Building a virtual bridge: Island-based providers use telemedicine technology to connect patients with psychiatric services.Access to psychiatric care is problematic in many locations, particularly in rural and other geographically remote areas. Without access to specialists, psychiatrically ill residents either remain untreated or the responsibility for evaluating and treating them falls to primary care physicians (PCPs). While that may be fine for some patients with mild or recent-onset illness, PCPs are among the first to emphasize the need for patient access to psychiatric specialists when illnesses are chronic, recurring, severe, difficult to diagnose, or life threatening, or when patients fail to respond to typical first-line treatment A first-line treatment or first-line therapy is a medical therapy recommended for the initial treatment of a disease, sign or symptom, usually on the basis of empirical evidence for its efficacy. protocols. [ILLUSTRATION OMITTED] As is typical of many states, 30 of Washington's 39 counties are designated rural. Review of several health plans' databases shows that approximately 19 of these 30 rural counties do not have a participating psychiatric specialist. San Juan County San Juan County is the name of four counties in the United States:
In 2007 three organizations in San Juan County came together to address this problem: * Inter Island Medical Center (IIMC IIMC International Institute of Municipal Clerks IIMC Indian Institute of Management Calcutta IIMC Institute for Investment Management Consultants IIMC Inadvertent Instrument Meteorological Conditions (US Army) ) in Friday Harbor on San Juan Island San Juan Island is the second-largest and most populous of the San Juan Islands in northwestern Washington, United States. It has a land area of 142.59 km² (55.053 sq mi) and a population of 6,822 as of the 2000 census. serves the entire region's healthcare needs. IIMC is a primary care clinic and level V trauma center trauma center n. A medical facility that is designated to treat severe physical trauma as a result of the specialized training of its staff and the availability of appropriate diagnostic and treatment tools. . * Compass Health has a clinic providing mental health and chemical dependency chemical dependency n. A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine. chemical dependency services in Friday Harbor. Compass Health regularly has flown a psychiatrist to Friday Harbor, but time and travel costs make this option untenable. * San Juan County Health & Community Services in Friday Harbor provides a wide array of direct public health services health services Managed care The benefits covered under a health contract and referral to additional social services social services Noun, pl welfare services provided by local authorities or a state agency for people with particular social needs social services npl → servicios mpl sociales available in the community. This consortium received a three-year federal Rural Health Care Services Outreach Grant to address five primary goals to increase residents' access to psychiatric services. Goals Develop and implement a videoconferencing-based system of psychiatric care for San Juan County residents. Equipment needs were identified by reviewing the literature and consulting with Compass Health's technology support provider, Advances in Technology. AIT has developed, installed, and maintained telemedicine technology throughout the Pacific Northwest. AIT and TelePresence Meaning "long distance presence," it refers to videoconferencing applications that feel like a live meeting. Notable features are larger screens that may approach a virtual reality environment and sensors that keep at least one window focused on whomever is speaking at the moment. Tech (TPT TPT Transport TPT Trumpet (music scores) TPT The Physics Teacher TPT Tara Palmer-Tomkinson (UK celebrity) TPT Trailer Park Trash TPT Temporary Part Time TPT Thermodynamic Perturbation Theory ) created "3D Telepresence," which allows both parties to have an experience much like a face-to-face encounter (For more about the technology, visit www.advancesintech.com/solutions/telepresence.html). Increase access and ensure sustainability by working with all health plans to make telepsychiatry a covered and reimbursable re·im·burse tr.v. re·im·bursed, re·im·burs·ing, re·im·burs·es 1. To repay (money spent); refund. 2. To pay back or compensate (another party) for money spent or losses incurred. benefit. The project has meaningful value only if the services become self-sustaining. A substantial body of literature demonstrates telepsychiatry's efficacy, feasibility, efficiency, and acceptability. A major objective of this project is to have health plans pay for the service. Provide and evaluate telepsychiatric services to 125 (estimated prevalence of need) San Juan County residents. All participants (patients and their families; IIMC physicians, nurses, and support personnel; and Compass Health's sup-port staff and psychiatrist) were actively involved in the practice protocols' design so they would be clear and comfortable in their respective roles and responsibilities. The general principles underlying this process are below: * All San Juan County residents are eligible to receive telepsychiatry services, as clinically appropriate. * Prospective participants either are or will become IIMC patients. * A PCP PCP abbr. 1. phencyclidine 2. primary care physician Pneumocystis carinii pneumonia (PCP) evaluates prospective participants to determine their "medical necessity" of being referred to the project. * When medically appropriate, a telepsychiatry appointment is scheduled with Compass Health's psychiatrist. * An IIMC care coordinator orients patients to the telepsychiatry process and supports them throughout treatment. * The PCP makes all necessary medical information available to the psychiatrist. * Upon completion of treatment, the psychiatrist makes the findings/recommendations available to the PCP. * IIMC arranges appropriate patient disposition and follow-up. Evaluate the community's perception of mental health issues and using telepsychiatry to address them. It is generally acknowledged that telepsychiatry services are well-received and accepted by participants. Promoting telepsychiatry throughout the community should help reduce stigma by showing that behavioral health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or problems can be treated successfully. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] Evaluate the medical cost-offset of telepsychiatry services. A substantial body of literature shows that when previously unavailable mental health services are provided, overall healthcare expenditures are reduced--even when factoring in the cost of newly available psychiatric services. Yet studies have not examined whether this cost-offset, prevalent in studies of in-person psychiatric care, holds for videoconferencing A real time video session between two or more users or between two or more locations. Although the first videoconferencing was done with traditional analog TV and satellites, inhouse room systems became popular in the early 1980s after Compression Labs pioneered digitized video systems services. The literature does indicate that telepsychiatry services are equal to in-person services in efficacy and satisfaction, so the cost-offset may hold for telepsychiatry as well. Experience so far Approximately eight months after the project's launch, we began providing telepsychiatric services and collecting data to evaluate them. As of this writing, 32 patients have been referred for treatment. Seven have completed treatment and have been referred back to their PCP for follow-up. All patients have reported I being extremely satisfied with their experience primarily because they do not have to leave the island for treatment. Additionally, patients have said that telepsychiatry is "just as good" as face-to-face encounters. They have appreciated having the case coordinator available to assist and sup-port them. Compass Health's psychiatrist, Dr. Mike Shen Shen, in the Bible, place, perhaps close to Bethel, near which Samuel set up the stone Ebenezer. , says, "They're surprised at first at how much it feels like a physically present interview," adding, "Some even seem more able to open up, perhaps because the social distance of the telepresence unit is less intimidating in·tim·i·date tr.v. in·tim·i·dat·ed, in·tim·i·dat·ing, in·tim·i·dates 1. To make timid; fill with fear. 2. To coerce or inhibit by or as if by threats. than being physically in the room." BY Jess C. Jamieson, PHD, and Tom Sebastian, MS, MPA MPA medroxyprogesterone acetate. For more information, e-mail jess.jamieson@advancesintech.com. More Online For details about a telepsychiatry project in Ohio, visit www.behavioral.net/williams0407; in Wyoming, visit www.behavioral.net/gantenbein0408. |
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