Pediatric Telepsychiatry Cuts Costs, Improves Symptoms

Deborah Brauser

June 13, 2012

June 13, 2012 — Pediatric telepsychiatry programs can improve symptoms, lower the number of appointment "no shows," and decrease costs because of fewer visits to emergency departments (EDs). The process can also help fight stigma and can allay concerns or embarrassment over in-person office visits, new research suggests.

Results from a survey study, presented June 12 at a press conference Web-based seminar (webinar), showed that after 2 years of participation in a telepsychiatry pilot program through the University of Texas Medical Branch (UTMB), in Galveston, Texas, 60% of the participating children and adolescents experienced a significant decrease in their symptoms, and overall ED visits were cut in half.

In addition, the rate of no shows during the program was 32%. The national no-show rate for pediatric Medicaid patients for behavioral health problems in an outpatient setting is between 42% and 72%, depending on the region.

More than 85% of the participants' parents reported being "quite satisfied" with the program. They also reported that it was easier for their children to access treatment and that they would use telepsychiatry again in the future if it were available.

"We weren't surprised, but we were quite pleased that the finding about the parents' perception of the program came back the way it did," said program leader Alexander Vo, PhD, telemedicine expert at UTMB and vice president of electronically mediated services at the nonprofit health plan Colorado Access.

Dr. Alexander Vo

"This is also a great way to distribute scarce resources to multiple locations. It's essentially a workforce multiplier," he told Medscape Medical News.

The take-home message is that telemedicine is "a very viable" option for delivering psychiatric care, Dr. Vo concluded.

"It's accepted among patients, it's cost effective and increases access to care, and it improves clinical outcomes. More and more patients who don't have access will probably want this. Also, in-home telepsychiatry is coming on quite strong because of the value of privacy and a reduction of stigma."

The webinar was hosted by the Internet Innovation Alliance (IIA) and Colorado Access, "a broad-based coalition supporting broadband availability and access for all Americans, including underserved and rural communities."

Distant Delivering

Dr. Vo reported that Texas, like most parts of the United States, has a shortage of child and adolescent psychiatrists (CAAPs). Because of this, and faced with a mandate "to provide access to quality medical and mental healthcare to all eligible Medicaid children," UTMB received a grant to develop a telemedicine program with 18 psychiatric clinics.

The goal of the new program was to increase access across the entire state. Currently, there are roughly 500 CAAPs in Texas, and they are mostly located around 4 major metropolitan areas.

"Telemedicine is the use of technology to deliver care from a distance. And it's been demonstrated as an effective means of overcoming barriers to care. To date, I believe there are over 300 small or large telemedicine programs in all kinds of settings throughout the country," he added.

UTMB currently offers telemedicine services in a number of specialities, including internal medicine and dermatology.

The new UTMB Network for Children (UTNC) program was set up to especially target rural areas that had "patients with high mental health need." Because the participating pediatric psychiatric clinics had varying levels of technological capabilities, a secure "virtual portal" was created to make the exchange of patient medical records more efficient and to increase the ease of communication between the clinics.

To date, 8000 children and adolescents have participated in the UTNC program, and almost 12,000 clinical appointments have been scheduled.

For this study, 530 of the participants' parents or caregivers filled out surveys to measure the impact of the UTNC program.

"Big Findings"

Results showed that before initiation of the program, 9% of the participants were ED users. That number had dropped by 50.5% at the time of the 2-year checkpoint.

"This is a very big finding for us, and quite surprising," said Dr. Vo. "This suggests that patients were probably using [EDs] as part of their regular care. This is a big part of what Medicaid populations do because of a lack of resources available for them, and we successfully diverted them from probably improper utilization."

"This also talks to the cost savings that could be achieved by avoidance of ED use. In the future, we'd also like to see how we could avoid or reduce hospital stays," he said.

In addition, 60% of the parents reported "dramatic improvement" in their children's functional behaviors or symptomology, 88.5% said that the program made it easier for their children to receive services by a specialist, and more than 89% said that they would use telepsychiatry in the future.

"People want this kind of service if they are not able to go in person," said Dr. Vo.

He reported that several factors helped contribute to the program's success. These included establishing partnerships with community health centers (including schools), having regulatory agency support, creating the patient data exchange portal, and having a broadband connectivity infrastructure.

"Broadband access allowed us to deliver quality care by providing expert guidance via real-time consultation and monitoring," he said.

However, some potential barriers to these types of services include reimbursement issues, such as whether telemedicine can be paid at the same rate as in-person visits, privacy/confidentiality issues, and licensure. Dr. Vo noted that a psychiatrist cannot currently offer telepsychiatry services to a patient located in a state where the clinician is not licensed.

"But efforts are being conducted by various organizations, such as the American Telemedicine Association, to potentially develop some standard licensing applications for cross-state licensures," he said.

Not a Recruitment Barrier

Overall, the use of technology and telehealth will be important for the future, he said. "It transcends rural or geographic barriers. It's a means to increase or provide or maintain access to care for very vulnerable populations, and it's a very good way to mitigate costs."

During the Q&A session after the presentation, an attendee asked whether telehealth services might hurt recruitment for physician positions in rural areas because it allows the offering of services from a possibly preferred metropolitan area.

"I think the same challenges will remain. You have to incentivize these specialists to come to rural areas, and I don't think telemedicine would be a significant barrier to recruitment. It's going to allow clinicians to see more rural patients, which could eventually attract them to living in those areas, especially if they want to scale down their practice," said Dr. Vo.

The webinar was hosted by the Internet Innovation Alliance (IIA) and Colorado Access. Dr. Vo has disclosed no relevant financial relationships. The IIA "is a broad-based coalition supporting broadband availability and access for all Americans, including underserved and rural communities."

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