Telepsychiatry offers access, flexibility, convenience, increased privacy

Telepsychiatry creates opportunities to increase access to treatment, flexibility, convenience of routine care and the potential of increased privacy, according to a report in JAMA Psychiatry.

A 2022 study of 126 million patients from all 50 states showed that 39% of all mental health visits were virtual (Lo et al.).

Carlos Blanco, MD, PhD, of the division of epidemiology at the National Institute on Drug Abuse, and colleagues highlighted decisions that will be necessary as telepsychiatry continues to expand in their JAMA Psychiatry “Viewpoint.”

They discussed the advantages of telehealth visits for mental health, but also the concerns over cost and quality of care as well as equity in care to those who preferred in-person visits.

Telepsychiatry could help decrease the cost of mental health care, while the relaxation of licensing regulations could increase the availability of clinicians, stimulate market competition and lead to lower prices for patients, they cited Mullangi and colleagues as saying. In addition, eliminating commuting times for patients could lead to an increase in functional supply and reach of clinicians in underserved areas.

“Fewer missed appointments could increase treatment adherence, which, combined with broader access to experts, may improve clinical outcomes resulting in fewer failed treatments and decreased need for hospitalization and emergency care,” Blanco and colleagues wrote.

However, although this may lower per-unit service costs, it may not lower aggregate treatment costs, they said.

Greater access could lead to an increase in discretionary care, which would offset service savings (Bestsennyy et al.). Consolidation could occur because larger systems may have advantages over smaller ones, which could potentially limit a patient's ability to choose his or her clinician (Glied et al.).

The expansion of telepsychiatry could also influence the quality of care, Blanco and colleagues said.

Research suggests that outcomes are similar between in-person care and telehealth. However, whether that holds true across all psychological disorders, levels of symptom severity and populations is currently unknown (Jones et al.).

Equity is also a key consideration, according to Blanco and colleagues.

“Lower costs could reduce inequities, as financial barriers to care have greater influence on those with fewer economic resources,” they wrote.

Blanco stated in a New England Journal of Medicine article, “To ensure that expansion of telepsychiatry reduces rather than exacerbates inequities by expanding access primarily for those with greater resources, it will be important to address the digital divide.”

With access to larger patient populations, clinicians could offer different opportunities that better match their skill sets, which could lead to increased productivity and income (Bestsennyy et al.).

“Increased access to clinicians and systems of care should help payers lower costs and honor patient preferences while improving the quality of care, patient centeredness and equity,” Blanco and colleagues stated.

“Expansion of telepsychiatry creates new opportunities to increase treatment access,” they summarized, “while it poses overlapping challenges to multiple stakeholders.

“Aligning the incentives of the key stakeholders offers a rare and important opportunity with far-reaching implications to lower the cost, increase the quality, advance equity of psychiatric care, and improve patients’ outcomes and satisfaction.”

References:

• Bestsennyy O, et al. Telehealth: a quarter-trillion-dollar post-COVID-19 reality? Published July 9, 2021. Accessed Oct. 24, 2022. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality.
• Blanco C, et al. N Engl J Med. 2022;doi:10.1056/NEJMp2202740.
• Glied S, et al. JAMA Health Forum. 2022;doi:10.1001/jamahealthforum.2022.0619.
• Jones CM, et al. JAMA Psychiatry. 2022;doi:10.1001/jamapsychiatry.2022.2284.
• Lo J, et al. Telehealth has played an outsized role meeting mental health needs during the COVID-19 pandemic. KFF. Published March 15, 2022. Accessed Oct. 24, 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/telehealth-hasplayed-an-outsized-role-meeting-mental-healthneeds-during-the-covid-19-pandemic.
• Mullangi S, et al. JAMA Intern Med. 2021; doi:10.1001/jamainternmed.2020.8710.