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COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future

Chen et al review the early benefits and challenges of telepsychiatry and discuss the role of digital health during the pandemic and moving forward.

Grace Wlasowicz, PhD, PMHNP-BC

What do the results of this study mean for a practicing NP?

“The information in this article matches my experience with telepsychiatry. Prior to the pandemic, I was aware of the literature citing that outcomes using telehealth matched in person visits. I have to admit, I was skeptical. During the pandemic, I transitioned my psychiatric NP practice to 100% telehealth, treating new and current patients. I learned a new model of care combining my psychiatric skills with technology. I am not a skeptic anymore. Though not without challenges, telepsychiatry can be an effective model of care.”

NP Psych Navigator contributors are paid consultants of AbbVie Inc.

The COVID-19 pandemic dramatically changed the way healthcare is provided and shifted heavily to a reliance on telehealth. Within psychiatry and other care settings, where telehealth has already demonstrated benefit, the uniform adoption of this technology was sporadic prior to the pandemic.1

Why was the research needed?

Even prior to the pandemic, telepsychiatry had been utilized at a higher rate than other forms of digital health. Previously conducted systematic reviews demonstrated telepsychiatry to have equal efficacy compared to in-person visits for any psychiatric diagnosis or population,2,3 and users have reported high satisfaction with telepsychiatry use.2,3

Despite the positive results and outlook towards telepsychiatry, uptake of the practice was previously low. In a study of 164 psychologists, 74% believed telepsychiatry to be beneficial, but only 26% actually used telepsychiatry in their practice.4

This study was conducted to review literature on telepsychiatry and analyze the early adoption of telehealth in the pandemic, as well as associated opportunities and challenges to inform future practice.

What did the researchers do?

The goal of the study was to highlight key changes that occurred to support telepsychiatry during the pandemic, analyze early quality improvement data regarding virtual visits, and discuss clinical recommendations about optimizing the use of telepsychiatry in a post-pandemic setting.

To do this, authors conducted a literature review of the effectiveness of telepsychiatry relative to in-person mental health care, and they described the reduction of barriers during the transition from outpatient psychiatry to telepsychiatry within the Massachusetts General Hospital (MGH) psychiatry department during March 2020. The MGH Department of Psychiatry had adopted telehealth prior to the pandemic; however, it was not highly utilized, with under 5% of visits being virtual.1 In March 2020, over 97% of visits were virtual.1

In addition, the authors reviewed departmental quality improvement data to identify and reported on potential advantages and limitations of telepsychiatry.

What were the main results of the study?

The authors found that notable benefits included robust clinical volumes despite social distancing, reduced logistical barriers to care, and decreased no-show rates. Challenges included additional demands placed on clinical and administrative staff, loss of rapport between patients and providers, and some patients not being adequately served or examined in a virtual setting.1

Clinicians at MGH Department of Psychiatry reported the possible advantages and limitations of telepsychiatry, and the authors found the following patterns in responses:

Potential Advantages and Limitations of Telepsychiatry

AdvantagesLimitations
• Protects the immunocompromised—both patients and providers• Can increase session disruptions—technology issues or interruptions
• Decreases time lost to commuting• Can be more difficult to interpret nonverbal communication
• Increases privacy—no physical traveling to mental health clinic• May be more difficult to establish patient–provider relationship
• Increases provider understanding of the patient’s home life and family• Cannot examine certain conditions as well—movement disorders, extrapyramidal symptoms, etc.
• Decreases rate of patients who don’t show up for appointments• Unable to monitor cardiac or metabolic function
• Increases access to care• Loss of privacy and sense of closed-door office setting
• Increases sense of personal safety associated with patients expressing violent behavior• Deepens health disparities in patients without technology access



Some providers expressed a desire to continue telepsychiatry services after the pandemic. The providers cited personal health concerns, decreased commute time, and scheduling flexibility as reasons to continue this practice.1

Why are these results potentially important?

Early data suggests changes to telepsychiatry enabled providers to continue critical patient care through the onset of the pandemic. Both healthcare providers and patients gained skills in utilizing telehealth, which is expected to continue.1

Understanding and considering the potential advantages and limitations of telepsychiatry, as well as healthcare providers preferences, can inform the development of better utilization of this type of technology as it continues to be a model of care in a post-pandemic world.1

What’s next?

When routine in-person care becomes feasible post-pandemic, further studies analyzing outcomes for in-person compared to remote care for specific conditions may be warranted. Additional research to explore the impact of telepsychiatry on the quality of care, for individuals and in group settings, will also be necessary.1

This summary was prepared independently of the study’s authors.

The content presented here is provided for educational purposes only. It is not intended as, nor is it a substitute for medical care or advice. Healthcare professionals should use their clinical judgment when reviewing educational resources on NP Psych Navigator.

References

  1. Chen JA, Chung WJ, Young SK, et al. COVID-19 and telepsychiatry: early outpatient experiences and implications for the future. Gen Hos Psych. 2020;66:89-95. doi: 10.1016/j.genhospsych.2020.07.002
  2. Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry. 2016;6(2):269-282.
  3. Chakrabarti S. Usefulness of telepsychiatry: a critical evaluation of videoconferencing-based approaches. World J Psychiatry. 2015;5(3):286-304.
  4. Glueckauf RL, Maheu MM, Drude KP, et al. Survey of psychologists’ telebehavioral health practices: technology use, ethical issues, and training needs. Professional Psychology: Research and Practice. 2018;49(3):205-219. doi: 10.1037/pro0000188

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