COVID-19: Telemedicine Boosting Access but Is Not a Panacea

Andrew D. Bowser

April 28, 2020

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The recent surge in telemedicine services fueled by the COVID-19 pandemic has improved access to psychiatry care and may have set the stage for even more dramatic forays into virtual care in the future. However, not all patients want video visits, and it is not clear that the way telepsychiatry is practiced right now will be the best model for clinical practice once the crisis abates, speakers said at the annual meeting of the American Psychiatric Association, which was held as a virtual live event.

Dr Avrim Fishkind

The COVID-19 pandemic has effectively "democratized" telepsychiatry, a mode of health care delivery that previously was thought of as "overly complex" and limited to a few specialists, said Avrim Fishkind, MD, CEO/consultant in emergency psychiatry and psychiatric emergency services design at Empathic Soul Health in Houston.

"In a blink of an eye, every psychiatrist and every mental health professional now can see themselves – and many have been forced into – becoming telepsychiatrists," Dr. Fishkind said in a presentation at the meeting.

"I think this is one of the greatest things that has ever happened to our profession," he continued. "Access to you is fantastic ... and your no-show rates decrease dramatically when people have flexibility to talk to you when they want to schedule and where they want to schedule."

On the other hand, telepsychiatry should not be viewed as a panacea, cautioned Patrice A. Harris, MD, a child and adolescent psychiatrist and current president of the American Medical Association. The AMA has advocated for the more flexible federal regulations and payment policies that have helped boost telemedicine adoption during the crisis.

"Not every regulation that was relaxed, and not everything we are doing now in the midst of this pandemic, should be continued," Dr. Harris said in a question-and-answer session earlier in the conference.

"I don't want us all to say, 'Wow, we had this experience, and it worked,' and then continue to do it in the exact same way," she added. "I know that we, the APA, and AMA, will be there to have a thoughtful, science-based, data-driven conversation about the next move regarding telemedicine and telehealth after we get through this pandemic."

Telepsychiatry has nevertheless proven very versatile and applicable to a broad swath of patients during the COVID-19 pandemic, according to Dr. Fishkind. "I start from the position that I can see every patient this way, and I have to find a reason why I can't," said Dr. Fishkind, who also is lead telepsychiatrist at the Harris Center in Houston and a past president of the American Association for Emergency Psychiatry.

Telemedicine services can be as good as office visits, if not better, he told attendees at the virtual meeting. For example, a virtual visit can obviate the need for an in-person evaluation of a child with autism for whom an in-person visit would be challenging for the patient and parent alike.

However, Dr. Fishkind acknowledged that telepsychiatry is not for everyone: "I don't want to say it's heaven on earth. There are some patients who do refuse to be seen this way."

What happens next in telepsychiatry is anyone's guess, though Dr. Fishkind said he envisions an online "wheel of access" model of psychiatric services delivery.

In this portal-style model, the psychiatric patient might log in, answer a few automated questions, and then, based on their responses, they would be routed to a social worker or nurse navigator at the center of that services wheel.

In turn, the navigator might route the patient to one of the services on the spokes of the wheel, such as a psychiatrist consult, video-based or online cognitive-behavioral therapy, peer forums, group therapy, a pharmacist, or to other clinicians and interventions.

"Patients would have instant access to all of the things that we always want them to have access to – but now, by using virtual technologies, they could actually get them," said Dr. Fishkind.

Dr. Fishkind reported no financial conflicts.

SOURCE: Fishkind A. APA 2020, Abstract.

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