Globally, most care delivered is virtual. Health systems have pivoted to providing consultations via phone or video visits. Some might argue a decade of adoption in regular times occurred in weeks during COVID-19. It is also likely that high rates of telehealth are here to stay as people are experiencing the value of talking to their doctors from home. It isn’t a panacea for all visit types, but telepsychiatry is also experiencing this pivot.
A new viewpoint in JAMA Psychiatry by Jay Shore and colleagues from the University of Colorado addresses current trends and future directions in telepsychiatry and virtual care. Historically, telepsychiatry has been highly leveraged as part of a temporary disaster response where support is needed in localized geographies to support the needs of local populations, like a natural disaster or a school shooting.
The use of telepsychiatry in COVID-19 has seen seismic shifts in care delivery; many of these shifts will remain when we get to the other side of this virus. Health systems raced to virtualize care and mobilize the necessary IT infrastructures to support safe care delivery at scale. Many settings were already working in this manner; for example, Employee Assistance Programs (EAP) have operated virtually but have not been fully utilized.
The lifting of federal and regulatory rules has largely aided the current shift toward telepsychiatry. Rules regarding reimbursement were also relaxed to allow for more flexibility in how care is delivered. Many States also relaxed licensure laws to enable psychiatrists to support patients in more states than their current license supported; this allowed a broader pool of doctors to practice and support patient needs.
Few would argue that these changes have transformed psychiatry, and while planning may be underway to allow for face-to-face care again in the latter part of 2020, what have we learned? What changes should remain as a standard of care and not a temporary solution to address a pandemic? What have we learned about creating and holding a therapeutic alliance with patients via technology? These changes have impacted both provider and patient. What adaptations have both parties made that can be carried forward at scale into the future? Is there a new fulcrum for virtual vs. face-to-face care?
One unknown is whether the changes in regulations, reimbursement, and licensure will revert after COVID; hopefully, the gains made in providing care in new ways will be weighed against any changes to prior states. Patient care is the priority. As stated earlier, the pace of change in psychiatry has been significant. It has brought us to new norms and a unique balance between technology as a support to developing a healing plan of care for patients.
Thanks for reading – Trina
(Opinions are my own)
Shore JH, Schneck CD, Mishkind MC. Telepsychiatry and the Coronavirus Disease 2019 Pandemic—Current and Future Outcomes of the Rapid Virtualization of Psychiatric Care. JAMA Psychiatry. Published online May 11, 2020. doi:10.1001/jamapsychiatry.2020.1643