Telemental Health Tech Needs to Be Integrated with Care, Studies Find

Born as a way to provide psychiatric evaluations to NASA astronauts, telemedicine is touching down in rural communities and proving to be an important resource for mental health treatment.

Organizations such as the Veterans Affairs Department are implementing telemedicine to augment mental and behavioral healthcare for post-traumatic stress disorder and traumatic brain injuries, among other uses. Meanwhile, states are pushing forward regulations that expand the use of the technology and help to fill gaps as they experience shortages of mental health professionals.

But while telemedicine for mental health is improving and growing in some areas, the expansion is uneven across the country, according to a recent report in Health Affairs.

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Virtual Visits Are Growing, but Erratically

The study, looking to inform the expansion of virtual visit legislation, analyzed Medicare telemental health visits in rural areas between 2004 and 2014. It found that the number of telemental health visits grew 45.1 percent annually on average during that time. But there were also notable differences in care across states.

“We found that from 2004 to 2014, there was rapid growth nationwide in telemental health use among rural Medicare beneficiaries diagnosed with mental illness. However, the use of telemental health within this population varied dramatically across states and was highly concentrated in terms of both who received that care and who provided it,” authors, led by Harvard healthcare policy professor Ateev Mehrotra, wrote in the report.

Specifically, beneficiaries who received a telemental health visit were more likely to be younger than 65, be eligible for Medicare because of disability and live in a relatively poor community, the report notes. Regulations also seemed to make a difference: States with pro-mental health regulations or telemedicine laws reported “significantly higher rates of telemental health use than those that did not.”

When it came to those who provided the visits, a small pool of physicians seemed to be doing the heavy lifting, with just 100 clinicians providing half of the 87,000 telemental health visits in the 2014 sample, MobiHealthNews reports. 

Similarly, a new observational study published in the Journal of Medical Internet Research found similar gaps in delivery for older and rural populations. The study looked at virtual visits in British Columbia, which have been publicly funded since 2012. It recommended that careful attention be paid to how new technologies, such as teleconferencing, patient portals and electronic messaging, are integrated into healthcare delivery systems to ensure they aren’t growing erratically.

Regulations and Technology Should Be Expanded Carefully

The authors of the Health Affairs study recommended similar care in integrating the tech as regulations around the use of telemedicine expand.

“Any payment policy for a new medical technology must find a balance between encouraging high-value care (where patients benefit clinically) and not encouraging low-value care (where there is little or no clinical benefit),” the study says. “With telemedicine, concerns about encouraging low-value care might be particularly salient because of its convenience.”

Health IT leaders and regulators should also take pains to encourage the use of virtual visits for new patients, since it seems to be augmenting care more than expanding it.

The authors write in the study:

Telemental health has been promoted as a way to extend mental health specialist care to patients without access to such care in their community, but we found that a relatively small fraction (less than 15 percent) of rural telemental health recipients received mental health specialty care only via telemental health. Thus, telemental health appears to be complementing and supplementing in-person care. While this may improve the care these patients receive, telemental health use does not appear to be greatly expanding the number of rural beneficiaries who receive any mental health specialty care.