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Patients interested in mental health care ‘eVisits’

Patients are interested in receiving treatment from a physician over the Internet, or “eVisits,” for issues related to mental health, and additional measures may be needed to guarantee prompt responses to their concerns, according to a study published in The American Journal of Managed Care.

“A number of companies now offer telehealth capabilities directly to consumers, and Google has linked Internet searches for basic health information with consumer access to health care systems offering telehealth services,” Steven M. Albert, PhD, of the department of behavioral and community health services at the University of Pittsburgh, Pennsylvania, and colleagues wrote. “Nevertheless, the appropriateness of eVisits for certain kinds of medical care is still in question. ...Whether it is appropriate for patients to seek ‘e-mental health’ via a patient portal is also unclear.”

To examine the features of mental health eVisits in a patient portal that did not offer a specific option for mental health, the researchers conducted a retrospective review of the online portal offered by the University of Pittsburgh Medical Center (UPMC). In the UPMC online portal, patients log in and complete a standardized questionnaire regarding their symptoms and health history. The provided information is reviewed by a physician, who then makes a diagnosis and recommends care, which may include ordering a prescription, and sends an electronic reply to the patient through the portal. None of the prestructured symptom options address mental health. However, patients can select “other” and opt to tell a physician about their symptoms.

The researchers reviewed eVisits completed between April 1, 2009 and June 20, 2012 — roughly the first 3 years of operation for the UPMC’s patient portal — noting when patients selected the “other” option. They then tracked physicians’ diagnoses in these eVisits using clinical classification software developed in the Healthcare Cost and Utilization Project.

Of the 2,292 patients who made 3,601 eVisits within the selected time period, 685 selected the “other” option, accounting for 858 eVisits. “Mental illness, primarily anxiety and depression, was the second most common diagnosis representing 12.6% of “other” selections. In addition, 13.4% of all patients who used the “other” category had an eVisit regarding mental health. Those who received mental health diagnoses accounted for 4% of eVisit patients. These patients were younger than those making standard eVisits, with a mean age of 41.1 years vs. 46 years. They were also younger than those with “other” visits that did not involve mental health issues, whose mean age was 46.4 years. They were also more likely to be female: 82.6% compared to 71.5% of those making standard visits and 70.2% of those whose “other” visits did not involve mental health issues.

In addition, physicians took longer to respond to mental health eVisits, with a same-day diagnosis rate of 71%, compared to 79% for all other diagnoses.

“One key conclusion is the need to develop a mental health eVisit and, more broadly, web-based tools to address mental health symptoms,” Albert and colleagues wrote. “ ... Still, mental health may offer particular challenges for eVisits. ... Assessment of the efficacy of mental health eVisits for diagnosis and entry to care remains an important area for future research.” – by Jason Laday

Disclosure: The authors report that they are involved in the design, monitoring and evaluation of the UPMC patient portal.