Improvement of postinpatient psychiatric follow-up for veterans using telehealth

Abstract

Purpose To describe the implementation and initial outcomes of a pilot interdisciplinary telehealth clinic, Allied Transitional Telehealth Encounters post-iNpatient Discharge (ATTEND), providing clinical pharmacy specialist follow-up for veterans transitioning from inpatient to outpatient mental healthcare in a Department of Veterans Affairs (DVA) hospital. Summary The ATTEND clinic’s primary intervention was providing medication management appointments through clinical video telehealth (CVT) to patient discharge locations through a DVA-provided tablet. An interdisciplinary team supported care through on-unit inpatient training, secure messaging, and self-help applications. Clinical outcomes were measured through readmission rates, wait times, self-report measures, and follow-up interview at the completion of ATTEND services. Twenty patients completed on-unit training, and 16 unique patients were seen for at least 1 outpatient appointment. Inpatient readmission rates were lower for ATTEND patients than with standard care (5% versus 19%, respectively). Wait times until first postdischarge mental health appointment were reduced by a mean of 18.6 (S.D., 8.8) days. The pharmacist made medication interventions, including dosing changes, education on incorrect administration, and medication discontinuation. Self-reported psychological symptoms decreased during ATTEND participation. Post-ATTEND interviews indicated high levels of acceptance and interest in continued tablet-based care. Primary challenges included unique technological limitations and effective care coordination. Conclusion The ATTEND telehealth clinic provided postinpatient mental health follow-up that was more prompt and convenient than conventional on-site appointments. Psychiatric self-report improved during ATTEND-facilitated transition to outpatient care, and the recidivism rate for ATTEND patients was lower than the general inpatient rate during the same time period.

Pharmacist-led telemental health transitions of care clinic improves antidepressant medication continuity posthospitalization

“…Rehospitalization rates and time to first MH postdischarge appointment were improved. While Brearly et al 7 provided weekly interventions until the patient established care with outpatient mental health services, the practice described here demonstrates that a pharmacist-led TOC service providing a brief, one-time intervention focused on medication adherence may also improve psychiatric postdischarge outcomes. The limited time and provider resources required for the one-time intervention makes this practice feasible to replicate.…”

“…Furthermore, it is among the first to combine the two modalities within the mental health population. Brearly et al 7 described implementation of a pilot telehealth clinic in which a psychiatric pharmacist provided medication management services following psychiatric hospitalization as part of a multidisciplinary team including a clinical psychologist, registered nurse, and psychology technician. Rehospitalization rates and time to first MH postdischarge appointment were improved.…”

“…Previous efforts to improve the transition from inpatient to outpatient medication management have been described. [3][4][5][6][7][8][9] To minimize travel burden, which is a frequent barrier to care, telehealth is becoming increasingly popular and can improve attendance at post-discharge appointments. 7 Strategies by pharmacists to improve outcomes after hospitalization have included more comprehensive discharge counseling, improving commu-Q 2020 CPNP.…”

Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness

“…Studies have shown that video telehealth can offer effective delivery of mental healthcare, [3][4][5] primary care, 6,7 and specialty ambulatory care. 8 -10 Patient populations who face sociodemographic and clinical challenges (e.g., travel distance to care for rural patients) can benefit from video telehealth.…”

Telehealth in Response to the COVID‐19 Pandemic in Rural Veteran and Military Beneficiaries

“…These technologies (also referred to as “mHealth”) involve synchronous or asynchronous communications with a clinician and/or interactions (often algorithm‐driven) that include text, video, and interactive/gamified information that trains and reinforces adaptive psychological functioning 35 . Examples beyond videoconference include virtual reality‐based exposure, ecological momentary assessment (symptom monitoring through smartphone‐based data collection), computer/smartphone‐facilitated coping‐skill training/support (VA Web interventions; Breathe2Relax), and text‐based chat with either a computer or a clinician 41 . These approaches, which address treatment barriers including availability, accessibility, and affordability of services, 42 have demonstrated clinical efficacy 43‐45 and provide options for easily accessible, evidence‐based interventions that can supplement in‐person visits or provide options for those who would otherwise not be able to access medical or psychological care.…”