Telehealth Resource Center

Telehealth Resource Center

Perspective from Erin W. DeLaney, MD
Disclosures: The authors report no relevant financial disclosures.
October 15, 2020
5 min read

Physicians leverage telehealth as a learning tool in mental health care

Perspective from Erin W. DeLaney, MD
Disclosures: The authors report no relevant financial disclosures.
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Family medicine residents sharpened their skills in behavioral health care by working with other medical professionals via telehealth, researchers wrote.

Additionally, findings from a second paper supported the use of telehealth as a training tool to improve mental health care in rural primary care settings.

Alexander Kowalski, DO, medical director at Rowan Family Medicine in New Jersey, told Healio Primary Care that family medicine residents and patients at his institution have “benefited greatly from the input of a behavioral health professional” during the past 5 years.

“The challenge was creating a way to do this via telemedicine, which was new to our practice and program,” he said.

The solution, Kowalski and colleagues wrote in Annals of Family Medicine, includes the following:

  • The resident, without other health care professionals’ help, conducts a full evaluation of the patient via telehealth.
  • The resident creates a virtual room by conferencing in a family medicine attending physician, who provides guidance on medication management. A clinical psychologist offers recommendations on behavioral interventions. Both nonresidents also discuss psychosocial stressors.
  • Other faculty members enter the virtual room to help the resident implement the patient’s management plan and, if needed, assess the patient further.
  • After the visit’s conclusion, the resident, attending physician and psychologist discuss the patient encounter and the resident’s comfort in managing complex situations.

“The biggest barrier was navigating technology issues and was solved with a simple solution of utilizing the conference call feature of personal cell phones to connect and discuss cases in real-time,” Kowalski said, adding that the model could easily work in rural areas.

Across the country in rural Washington, Morhaf Al Achkar, MD, PhD, a family physician in the department of family medicine at the University of Washington, and colleagues investigated the feasibility of a collaborative care model that included regular systematic case reviews by a consulting psychiatrist that were conducted remotely, and whether this strategy could eventually improve the skill sets of primary care providers in managing the mental health care of their patients.

“An important principle of traditional specialty consultation is to disseminate authoritative clinical knowledge to the referring clinician and medical community,” they wrote. “We hypothesized that over time, the collaborative care model serves as a training and workforce development strategy, a potentially important benefit.”

Given the shortage of rural primary care personnel with expertise in team care for patients with common mental health disorders, the researchers said “building the workforce for this population is a national priority.”

Achkar and colleagues interviewed 17 employees — nine case managers, four primary care physicians, three consulting psychiatrists and one medical assistant — who participated in webinars and learned the collaborative care model via the Advancing Integration Mental Health Solutions (AIMS) Center of the University of Washington approximately 2 years before being interviewed.

Based on the interviews:

  • PCPs became more capable of diagnosing mental illnesses, engaging with patients and developing treatment plans.
  • Psychiatrists embraced their role as teachers and became less condescending to PCPs.
  • Medical assistants learned to screen for mental illness and talk to affected patients.
  • Receptionists and billers became more proficient in their respective duties.

“Participants’ feedback supported the view that telepsychiatric case review-based consultation enhanced skills of diverse clinical team members over time,” Achkar and colleagues added.