The State and Sustainability of Telepsychiatry Programs

Abstract

Telepsychiatry, or the provision of psychiatric care across a distance using communication technologies, has become widespread and has been used successfully for treating a variety of mental illnesses. Little is known, however, about the sustainability of telepsychiatry programs and their long-term success. The goal of this study was to determine current trends in telepsychiatry by completing an extensive literature review, and to follow up with the authors of telepsychiatry research to examine the current status of their programs and success factors or barriers associated with their experiences. Results indicated that modern telepsychiatry programs often target veteran/military or child populations, and that many rely on either federal or internal funding. Interestingly, several researchers indicated that they wished to improve current funding mechanisms, while others wished for improvements in the technology used. Implications of these findings for behavioral health researchers are discussed, along with suggestions for improving future telepsychiatry programs.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…Physicians are highly influential in telepsychiatry, 7 and they decide about telemedicine use for more than 90% of patients. 3,35,101 This critical finding suggests that encouraging growth of telepsychiatry must start by first addressing clinician concerns, 35 which are further reviewed below (also see Table 2 102,103 ).…”

“…59 Research has been underfunded, such that projects are discontinued and findings go unpublished. 3,38 Ironically, poor research funding limits evidence to support telemedicine, the lack of which may be a reason organizations are reluctant to provide longterm funding for telemedicine. 25 More high-quality research and data are desired 105 about referring and consulting clinician satisfaction, the characteristics of the technology used, the cost (preferably through cost-benefit analyses), and longitudinal evaluation.…”

“…3,8,27,38,59,67,77,78,80,85,86,89,[115][116][117][118] Telepsychiatry has been largely supported by federal, internal, or grant funding, with relatively few programs with long-term commercial sustainability. 3,8,116,118 In one survey, nearly half of respondents indicated they did not provide telemedicine services because of lack of payment. 115 Billing clinicians reported lack of reimbursement and related problems including denials as well as previous authorization/case reviews required.…”

“…1 Two-thirds of primary care physicians in the United States reported that they could not access outpatient mental health services for their patients, 2 and nearly 50% of rural hospitals reported a mental health professional shortage. 3 Telepsychiatry (ie, 2-way video) provides access to psychiatric care, enhanced quality of care, and reduced health care costs. [4][5][6] An increasing body of literature reports effectiveness and outcomes equivalent to in-person care across a broad range of mental health disorders and patient populations.…”

Telepsychiatry intervention is better for ADHD symptoms than usual treatment augmented by telemedicine consultation

“…Even with such encouragement, however, the use of ‘virtual visits’ through video teleconferencing (VTC) remains relatively underutilised by providers and third-party payers 1. This study evaluated the impact of improving access to expert care for youth with ADHD in rural areas by utilising a ‘hub and spoke’ model to deliver mental healthcare from a central, urban academic ‘hub’ to distal ‘spokes’ through VTC technologies.…”