There was a 50% increase in overall telehealth visits during the first 3 months of 2020, according to data from the Centers for Disease Control and Prevention.

CDC. Trends in the use of telehealth during the emergence of the COVID-19 pandemic — United States, January–March 2020. Morbidity and Mortality Weekly Report. 69(43);1595–1599.

Since then, the use of telepsychiatry to address urgent mental health concerns has also accelerated, largely due to the COVID-19 pandemic.

 

Research indicates that patients who access telepsychiatry services have fewer inpatient admissions, reduced length of stay when admitted to acute care facilities, lower costs, and improved satisfaction with their care.

Gude J, Subhedar RV, Zhang MH, et al. Emerging needs and viability of telepsychiatry during and post COVID-19 era: a literature review. Cureus. 2021;13(8): e16974.

 

While the telehealth trend has expanded access to mental health care for many, there are still related concerns and challenges regarding patient privacy and quality of care.

Greenhalgh T, Wherton J. Telepsychiatry: learning from the pandemic. British J Psych. 2022;220:257–261.

 

 

Rural vs urban telehealth use

However, certain demographics utilize this approach to healthcare more than others.

In addition to disparities among age, racial, educational, and socioeconomic groups, physicians and patients in urban areas have adopted this new communication method in higher proportions compared to their rural neighbors.

A 2020 CDC survey indicated that urban health centers are much more likely to offer telehealth services compared with those in rural areas; the data showed that 29.9% of rural clinics completed more than 30% of doctor appointments using telehealth technology.

Telehealth use in rural healthcare. Rural Health Information Hub. Updated July 1, 2021.

Additionally, some hospitals in rural areas only offered telehealth for certain specialties such as radiology, emergency medicine, and trauma healthcare.

 

When telehealth services are not available, including those for mental healthcare, patients face increased travel time and expenses, higher medical costs, and reduced access to care.

Butzner M, Cuffee Y. Telehealth interventions and outcomes across rural communities in the united states: narrative review. J Med Internet Res. 2021;23(8):e29575.

 

 

Clinicians’ response to telepsychiatry

Depending on state licensure requirements, different clinician levels may offer telepsychiatry services to patients. In some cases, physician’s assistants and nurse practitioners can deliver mental health services via telehealth. Additionally, physicians may provide services across state lines according to various interstate licensure compacts.

However, some clinicians report issues with healthcare delivery using telehealth. According to a 2021 study, these issues include:

Natafgi N, Childers C, Pollak A, et al. Beam me out: review of emergency department telepsychiatry and lessons learned during Covid-19. Curr Psychiatry Rep. 2021;23(11):72.

 

• Concerns regarding productivity and payment

• Difficulty reading the patient’s nonverbal cues

• Increased burden placed on other healthcare staff

• Difficulty establishing and building rapport with the patient

• Troubleshooting equipment issues

Despite these issues, the study suggests that most psychiatrists are still comfortable with providing services using telehealth technology.

 

Areas for improvement

Research has shown that logistical issues (such as limited access to the technologies needed to conduct telehealth, and users’ technological limitations) can prevent patients from accessing these services. While physicians are not at fault for this, creating a better broadband infrastructure is essential for providing telehealth services to those in more isolated areas.

Educational standards may also need an overhaul in the era of telepsychiatry. According to an article published by Healthcare IT News, doctors observe and direct medical students as they learn to perform physical assessments.

Jercich K. Telehealth seems here to stay – so how can it be improved? Healthcare IT News. August 5, 2020.

 

But due to the nature of telepsychiatry, the usual methods of assessing a patient may not be feasible. Therefore, medical students and practicing physicians must receive training through virtual examinations and the use of advanced healthcare technology.

 

Financial concerns

Finally, many physicians remain concerned about reimbursement when using telehealth. Several temporary policy changes are already in place federally, but those pertaining to physician payment remain disputed.

Some do not believe the fee-for-service payment model is designed to benefit physicians using telehealth; additionally, while payment reforms now help doctors offering telehealth, there’s no clear indication of how long those reforms will actually stay in place.

“One of the things [to think about] for us is what the future holds about Medicare and Medicaid—and private insurance—and what they’re going to cover,” family medicine specialist Conrad Flick, MD, said in the Heathcare IT News article. “The regulatory, legal side—I think it’s just a matter of getting reasonable pay for these services."

Cost parity would be nice.