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Home-based telepsychiatry comparable to in-person treatment of PTSD

SAN DIEGO —A nationwide shortage of mental health professionals and other barriers to care may make home-based telemedicine an effective option for the diagnosis, assessment and treatment of many mental health conditions, including PTSD, according to data presented at U.S. Psychiatric and Mental Health Congress.

However, despite addressing many issues facing care access, the use telemedicine has been stunted and slowed due to fears regarding patient safety, reimbursement challenges and technological limits, according to the presenters.

“Why do it? Why push the envelope? Why not just stick with traditional things, particularly with [PTSD]? We think that there are probably a lot of aspects regarding the disorder and the delivery setting that are keeping people away from treatment: stigma, parking, travel time, work. The number one reason for drop out in prolonged exposure and [cognitive behavioral therapy] is ‘life gets in the way’. We thought if we take some of these things out of the picture, we might be able to enhance care,” Ron Acierno, PhD, professor and associate dean for research, Medical University of South Carolina, said during a presentation.

Ron Acierno

Allowing patients to access care from home would eliminate two major barriers to care: travel and stigma associated with visiting mental health care clinics.

Acierno and co-speaker Mark B. Hamner, MD, professor, department of psychiatry and behavioral sciences at the Medical University of South Carolina, pointed out that among Iraqi war veterans, 42% are screened for PTSD, but only 25% of those with PTSD receive services to address the condition. This is where telemedicine, specifically home-based telemedicine, could be beneficial, according to the presenters.

Both cognitive behavioral therapy and prolonged exposure therapy, common treatment options for PTSD, can be effectively delivered via telemedicine. However, to use home-based telemedicine, patients must have access to a computer and Internet connectivity to utilize telepsychiatry treatment.

Additionally, patients must first meet for an in-person introductory session, as well as initiate each call, and be advised that the session signal could be stolen, although since it is encrypted, it is most likely uninterpretable.

Increased access to care in inner city areas, reduction in transportation expenses in rural areas and reduction in absenteeism in the workplace are all added benefits of utilizing telemedicine, according to Acierno and Hamner.

Telemental health, including computerized and internet-based cognitive-behavioral therapy (CBT), virtual reality exposure therapy and mobile therapy, may be especially beneficial to younger patients, who have a ‘comfort level’ with technology, according to Acierno and Hamner.

Certain issues need to be considered when dealing with home-based telemedicine care, including handling suicidality, HIPPA compliance, collection of measures and outcomes, licensing complications, family involvement and therapeutic relationship parameters. Many of the issues facing telemedicine use can be tackled, said the presenters. Health care providers dealing with suicidal patients via home-based telemedicine would know where to send medical help, and since the patient would be initiating the care and encrypted call, HIPPA compliance would be met. In addition, since care is being handled electronically, emails, screens shots and verbal reports could all be collected to analyze measures and outcomes.

Citing recent studies, Acierno and Hamner said that contrary to common beliefs, patients who received care via telemedicine did not have a higher dropout rate compared with patients receiving in-person care. Also, there were no difference seen in therapist relationship satisfaction, obstacles or stressors associated with treatment completion, or relevance of treatment between care groups. However, a nonsignificant, but higher proportion of patients receiving care via telemedicine reported having more difficulty with exposure therapy procedures, according to the presenters.

Acierno and Hammer noted that further research is needed to determine the barriers to telemedicine, such as difficulty with neurological assessments, as well as further research on service models, pharmacotherapy delivery and cost.

“I don’t think we can expect to take away the valiance of memories that are horrible. We can moderate them, but should we really eliminate them to reduce all the symptoms? I don’t think so,” Acierno concluded.  – by Casey Hower