Study: Telemental healthcare associated with increased outpatient contact, hospitalization follow-ups

The use of telehealth to provide services for patients with severe mental illness (SMI) shows promise, but does not necessarily improve rates of intake for medication. It remains unclear whether an expansion of these services would improve quality of care.

These were among the results of a cohort study published in JAMA Network Open on June 27 that included 118,670 patients with schizophrenia or related psychotic disorders, and/or bipolar I disorder in non-metropolitan counties.

The study found the use of telehealth services improved the rates of patient follow-up with healthcare professionals after hospitalization, along with a “modest increase” in contact with outpatient specialty mental healthcare professionals.

“However, no substantive changes in medication adherence were noted and an increase in hospitalizations was observed,” the report noted.

The increase in hospitalizations does not necessarily mean that the use of the telehealth resulted in poorer care, and ending with a hospital visit, the report cautioned, but rather the use of telehealth allowed healthcare professionals to correctly identify and stabilize patients having an acute crisis.

WHY THIS MATTERS

As care delivery becomes more distributed, patients have more options to seek care outside of traditional health systems.

However, this access to multiple care channels has created a new problem: the virtual fragmentation of healthcare. Community health centers have turned to telehealth to improve their services.

While use of telehealth or telemedicine technologies has been rapidly evolving, given a push forward due to the pandemic, research is limited concerning the deployment of specialty mental healthcare and medication adherence through telehealth technology.

In rural areas, access to specialty care remains a challenge for patients with serious mental disorders, the report noted. There is currently an active debate in many states regarding whether to extend pandemic-related temporary expansions of telemedicine for mental illness care.

Other digital services, including the use of tablets, have helped bring mental health programs to patients in rural areas.

According to another study published in JAMA Network Open, providing a video-enabled tablet to veterans living in rural areas decreased emergency department visits and suicidal behaviors.

THE LARGER TREND

Research compiled in 2018 had previously described the feasibility of applying telemedicine in the treatment of schizophrenia and psychotic disorders.

According to Trilliant Health’s trends analysis, which focused on U.S. telehealth use between March 2020 and November 2021, about a quarter of Americans used telehealth during COVID-19.

However, other researchers have found therapists engaging with a higher percentage of clients from lower socioeconomic status groups, patients on Medicaid and families were less likely to keep using telehealth after the pandemic.

Use of telehealth for behavioral health is also on the rise, according to the report. However, new digital health tools provided by retailers, including Amazon and Walmart, as well as device offerings from Apple, Google and a slew of startups could lead to more sophisticated and efficacious telehealth offers across a broad spectrum of care.