What is telemedicine psychiatry?

Telemedicine across the state of Florida and America has exploded due to the general concern for face-to-face consults. This past year, technology has been essential in keeping our relationships alive. Everything from weddings, birthday parties, to business meetings transitioned to Zoom or other video meeting platforms. We kept up with friends and acquaintances who we could not see in person with social media updates, FaceTime, and group text messages. Now, as we begin to return to a more normal life pre-pandemic with the advancement of vaccine distribution, technology-mediated communication is here to stay. Although offices are beginning to reopen, there are areas in which there are no option for a patient to find a psychiatrist near their local residence. Furthermore many workplaces are opting to provide virtual appointments for psychiatry services, telemedicine is the wave of the future – at least for mental health and psychiatry.

How does telemedicine work?

Telemedicine is the use of technology in place of a face-to-face visit with your provider. Telemedicine services have grown in increased popularity due to ease of use and increased accessibility of both clients and providers who may not have had access previously and in our case can provide telemedicine across the state of Florida. COVID-19 has certainly expanded the demand for virtual care for obvious reasons and now that it has been properly introduced, we don’t see it going anywhere anytime soon. (Nadkarni et al., 2020). Of course, telemedicine services are more practical for certain specialties over others, for example, telemedicine in psychiatry and mental health. As long as the client is maintaining their health with a primary care provider, psychiatry does not often require use of in-person visits unless the provider deems a physical assessment necessary. Certain medications requiring lab draws can be done at independent labs if necessary. Not to mention telemedicine services aid in the severe shortage in mental health providers. Psychiatrists are in limited supply especially in smaller cities, with the integration of telemedicine patients can be seen from any location as long as the prescriber is licensed by the state they are seeing clients in.

How would I get my prescriptions?

Instead of seeing a psychiatrist near you, Electronic prescribing allows prescriptions to be sent to any pharmacy which accepts electronic prescriptions anywhere able to conduct telemedicine across the state of Florida. Most commercial pharmacies have adopted this technology and capable of receiving the order electronically.

What examples are there of the increased use of telemedicine during the pandemic in rural areas?

Telehealth has been a concept first experimented and launched 1960 by NASA and the Nebraska Psychology Institute (LeRouge, & Garfield, 2013). However, there were significant barriers associated with the implementation of widespread use; lack of equipment, HIPAA regulations, access to broadband internet, financials, limitations imposed by regulatory agencies, and insurance reimbursement has impeded the growth of telehealth. In 2010 Obama imposed the plan of Connecting America which involved the evolution of technical advances in healthcare, including use of telemedicine to promote access to care in areas which may not have access to healthcare or specialists (LeRouge, & Garfield, 2013). During the emerging cases of Covid-19 many regulations on insurance reimbursement and DEA restrictions had lessened. These more flexible regulations enabled practices to go virtual while still getting reimbursed at face-to-face rates by insurance companies. Psychiatry has been widely adopted as a virtual platform due to the limited need for physical assessments in order to conduct an evaluation. Telemedicine advancements in psychiatry has enabled access to patients to receive treatment on a more widespread scale. Telemedicine in other specialties such as primary care, urgent care, or specialist visits are more likely to require patients undergo further testing to determine the best treatment approach.

Why is telemedicine increasing in rural areas?

As the use of internet grows, so can telemedicine, rural areas are advancing at varying paces with greater access to broadband internet, enabling the ability to scale care. Additionally, local specialists such as psychiatrists in remote areas are often in high demand, booked out weeks in advance, at times unable to accommodate a growing caseload and stops seeing new patients all together. If immediate attention is needed for an emergency such as severe depression there may be a forced hospitalization for safety due to lack of access to care. Over time, excessive hospitalizations further drive up the cost of healthcare over time (Chen, 2018). Instead of this vicious cycle of wasted resources, psychiatry can be more readily and easily delivered by telemedicine across the state of Florida. Prevention is in fact one of the key components to a well-developed healthcare delivery and medication adherence is highly recommended in psychiatry. Areas in which resources are lacking, telehealth offers an alternative to untreated patients.

Can telehealth truly replace in-person doctors?

Telemedicine in psychiatry can have its limitations, especially in more complex conditions (Costa et al., 2021). It also requires the client to maintain accountability and communicate their needs for mental health treatment. There are limitations on the provider as well, instead of having a psychiatrist near you, they may miss certain behaviors or cues on a virtual platform. Key information such as vital signs and laboratory tests are not as widely utilized as when the patient is in the office. The provider may opt to only treat certain conditions via a telehealth platform in order to lessen risk or potential for error. When referring to psychiatry specifically, many high functioning clients can benefit tremendously from the ease of use and availability of a virtual provider.

What can be done to increase access to telemedicine psychiatry in rural areas?

Instead of seeing a psychiatrist near you, ensuring access to equipment and resources that are required to enable telemedicine across the state of Florida. Increase education on the availability of the platforms for those who may not be familiar with or may need more education on the notion of seeing a virtual provider. Instilling the idea that the advancements in telemedicine are here to stay, and with a healthcare system already under strain it is of the utmost importance to ensure good physical and emotional health. LeRouge, C., & Garfield, M. (2013). Crossing the Telemedicine Chasm: Have the U.S. Barriers to Widespread Adoption of Telemedicine Been Significantly Reduced? International Journal of Environmental Research and Public Health, 10(12), 6472–6484 Nadkarni, A., Hasler, V., AhnAllen, C. G., Amonoo, H. L., Green, D. W., Levy-Carrick, N. C., & Mittal, L. (2020). Telehealth During COVID-19-Does Everyone Have Equal Access? American Journal of Psychiatry, 177(11), 1093–1094. https://doi.org/10.1176/appi.ajp.2020.20060867 Chen, J., Bloodworth, R., Novak, P., Cook, B. L., Goldman, H. H., Rendall, M. S., Thomas, S. B., & Reynolds, C. F., 3rd (2018). Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities. American journal of preventive medicine, 54(1), 103–112. https://doi.org/10.1016/j.amepre.2017.10.011 Costa, M., Reis, G., Pavlo, A., Bellamy, C., Ponte, K., & Davidson, L. (2021). Tele-Mental Health Utilization Among People with Mental Illness to Access Care During the COVID-19 Pandemic. Community Mental Health Journal, 57(4), 720–726. https://doi.org/10.1007/s10597-021-00789-7