Psychiatric Face-Time: Telehealth for Technology Driven Innovations in Geriatric Mental Health Care

Abstract

Introduction: Telepsychiatry, the provision of psychiatric care via live interactive video conferencing, has been demonstrated to be a cost-effective means of increasing access to mental health care. Its use has been studied across various patient populations and clinical settings to include older adults and those in long term care settings [1]. In 2003, there were approximately 2200 geriatric psychiatrists in the United States, barely half of the estimated number required to meet the mental healthcare needs of older adults [2]. Access to appropriate, specialized psychiatric care remains an unmet need for this underserved population. Here we describe a unique model of clinical service delivery developed to increase access to geriatric mental health care. The geriatric psychiatry telehealth service at the University of South Carolina School of Medicine represents a collaborative effort between academia and a rural senior care program. Academic geriatric psychiatrists provide clinical psychiatric consultative services via telehealth to participants of the Program of All-inclusive Care for the Elderly (PACE). PACE is a specialized program designed to provide coordinated medical care and ancillary clinical services to community dwelling older adults. Methods: We conducted a retrospective chart review on 34 PACE patients evaluated by telepsychiatry. Of these, 6 had incomplete data and were excluded from data analysis. Univariate analysis was conducted for demographic data, presence of medical co-morbidities, diagnosis, and types of treatment recommended. Chi square analysis was conducted to examine factors affecting no-show rates. Results: Results showed mean age of 75, with majority of patients being female and African American. A majority had at least 4 medical co-morbidities and were on 10 or more medications. Most were not hearing or visually impaired. More than 40% were referred for behavioral issues with almost 40% having a diagnosis of dementia at baseline and 70% with dementia diagnosis after initial telepsychiatry consultation. Sixty four percent of patients kept all appointments, and almost one third were seen three or more times. Patients who were referred for anxiety were more likely to miss appointments (p<0.05) than those referred for other reasons. Conclusions: This study demonstrates a unique collaborative effort between an academic telepsychiatry program and PACE. Telepsychiatry can be used to meet the mental health care needs of older adults, including those with cognitive impairment and significant medical co-morbidities. Patients referred for anxiety may be more likely to miss appointments. Determination of ways to minimize anxiety and prepare patients for the telepsychiatry encounter, as well as outcome studies are future areas of focus. 1. Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health 2013; 19(6): 444-54 2. Bartels SJ. Improving system of care for older adults with mental illness in the United States. Findings and recommendations for the President’s New Freedom Commission on Mental Health. Am J Geriatr Psychiatry. 2003 Sep-Oct;11(5):486-97.