160 million Americans live in regions with mental health professional shortages. Many of these areas are rural, where driving to the nearest treatment option is unrealistic due to distance, or personal and professional obligations. Cost and access also are barriers to care, with a predicted shortage of 21,000 adult psychiatrists by 2030 making matters worse.
Telepsychiatry can be a lifeline to areas with few mental health options by increasing access to treatment. However, access does not equal quality, and subpar care could do more harm than good.
A new peer-reviewed study in the Journal of Medical Internet Research shows the efficacy of telepsychiatry for anxiety and depression care across regions. Rural areas with few mental health options showed comparable clinical outcomes to urban areas with many options, demonstrating virtual care’s power to positively impact those who cannot travel to an in-person session.
After an average of five appointments across 15 weeks, the study showed:
67% of patients no longer had clinically significant anxiety symptoms, and 62% no longer had clinically significant depression symptoms.
26% of patients with anxiety and 29% with depression achieved clinical remission of symptoms.
The study of 1,826 treatment-seeking patients, from Talkiatry, a national mental health practice that provides in-network psychiatry and therapy, set out to determine whether there was a clinically meaningful change.
Healthcare IT News sat down with Dr. Georgia Gaveras, cofounder and chief medical officer at Talkiatry, to discuss the findings of this study.
Q. Please tell us about the telepsychiatry study you published in the Journal of Medical Internet Research.
A. Depression and anxiety are two of the most common mental health conditions across the country. While there are a number of treatments available, many people have trouble accessing care when they need it.
Telepsychiatry has shown great promise in increasing access to mental health support for depression and anxiety, but little was actually known about its actual impact outside of anecdotal feedback. Our team set out to scientifically determine if the telepsychiatry model was as successful as had been touted in the media, and if so, exactly how effective was it?
Our peer-reviewed study in the Journal of Medical Internet Research, “Evaluating Clinical Outcomes in Patients Being Treated Exclusively via Telepsychiatry: Retrospective Data Analysis,” backed up claims about the effectiveness of value-based telepsychiatry. By showing that patients experienced robust and clinically significant improvement in depression and anxiety symptoms, the study demonstrated the potential to improve access to quality psychiatric care for the communities that need it.
The study evaluated 1,826 treatment-seeking patients located across the U.S. for clinically meaningful changes in one of two validated outcome measures of depression and anxiety: the Patient Health Questionnaire-8 (PHQ8) or the Generalized Anxiety Disorder Questionnaire-7 (GAD7). They were enrolled in commercially available health insurance.
All analyzed patients completed the GAD-7 and PHQ-8 before their first appointment and at least once after eight weeks of outpatient telepsychiatry treatment at Talkiatry. The providers were all psychiatrists, and treatment consisted of a comprehensive diagnostic evaluation, supportive psychotherapy and medication management.
Q. What were the results discovered in the study? How did telepsychiatry help?
A. After an average of five appointments over 15 weeks, our study showed that 67% of patients no longer had clinically significant anxiety symptoms, and 62% no longer had clinically significant depression symptoms. In addition, the data demonstrated that 26% of patients with anxiety and 29% with depression achieved clinical remission of symptoms.
On average, the study showed a seven-point reduction in severity scores based on the GAD7 and PHQ8 questionnaires. For reference, a five-point or 50% reduction is clinically significant. Treatment efficacy extended across geographical areas, as well: data between rural and urban patients was similar, highlighting telepsychiatry’s potential in overcoming treatment disparities that stem from where a patient lives.
These results cement the importance of building a trusting relationship between psychiatrists and patients in virtual care. A strong therapeutic alliance can absolutely be created virtually, and most critically, telepsychiatry helps patients who are feeling the serious effects of a mental health issue get better quickly.
By delivering positive outcomes while reducing the cost of care, this study demonstrates the efficacy of a value-based approach in telepsychiatry. It also shows that telepsychiatry can be a powerful alternative to intensive, expensive care options that lead to comparable results.
Q. How does telepsychiatry foster the right kinds of outcomes for success in value-based care?
A. Thirty percent of patients lack local access to mental health care. The issue is more pronounced within rural, low-income, and Black or brown communities. Additionally, the country continues to grapple with a mental healthcare provider shortage. In fact, more than half of counties in the U.S. lack even a single psychiatrist.
Fortunately, the rise of telehealth during the pandemic was a boon to patients who needed care. It especially benefited traditionally marginalized populations in medicine, including the LGBTQ community. It also opened new care possibilities to those who felt stigmatized by or reluctant to seek mental health services.
For many Americans, telehealth is also their only viable path to treatment. To ensure health equity with patients across geographies and populations, it’s very important that mental healthcare is covered by as many insurers as possible. It is imperative we continue to campaign for more and more insurers to cover behavioral healthcare.
These two elements in combination – expanding access and increasing insurance coverage – play a huge role in making our communities safer, and keeping our families and friends healthier. On the economic front, they also help drive down costs to providers and insurers because patients are receiving quality treatment before their mental health challenges force them to visit the emergency room. It’s a win-win for everybody.
Q. Where do you see telepsychiatry headed in 2024?
A. Since the pandemic forced providers to immediately switch to virtual appointments, most of the initial focus in telepsychiatry care centered on increasing access for those living in rural areas and underserved minority populations. While this has undeniably been a good development (and one that was long overdue), in many respects quality of care got pushed to the side.
This year, we’re going to see an industrywide push to ensure access is coupled with excellence using tools like measurement-based care, to the benefit of the patient.
I believe this will be the year that we see significant momentum in addressing the mental health clinician shortage, too. Finding new ways to encourage aspiring psychiatrists from all demographics to join the field is the best path forward to increasing equity, access and quality of care.
Right now, just 10.4% of psychiatry practitioners come from underrepresented groups, and providers of color make up a very small portion of the behavioral health provider workforce. Industry organizations and educational institutions will do their part to foster the next generation of psychiatrists and therapists.
While it will still be a few years before we see a big impact on the clinician shortage, we’ll look back at this year as the tipping point.
Finally, we’re approaching a year since the DEA released its ill-advised guidelines for prescribing controlled substances via telehealth appointment. After receiving more than 38,000 public comments, the DEA granted a year-long extension that allowed telehealth providers to continue offering controlled substances through telehealth.
While the extension is appreciated, there is more than enough information available now to enact a permanent policy that features responsible guardrails and also ensures patients receive access to safe, quality care. I believe implementing a special registration that does not create undue burdens on providers while requiring reasonable policies to maximize patient wellbeing is the best path forward.
This would streamline DEA registration and provide clarity to pharmacies on their roles and responsibilities when filling telemedicine prescriptions. Requiring regular virtual patient visits, only letting providers trained in prescribing controlled substances offer specific medications, and limiting the total number of controlled substance prescriptions, is beneficial for all: patients, providers and regulators.
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