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Videoconferencing Enhances Access to Psychiatric Care for Children and Adults With Mental Illness in Rural Settings


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Academic Telepsychiatry Programs Enhance Access for Rural Populations

by Ana Maria Lopez, MD, MPH, FACP
Medical Director, Arizona Telemedicine Program
Professor of Medicine and Pathology, University of Arizona



Telepsychiatry transforms interactions between patients and clinicians from face-to-face visits to virtual videoconferences. The need for telepsychiatry services is particularly high in rural areas, where children and adults have limited access to mental health services. Rural populations are also more likely to be poorer, sicker, older, uninsured, and medically underserved than urban populations.1

Telemedicine technology has the potential to enhance access to mental health care in rural settings. The American Telemedicine Association has developed practice guidelines for video-based mental health services.2 Although videoconferencing equipment is readily available to consumers, the software must be compliant with the requirements of the Health Insurance Portability and Accountability Act.

Matching the technology with the patient’s need is critical to clinical efficacy and cost-effectiveness. For example, an inexpensive desktop phone that delivers real-time video over a broadband Internet connection may be sufficient for brief counseling sessions with high functioning patients. In contrast, a more expensive high-definition videoconferencing system may be needed for the long-term management of individuals with chronic mental illnesses. Also, new technology has enabled telepsychiatry consultations to take place in “store and forward” fashion.3 By allowing clinical data (including video) to be collected and reviewed at a later time by a psychiatrist, asynchronous technology can offer patients increased access to mental health specialists.

Telepsychiatry is often used for medication management, as seen in the pediatric telepsychiatry intervention at the University of Virginia, although it has been used successfully for other services, including counseling, behavioral modification, and clinical supervision. Further, in the adult program at the University of Virginia, a psychiatric resident serves primarily as a teleconsultant to the patient’s primary care physician. This consulting approach provides team-based care for the patient and mentoring/educational opportunities for the referring clinician. The referring clinician increases his or her skills in caring for patients with mental health conditions. The relationship with the teleconsultant may also ease the rural clinician’s sense of isolation, which is often cited as a barrier to rural practice.

Barriers to the broad implementation of telemedicine include a lack of parity for reimbursement of telemedicine services compared with in-person care and state licensure requirements. Parity for telemedicine services is evolving as 20 states and Washington, DC, have enacted telehealth parity laws for private insurance coverage and reimbursement.4

Telemedicine services generally require the clinician to be licensed in the same state in which the patient resides. This limitation has led to the emergence of companies that can walk the clinician through the arduous process of obtaining licensure in multiple states. A promising model is New Mexico's limited telemedicine license, which allows physicians from other states to use telemedicine to care for patients in New Mexico.5

Many private and university programs, including the program at the University of Virginia, have implemented successful telepsychiatry interventions for both adult and pediatric patients living in rural areas. A unique aspect of the University of Virginia program is its engagement of residents and fellows to provide telepsychiatry services. Having experienced telepsychiatry as a part of their training, residents and fellows may be more likely to integrate its use into their future practices. To date, the University of Arizona College of Medicine is the only medical school to develop a formal curriculum in telemedicine.6

About Ana Maria Lopez, MD, MPH, FACP

Dr. Lopez is the founding Medical Director of the Arizona Telemedicine Program and Professor of Medicine and Pathology at the University of Arizona. She is a medical oncologist, researcher, and educator who has dedicated her work to the amelioration of health care disparities. Dr. Lopez also serves as a Regent for the American College of Physicians.

Disclosure Statement: Dr. Lopez reported having no financial interests or business/professional affiliations relevant to the work described in this commentary other than her employment at the University of Arizona.


References


1National Rural Health Association. What’s Different about Rural Health Care? Available at: http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care.

2American Telemedicine Association. ATA Unveils New Practice Guidelines for Online Mental Health Services. Available at: http://www.americantelemed.org/news-landing/2013/05/28
/ata-unveils-new-practice-guidelines-for-online-mental-health-services
.

3Butler TN, Yellowlees P. Cost analysis of store-and-forward telepsychiatry as a consultation model for primary care. Telemed J E Health. 2012;18(1):74-7.

4American Telemedicine Association. 2013 State Telemedicine Legislation Tracking.

5New Mexico Medical Board. Instructions for Completing the License Application for Telemedicine License. Available at: http://www.nmmb.state.nm.us/pdffiles/MDAppTeleMedicine.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

6López AM, Webster P, Major J, et al. Integrating telemedicine in the medical school curriculum [abstract]. American Telemedicine Association 17th Annual International Meeting & Exposition; April 29-May 1, 2012; San Jose, CA.

Original publication: December 04, 2013.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 23, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.