and patients may be a vital component to improving mental health outcomes across the country. As telepsychiatry service options continue to grow, making this service mode available to rural population, there may be a positive impact on mental health outcomes in the United States.
For more information, you can find the full study in the Journal of Rural Mental Health.
CITATION: Hughes, M. C., Gorman, J. M., Ren, Y., Khalid, S., & Clayton, C. (2019). Increasing access to rural mental health care using hybrid care that includes telepsychiatry. Journal of Rural Mental Health, 43(1), 30-37. http://dx.doi.org/10.1037/rmh0000110