ABSTRACT
This study aimed to (a) describe the process of rapid uptake of telemental health in an outpatient mental health clinic for veterans and their family members during the coronavirus disease 2019 (COVID-19) pandemic and (b) present patient and provider attitudes about telemental health. Virtual visit (video and phone) trends for this clinic are described over the 8 weeks pre- and post-COVID-19 closure. As part of a quality improvement initiative over a subsequent 2-week period, 147 patient visits (127 unique individuals), and 24 mental health providers who were part of a multidisciplinary team were eligible to complete an anonymous self-report satisfaction survey immediately after a telehealth session. Prior to the COVID-19 closure, the clinic averaged 112.75 completed visits per week, with virtual visits accounting for less than 5% of all appointments. In the second month after closure, the clinic averaged 153.75 completed visits per week (36.36% increase in volume), with virtual visits accounting for 100% of visits (42% phone, 58% video). The proportion of video compared to telephone visits increased pre to postclosure. The no-show rate significantly decreased pre to postclosure (10.87% vs. 15.01%, resp., chi2 = 17.81, p < .001). Patient and provider satisfaction with telemental health were high. Prospectively, most patients (83.56%) expressed preference for televisits-only or televisits combined with in-person visits. Patients and providers were satisfied with telemental health. Convenience was an oft-cited advantage by both patients and providers. Telemental health may represent a cost-effective solution to mental health care access during and beyond COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement Rapid and wide-spread uptake of telemental health in an outpatient clinic serving veterans and military service members was feasible and deemed satisfactory to patients and providers. Telemental health was associated with lower no-show rates. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Coronavirus 2019 (COVID-19) has profoundly impacted the well-being of society and the practice of medicine across health care systems worldwide. As with many other subspecialties, the clinical paradigm in behavioral neurology and neuropsychiatry (BN-NP) was transformed abruptly, transitioning to real-time telemedicine for the assessment and management of the vast majorities of patient populations served by our subspecialty. In this commentary, we outline themes from the BN-NP perspective that reflect the emerging lessons we learned using telemedicine during the COVID-19 pandemic. Positive developments include the ability to extend consultations and management to patients in our high-demand field, maintenance of continuity of care, enhanced ecological validity, greater access to a variety of well-reimbursed telemedicine options (telephone and video) that help bridge the digital divide, and educational and research opportunities. Challenges include the need to adapt the mental state examination to the telemedicine environment, the ability to perform detailed motor neurologic examinations in patients where motor features are important diagnostic considerations, appreciating nonverbal cues, managing acute safety and behavioral concerns in less controlled environments, and navigating intervention-based (neuromodulation) clinics requiring in-person contact. We hope that our reflections help to catalyze discussions that should take place within the Society for Behavioral and Cognitive Neurology, the American Neuropsychiatric Association, and allied organizations regarding how to optimize real-time telemedicine practices for our subspecialty now and into the future.