Telehealth Safe, Effective for Acutely Ill Psychiatric Patients

Batya Swift Yasgur, MA, LSW

April 08, 2021

Telehealth is safe and effective in treating and managing acutely ill psychiatric patients in a partial hospital program and may be superior to in-person treatment in regard to patient retention and reducing suicidality, new research suggests.

Results of the study, which was conducted during the COVID-19 pandemic, showed that telehealth was equally efficacious as in-person treatment in relation to patient satisfaction, symptom reduction, and improved functioning and well-being.

In addition, more telehealth patients completed the entire treatment than did patients treated in person, and more telehealth patients reported reductions in experiencing a death wish or suicidal ideation.

"The take-home message is less for practicing clinicians but more for insurance companies, government administrators, and officials, which is that telehealth should be equivalently compensated level of care [as in-person treatment]," lead author Mark Zimmerman, MD, professor of psychiatry and human behavior, Brown University, Providence, Rhode Island, told Medscape Medical News.

"There's no evidence that delivering behavioral healthcare in this manner results in poorer outcomes, and as a result, patients should be given the choice of what type of treatment they want," said Zimmerman, who is also the director of the Outpatient Division at the Partial Hospital Program, Rhode Island Hospital.

The study was published online March 16 in the Journal of Clinical Psychiatry.

Limited Information

"While there have been a number of studies establishing the effectiveness of telehealth treatment in outpatient settings, there have been no such studies in establishing the effectiveness of telehealth treatment in more severely ill groups of patients treated in a partial hospital setting," Zimmerman said.

In addition, only "limited information" is available regarding telehealth for individuals with multiple psychiatric disorders. Most such research focuses on patients with single disorders.

The Rhode Island Hospital Adult Partial Hospitalization Program, an acute care setting, utilized telehealth to deliver behavioral health treatment in response to public health recommendations for social distancing during the COVID-19 pandemic.

"The question we asked was whether or not running a program that was mostly, although not entirely, group-therapy based but which also included individual therapy sessions with psychologists and psychiatrists would be as safe and as effective as our in-person treatment program," Zimmerman said.

The study was part of the ongoing work of the Rhode Island Methods to Improve Diagnostic Assessment and Services.

The researchers compared 207 patients who received virtual care from May 2020 to September 2020 to 207 patients who received in-person care during the same months of 2019.

There were no significant differences between the in-person and the telehealth groups with regard to gender, race, or marital status or in patients' principle diagnoses, which included, mood, anxiety, substance use, eating, psychotic, somatoform, impulse control, adjustment, and borderline personality disorders.

The intervention, based largely on acceptance and commitment therapy, was delivered in group and individual settings.

The focus, content, and structure of the virtual program remained "consistent" with the in-person program. However, in the in-person program, four daily group therapy sessions were usually conducted, whereas in the virtual program, three daily group therapy sessions were offered. The content of the fourth session was integrated into the other sessions to make additional time available for morning check-in, which was conducted by staff via Zoom.

Patients completed the Clinical Useful Patient Satisfaction Scale at the end of their intake session and on the day of discharge. They also completed a modified version of the Remission From Depression Questionnaire (RDQ-M).

High Patient Satisfaction

At intake, most patients in both groups expressed hope that they would get better. At treatment completion, over 90% of the patients reported being "very satisfied" or "extremely satisfied" with their treatment. There were no significant differences between the groups.

There were, however, significant differences in treatment completion. A higher percentage of patients completed the virtual program than completed the in-person program (72.9% vs 62.3%; χ2 = 5.34; P < .05).

In both groups, transfers to inpatient care or dissatisfaction-related withdrawal from treatment was low, and there were no significant differences between the groups. However, the mean number of days of program attendance was significantly higher in the virtual than in the in-person group (13.5 ± 8.1 vs 8.5 ± 5.0; t = 7.61; P < .001).

Patients in both groups significantly improved from admission to discharge on each of the RDQ-M subscales.

Importantly, no patients attempted or completed suicide during their treatment. Moreover, there was a significantly greater reduction in the percentage of patients who reported death wishes and suicidal ideation in the virtual-therapy group in comparison with the in-person group, as determined on the basis of RDQ-M subscales.

"A few patients mentioned that they never would have come in person to the partial hospital program, even in the absence of COVID-19, because of transportation issues or medical illnesses that limited their ability to get out and come on a daily basis," said Zimmerman.

"Telehealth treatment increases accessibility for many individuals who have difficulties coming in person, and I suspect that as the COVID-19 pandemic resolves, a number of patients will be asking if they can continue virtual treatment," he added.

Telehealth Is "Essential"

Commenting on the study for Medscape Medical News, Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry, Encino, California, noted, "Innovation often takes decades to be put into motion, and studies like this will help people who were skeptical in the past to understand that telehealth is essential."

Kaftarian, who is a member of the American Psychiatric Association's Committee on Telepsychiatry and was not involved in the research, said there is "no absolute contraindication to telehealth being used for any population, regardless of the type of mental illness or setting, although there may be times where telehealth may not be appropriate for a specific patient."

Steven Chan, MD, MBA, also a member of the American Psychiatric Association's Committee on Telepsychiatry, told Medscape Medical News that the study "supports the use of telehealth for even more intensive psychiatric settings."

Chan, who is a clinical assistant professor at the Stanford University School of Medicine and was not involved with the study, said he is "hopeful that this study's benefits will spur more research and more clinical services in new, innovative ways to deliver mental health care through technology."

No source of funding for the study was listed. Zimmerman and coauthors report no relevant financial relationships. Kaftarian is the CEO of Orbit Health, a telepsychiatry company. Chan reports consulting with Orbit Telepsychiatry for potential future stock options yet to be granted and otherwise receives no compensation. He was previously a contracted physician at HealthLinkNow and Traditions Behavioral Health.

J Clin Psychiatry. Published online March 16, 2021. Abstract

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