Abstract
Objective
The goal of this study was to assess the outcomes of a primary-based telepsychiatry
intervention program for older managed care enrollees with depression/anxiety and
with limited access to in-person psychiatric care.
Design
A pre-post design was used to examine service use (n = 218) and severity of depression
(n = 204). Enrollment, claims, and depression and anxiety score data were obtained
from the medical group. The implementation process and self-reported outcomes were
examined.
Setting and Participants
The program was funded by the Senior Care Action Network (SCAN) group and implemented
by a large medical group serving older adults who were identified as needing outpatient
psychiatric care, including those with psychiatric hospitalizations, depression/anxiety
disorders, comorbid substance use disorders, or other multiple comorbidities.
Methods
Poisson regressions were used to examine changes in predicted rates of outpatient
services, emergency department visits, and hospitalizations up to 24 months prior
and 24 months following the first telepsychiatry visit. Changes in predicted severity
of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry
visit were examined.
Results
The number of outpatient services declined significantly by 0.24 per patient per 6-month
time frame following the first telepsychiatry visit. The number of emergency department
visits and hospitalizations also declined after the first visit (0.07 and 0.03 per
patient per 6-month time frame, respectively). Depression severity scores also declined
in the quarters following the first visit (1.52). The medical group reported improvements
in both wait time for appointments and no-show rates with the integration of telepsychiatry
in primary care.
Conclusions and Implications
The telepsychiatry program lowered service use, depression severity, and increased
better access to psychiatry care. The findings highlight the potential benefits of
sustaining and expanding the telepsychiatry program by SCAN and other plans facing
a limited supply of psychiatrists.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Telepsychiatry and e-mental health services: potential for improving access to mental health care.Psychiatr Q. 2006; 77: 335-342
- Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries.Med Care. 2004; 42: 512-521
- The association of depression and anxiety with medical symptom burden in patients with chronic medical illness.Gen Hosp Psychiatry. 2007; 29: 147-155
- Remote telepsychiatry workforce: a solution to psychiatry's workforce issues.Curr Psychiatry Rep. 2020; 22: 8
- Telepsychiatry: promise, potential, and challenges.Indian J Psychiatry. 2013; 55: 3
- Telepsychiatry use in U.S. mental health facilities, 2010–2017.Psychiatr Serv. 2020; 71: 121-127
- Review of key telepsychiatry outcomes.World J Psychiatry. 2016; 6: 269
- Comparison of collaborative care and colocation treatment for patients with clinically significant depression symptoms in primary care.Psychiatr Serv. 2018; 69: 1184-1187
- Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies.Int Rev Psychiatry. 2018; 30: 292-309
- Comparison of teleintegrated care and telereferral care for treating complex psychiatric disorders in primary care: a pragmatic randomized comparative effectiveness trial.JAMA Psychiatry. 2021; 78: 1189-1199
- Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.JAMA Psychiatry. 2015; 72: 58-67
- Geriatric telepsychiatry: systematic review and policy considerations.Am J Geriatr Psychiatry. 2019; 27: 109-127
- Telehealth benefits offered by Medicare Advantage plans in 2020.Med Care. 2021; 59: 53-57
- Tech adoption climbs among older adults.Pew Research Center. Internet, Science & Tech, USA2017https://policycommons.net/artifacts/617864/tech-adoption-climbs-among-older-adults/1598740/Date accessed: November 8, 2022
- The demographics of device ownership, Pew Research Center 29: 2015.https://www.pewresearch.org/internet/2015/10/29/technology-device-ownership-2015/Date accessed: November 11, 2022
- Telehealth use in geriatrics care during the COVID-19 pandemic—a scoping review and evidence synthesis.Int J Environ Res Public Health. 2021; 18: 1755
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- Array behavioral care.
- A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097
- Chronic Conditions Data Warehouse.
- Figure 2. Mental Health Services Received in Past Year Among U.S. Adults with Any Mental Illness (2020). National Institute of Mental Health. Mental Health Information: Statistics Web site.https://www.nimh.nih.gov/health/statistics/mental-illnessDate: 2022Date accessed: September 28, 2022
- A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK.BMJ Open. 2015; 5: e007575
- Demographic and clinical predictors of high healthcare use in patients with inflammatory bowel disease.Inflamm Bowel Dis. 2016; 22: 1442-1449
- Self-management strategies and comorbidities in chronic disease patients: associations with quality of life and depression.Psychol Health Med. 2021; 26: 1031-1043
- Analyzing admission rates for multiple ambulatory care-sensitive conditions.Am J Manag Care. 2020; 26: e155-e161
- Adherence and healthcare utilization among older adults with COPD and depression.Respir Med. 2017; 129: 53-58
- Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR∗D report.Am J Psychiatry. 2008; 165: 342-351
- Alcohol use disorder and depressive disorders.Alcohol Res. 2019; 40: 3-10
- An evaluation of the clinical and economic burden among older adult Medicare-covered beneficiaries with treatment-resistant depression.Am J Geriatr Psychiatry. 2020; 28: 350-362
- Best practices in tele-teaming: managing virtual teams in the delivery of care in telepsychiatry.Curr Psychiatry Rep. 2019; 21: 1-8
- An update on telepsychiatry and how it can leverage collaborative, stepped, and integrated services to primary care.Psychosomatics. 2018; 59: 227-250
- Reducing the impacts of mental health stigma through integrated primary care: an examination of the evidence.J Clin Psychol Med Settings. 2021; 28: 679-693
- The effectiveness of collaborative care on depression outcomes for racial/ethnic minority populations in primary care: a systematic review.Psychosomatics. 2020; 61: 632-644
- Patient satisfaction with geriatric psychiatry services via video teleconference.Am J Geriatr Psychiatry. 2020; 28: 491-494
Article Info
Publication History
Published online: November 07, 2022
Accepted:
October 6,
2022
Received in revised form:
October 4,
2022
Received:
June 22,
2022
Publication stage
In Press Corrected ProofFootnotes
This work was supported by the Senior Care Action Network (SCAN) Health Group . The sponsor, SCAN Health Group, played a role in the conception and design of the evaluation and review and final approval of the paper, but did not play a role in subject recruitment, data collection, analysis, or preparation of the paper.
D.L., D.O., and R.B. are employees of SCAN Group but played no role in data collection or its analysis.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
