Q&A: Telehealth 'should be one part of a broader approach' to managing behavioral health
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Key takeaways:
- In rural behavioral health clinics, the no-show rate was 17% for telehealth vs. 13% for in-person visits.
- PCPs should practice collaborative decision-making with patients to ensure the best possible outcomes.
Patients with behavioral health challenges who used telehealth had higher odds of missing scheduled appointments compared with those receiving in-person care, according to the results of research published in JAMA Network Open.
Dependra Bhatta, PhD, director of behavioral and primary health analytics with the Northeast Delta Human Services Authority, and colleagues observed this in a cohort study including data from 9,715 appointments, 6,397 of which were telehealth, for 1,421 patients aged 18 years or older. The researchers found that the no-show rate for in-person appointments was 13%. For telehealth appointments, the rate was higher, at 17%.
Healio spoke with Bhatta to learn more about the study findings and what primary care providers need to know.
Healio: Why did you decide to research this subject?
Bhatta: We decided to research this subject because missed appointments, or no-shows, can have significant implications for patients' health and the efficiency of health care resources. Telehealth has become widely implemented, especially during the COVID-19 pandemic, to provide behavioral health services, but there is limited research comparing no-show rates between telehealth and in-person care in rural settings, particularly for patients with lower income.
Understanding the factors influencing no-shows in telehealth appointments is crucial to inform health care institutions on resource management and improving health outcomes. By investigating this topic, we aimed to shed light on the unintended consequences of telehealth use and highlight the importance of considering patient needs and preferences in implementing remote health care solutions.
As a researcher, I believe that studying this subject can contribute to enhancing the effectiveness of telehealth services and address potential barriers to care, ultimately leading to better health care access and outcomes for patients with behavioral health challenges in rural areas.
Healio: Will you briefly describe your findings and their importance?
Bhatta: In our research, we conducted a retrospective analysis of electronic health records of patients with behavioral health conditions who scheduled appointments in outpatient clinics in rural Louisiana. We compared the no-show rates between telehealth appointments and in-person care.
Our findings revealed that patients using telehealth had a statistically significantly higher odds of no-shows compared with patients receiving in-person care. This suggests that, despite the widespread implementation of telehealth during the COVID-19 pandemic, it may unintentionally contribute to higher rates of missed appointments for patients with behavioral health challenges.
The importance of these findings lies in understanding the impact of telehealth use on patient attendance and engagement in health care services. Identifying higher no-show rates in telehealth appointments can prompt health care institutions to develop targeted strategies to reduce barriers to care, especially for vulnerable populations in rural areas.
This research underscores the significance of considering patient needs, preferences and potential challenges when implementing telehealth solutions. By addressing these factors, health care providers can enhance patient engagement and ultimately improve the effectiveness of telehealth services, leading to better health outcomes for individuals with behavioral health conditions.
Healio: What should PCPs take away from the study?
Bhatta: PCPs should take away several key points from the study:
- Awareness of no-show rates. The study highlights the higher no-show rates for telehealth appointments among patients with behavioral health challenges. This information can help PCPs better understand the potential challenges patients may face in engaging with telehealth services.
- Consider patient preferences. Although telehealth offers convenience and accessibility, it may not be suitable for all patients with behavioral health challenges. PCPs should consider discussing telehealth options with their patients and understanding their preferences and comfort level with virtual visits.
- Evaluate patient needs. Patients with behavioral health challenges may benefit from in-person appointments due to the importance of establishing a therapeutic patient-clinician relationship and the need for nonverbal cues and psychological support. PCPs should assess each patient's specific needs and tailor their recommendations accordingly.
- Address barriers. If recommending telehealth for patients with behavioral health challenges, physicians should also address potential barriers to attendance. Strategies such as sending reminders, offering flexible scheduling and providing support in using technology can help mitigate no-show rates.
- Individualized approach. The study's findings emphasize the importance of taking an individualized approach to health care recommendations. PCPs should consider the unique circumstances of each patient and collaborate with them to determine the most appropriate mode of care delivery.
Ultimately, the study does not suggest that in-person appointments are always superior to telehealth for patients with behavioral health challenges. Instead, it highlights the need for careful consideration of patient preferences and needs when deciding on the mode of care delivery. PCPs should work collaboratively with their patients to make informed decisions that ensure the best possible outcomes for their behavioral health care.
Healio: Is there anything else you would like to add?
Bhatta: As the health care landscape continues to evolve, telehealth remains a valuable tool for expanding access to care, especially for patients with behavioral health challenges who may face barriers to in-person visits. Although the study highlights the higher no-show rates for telehealth appointments among this specific population, it's essential to recognize that telehealth can still be beneficial for many patients.
To maximize the benefits of telehealth and address the challenges identified in the study, health care providers should consider implementing strategies to improve patient engagement and retention in telehealth services. These strategies may include:
- Patient education: Educating patients about the benefits and functionalities of telehealth can help alleviate any concerns or uncertainties they may have about virtual visits.
- Technological support: Providing technical assistance and support to patients who may be less familiar with using technology can enhance their confidence in participating in telehealth appointments.
- Continuity of care: Maintaining continuity of care between telehealth visits and in-person appointments can strengthen the patient-clinician relationship and improve treatment adherence.
- Culturally sensitive care: Taking into account cultural factors and tailoring telehealth services to meet patients' cultural preferences can enhance their comfort and willingness to engage in virtual care.
- Collaborative care teams: Collaborating with behavioral health specialists and other health care professionals can offer comprehensive care and support for patients with complex behavioral health needs.
Although telehealth can be a valuable option, it should be one part of a broader approach to behavioral health care delivery. PCPs, along with their interdisciplinary teams, play a crucial role in ensuring that patients receive the most appropriate and effective care to improve their overall health and well-being.
As research continues to explore the nuances of telehealth in different health care settings, the medical community can adapt and refine its practices to optimize the benefits of this evolving health care modality while ensuring that patients' needs remain at the forefront of care decisions.