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Videophones and psychiatry.

Community-based case management is now the preferred treatment approach for those psychiatric patients who suffer from severe mental illness and live in the community.

Intensive case managers perform a variety of supporting roles that range from treatment coordination and adherence monitoring, to social support, to family and caretaker education. In addition, case managers are responsible for resource management and service use.

While this approach to treatment has been very successful in our hospital, we have identified several remaining barriers to treatment. Our catchment area is extensive, and case managers spend a considerable amount of time traveling to make home visits.

In addition to dealing with issues involving distance and traffic, our patient population has very high medical comorbidity. Often, these medically and mentally ill patients refuse to travel to their medical appointments. These challenges make for poor use of case managers' time and poor physician time allocation, and have a negative impact on the overall health outcomes of our patients.

As a way to overcome those barriers to treatment, we deployed several videophones that case managers carry while making their home visits. Videophones, a telehealth application, give them video access to the psychiatrist. They are uniquely tailored to this use because of their durability, portability, and ease of use (they weigh less than 1 pound).

For us, videophones have proved to be an invaluable tool. They further increase medical access at the earliest sign of decompensation or medication side effects, or when the case manager requires a medical opinion for any reason. Use of this application has led to fewer emergency department and walk-in visits, increased treatment adherence, and improved use of bed days of care.

This technology also has led to high patient satisfaction with overall services. Patients feel they are being treated with "modern technology." This technology gives family and caretakers access to the psychiatrist for routine questions and concerns about their loved ones' treatment, which in turn has led to high levels of satisfaction from family.

However, videophones share some of the challenges of telemedicine in general, such as reimbursement and liability. In addition, their image size and bandwidth can limit their use in evaluating movement disorders and subtle symptoms, such as affect. On the other hand, image size can be improved with peripheral attachments that are easy to obtain and use.

Videophones have the additional advantage of being affordable (approximately $500 a unit), compared with other telemedicine options. They can be used over "plain old telephone system" (POTS) lines, and their very simplicity of use can overcome some of the barriers to use found in higher band equipment such as ITV. These bigger and more sophisticated telemedicine options at times require technical support and deployment of upgraded communication lines, and have limited mobility.

Videophone technology is a reasonable adjunct to improve access to routine medical support for case managers who are making home visits. It also improves resource management and use, and is easily accepted by patients, their families, and medical staff.

DR. NIEVES is a psychiatrist at the Hampton Veterans Administration Medical Center in Hampton, Va., and is an assistant professor of psychiatry at Eastern Virginia Medical School in Norfolk.

BY J. EDWIN NIEVES, M.D.
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Title Annotation:treatment at doorstep
Author:Nieves, J. Edwin
Publication:Clinical Psychiatry News
Geographic Code:1U5VA
Date:Mar 1, 2006
Words:531
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