HJNO Mar/Apr 2022

HEALTHCARE JOURNAL OF NEW ORLEANS  I  MAR / APR 2022 53 Jan Kasofsky, PhD Senior Vice President of Behavioral Health & Human Services Access Health Louisiana studies indicate strong support for tele- therapy and telepsychiatry. The agency for Healthcare Research and Quality reviewed 58 citations to identify telehealth interven- tions with positive outcomes. The most consistent benefit was reported when telehealth was used for communication and counseling, or remote monitoring in chronic conditions. They noted improved outcomes in measures of mortality and quality of life and reductions in hospital- izations. Limited evidence also supported the benefit of telehealth for integrating be- havioral healthcare with primary care. 1 In a recent study analyzing collabo- rative care, or how well the physical and virtual mental health providers worked together, it was found that there was good client engagement, good rapport, and it was mutually rewarding for the client and staff. This study also showed that the vir- tual platform could be used to accurately assess the client’s level of need for mental healthcare and thereby connect them to the appropriate level of care intensity; this approach supported a more efficient use of the psychiatrist’s limited time. 2 In an earlier study utilizing a virtual teletherapy/telepsychiatry platform in a rural clinic, it was found that integrat- ing a virtual collaborative mental health team yielded significantly and substan- tially greater treatment response rates, remission rates, reductions in depression severity, increases in mental health status and quality of life, better health outcomes, and that evidence-based approaches were implemented with higher fidelity to the treatment model by expanding access as needed to behavioral health specialists. 3 It is easy to see that demand for virtual and hybrid behavioral healthcare mod- els will continue to grow and precede the development and implementation of standardized quality measures. We can expect pre-appointment, virtual visits to be added to better determine and speed up access to the appropriate level of care; expanded provider use of wrap-around services across the delivery system due to more convenient and rapid access to their patients’ health data and to each other; hy- brid models dominating the market and virtual care surpassing in-person appoint- ments; and expanded on-line scheduling. While access and convenience are the main drivers for widespread acceptance of virtual mental healthcare for now, that may change once quality can be measured and in-person, verses virtual care, can be quantitatively compared. REFERENCES 1 Totten, A., PhD; Womack, D., MS, RN; Eden, K., PhD; McDonagh, M., PharmD; Griffin, J., MS; Grusing, S., BA; Hersh, W., MD. “Telehealth: Map- ping the Evidence for Patient Outcomes From Systematic Reviews.” Agency for Healthcare Re- search and Quality, U.S. Department of Health and Human Services. June 2016. NCBI Bookshelf, Report 16-EHC034-EF. 2 Howland, M. MD; Tennant, M., BA; Bowen, D., PhD; Bauer, A., MD, MS, FACLP; Fortney, J., PhD; Pyne, J., MD; Shore, J., MD, MPH; Cerimele, J., MD, MPH. “Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study.” The Journal of Rural Health, Oct. 6, 2020: 1-8. 3 Fortney, J., PhD; Pyne, J, MD; Mouden, S., MS, CRC; Mittal, D., MD; Hudson, T., PharmD; Schro- eder, G., PhD; Williams, D., PhD; Williams, D., PhD; Bynum, C., PhD; Mattox, R., MD; Rost, K., PhD. “Practice-Based Versus Telemedicine-Based Collaborative Care for Depression in Rural Fed- erally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Tri- al.” American Journal of Psychiatry 170, no. 4 (April 2013): 414-425. https://doi.org/10.1176/ appi.ajp.2012.12050696 sociated with travel for care, telecom- munications equipment, provider staffing, cost offsets to averted care, and more. 3. The experience domain focuses on the actual experience of the telehealth approach. It includes the usability and effect of telehealth on patients and the care team members and whether the use of telehealth resulted in the lev- el of care that patients and providers expected. It looks at whether the care delivered through telehealth is com- parable to the quality of an in-person appointment. 4. The fourth domain considers the clin- ical and operational effectiveness of the telehealth modality. This domain measures the comparative effective- ness of virtual services to those pro- vided in person. It includes the ability of the overall system to assist in the coordination, or integration, of care across various healthcare settings and to facilitate care and decision making. It measures the ability of the telehealth system to record and transmit images, data, and other in- formation accurately to patients and members of the care team, as well as the system’s ability to exchange infor- mation between stakeholders seam- lessly. Clearly, as the NQF’s recommended quality domains evolve into standardized measures for telemedicine and telethera- py, the answer to the quality question re- garding how well virtual care compares to in-person care will be better understood. But, while we wait for standardized measures to be adopted, several published