Models of Telemental Health

Models of Telemental Health

Telemental health services are delivered in a range of settings to patients with varying degrees of mental illness. Whether it be hospitals, assisted living homes, primary care physician offices or even patient homes, telemental health services can be integrated into most, if not all, clinical practice systems. Aside from clinical settings, patients can access care right from their homes with direct to consumer platforms that function as virtual provider offices. 

The following is a description of two types of telemental healthcare: the clinic-clinic model and the clinic-home model.

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An Epidemic of Patient Non-Compliance

Since the early '90's it's been thought that a majority of patients who are prescribed antidepressant medications fail to take them as directed. HEDIS data from that time suggested that only about 48% of patients prescribed medication were still taking it at six weeks, and only about 21% were still taking it at 12 weeks.

There is a widely held belief that there is better compliance with selective serotonin reuptake inhibitors (SSRIs) as compared with tricyclic antidepressants because of their faster onset of therapeutic action, greater efficacy, and better tolerance. To test that theory, researchers conducted a multi-center, randomized, parallel-group, open-label comparison of dothiepin (a Tricyclic) and fluoxetine (a SSRI) and compared compliance across the two groups.

As shown in the table below, seventy six percent of the fluoxetine patients (N=58) and 64% of dothiepin patients (N=49) were compliant with treatment at or above the 80% level over the 12-week study - a significantly greater degree of compliance for the SSRI group. These data represent a more precise estimate of compliance than do HEDIS data. They are suggestive of an overall higher level of antidepressant medication adherence than previously thought, with a compliance advantage for the SSRI's. 

However, to my eye, the more interesting aspect of this study is the finding that between one-quarter and one-third of patients who were prescribed antidepressant medication stop taking it during the first three months of treatment.

As Yogi Berra famously said, "If people are determined to stay away from the ballpark, you just can't make them." Twelve weeks or fewer is too short a time frame to treat depression effectively and prevent its recurrence.

Data such as these are particularly disappointing since it is well established that more than 80% of patients with depression can be treated effectively when there is treatment adherence.  Over 70% of prescriptions of antidepressant medications in the U.S. are written by primary care practitioners. And when treatment is consistent with best practice guidelines, that is good all the way around.

However, for the one-quarter to one-third of patients who don't comply with treatment recommendations, or for those patients who don't show a significant treatment response within six weeks, referral to a 1DocWay psychiatrist or psychologist can be essential to engaging patient compliance or modifying treatment strategy.

Contact us to learn more about how 1DocWay telepsychiatry and telepsychology can help improve patient compliance.

How Do I Know if Telemedicine is Right For Us?

Over the past few months of talking with different organizations about the ways that 1DocWay helps hospitals, nursing facilities, and clinics, I’ve heard different variations of the same concern: is telemedicine right for us?

Some people think their facility might be too small to benefit from telemedicine, or their organization doesn’t have the technical expertise to adapt to a telemedicine system. There are concerns about managing the security and compliance needs in an organization that already has constraints on IT personnel and resources.

These are smart questions and in any business decision it’s important to assess the risks of moving forward.

In the last 24 months 1DocWay has helped over 50 facilities adopt telepsychiatry and every day more FCHQs, primary care clinics, and nursing homes are choosing telepsychiatry. When deciding whether telemedicine is right for your organization, consider some of these facts:

  • Most facilities adopting telepsychiatry have no IT department at all or up to one person managing all of IT for that facility.
  • Over 90% of the facilities that we work with are able to get telemedicine up and running with less than 5 hours of investment needed for technical set up and training.
  • Over 90% of the facilities that we work with don’t require any new purchases of hardware or software; they’re able to leverage existing technology as long as it was purchased within the last 3 years.

If you’re still not sure if telemedicine is right for your organization, reach out for a free consultation. We can talk about what the risks may be for your specific facility to move forward. Then, let’s review what the risks are of not moving forward!