Health Care Providers' Perceptions of Quality, Acceptance, and Satisfaction With Telebehavioral Health Services During the COVID-19 Pandemic: Survey-Based Study.

BACKGROUND: Due to rapidly increasing rates of COVID-19 across the country, system-wide changes were needed to protect the health and safety of health care providers and consumers alike. Technology-based care has received buy-in from all participants, and the need for technological assistance has been prioritized. OBJECTIVE: The objective of this study was to determine the initial perceptions and experiences of interprofessional behavioral health providers about shifting from traditional face-to-face care to virtual technologies (telephonic and televideo) during the COVID-19 pandemic. METHODS: A survey-based study was performed at a large, integrated medical health care system in West-Central Florida that rapidly implemented primary care provision via telephone and televideo as of March 18, 2020. A 23-item anonymous survey based on a 7-point Likert scale was developed to determine health care providers' perceptions about telephonic and televideo care. The survey took 10 minutes to complete and was administered to 280 professionals between April 27 and May 11, 2020. RESULTS: In all, 170 respondents completed the survey in entirety, among which 78.8% (134/170) of the respondents were female and primarily aged 36-55 years (89/170, 52.4%). A majority of the respondents were outpatient-based providers (159/170, 93.5%), including psychiatrists, therapists, counselors, and advanced practice nurses. Most of them (144/170, 84.7%) had used televideo for less than 1 year; they felt comfortable and satisfied with either telephonic or televideo mode and that they were able to meet the patients' needs. CONCLUSIONS: Our survey findings suggest that health care providers valued televideo visits equally or preferred them more than telephonic visits in the domains of quality of care, technology performance, satisfaction of technology, and user acceptance.

Understanding Coding and Payment for Psychiatrists' Services: How We Got Here and Where We're Going.

Psychiatrists often have difficulty understanding how to document, code, and bill for their services in a way that expedites adequate payment and avoids billing problems or future issues. This is very understandable because many psychiatrists in small or solo practices do their own billing without any formal training in the vagaries of coding and reimbursement policies. For many years, the American Psychiatric Association (APA) has devoted substantial resources to guiding psychiatrists through this maze, with direct member assistance and resources publicly available at www.psychiatry.org. APA staff, councils, and committees have also been working for many years to improve coding and reimbursement for psychiatric services. Current and former members and staff of the APA Committee on RBRVS, Codes, and Reimbursement have authored this article to help psychiatrists gain a better understanding of the current coding and reimbursement structure for psychiatric services, including how it evolved and what the future holds.

A quality improvement process for implementing the Texas algorithm for schizophrenia in Ohio.

Medication algorithms developed in Texas are being implemented in a number of states in the United States and internationally. This report describes a quality improvement process adapted from the Texas Medication Algorithm Project that was used to implement the Texas algorithm for schizophrenia in Ohio. A total of 38 physicians were surveyed about their perceptions of barriers to implementation of the guidelines. The physicians generally thought that the schizophrenia algorithm was good, current, and applicable. Although they did not perceive barriers to its implementation, they did not seem to alter their practices to a great extent in response to the algorithm. The results of the study may guide other states in their implementation of algorithms.

Patterns of antidepressant use among children and adolescents.

OBJECTIVE: The purpose of this study was to identify patterns of new antidepressant use among children and adolescents and to determine whether the duration of treatment was sufficient. METHODS: A retrospective 12-month analysis was conducted of claims data for a cohort of nine- to 18-year-old new users of antidepressants in an Ohio Medicaid population. Treatment duration was categorized into five time intervals reflecting initial treatment through various continuation periods. RESULTS: A total of 554 children and adolescents started an antidepressant regimen during a three-month period. These children were mostly Caucasians (78 percent), and their average age was 13 years. Boys and girls were equally represented. The use of antidepressants increased with age among girls but declined among boys. The distribution of antidepressants dispensed was selective serotonin reuptake inhibitors, 47 percent; tricyclic antidepressants, 27 percent; and other antidepressants, 23 percent. The specific agent used varied by primary psychiatric diagnosis. The proportion of children who completed treatment was 94 percent for the four-week treatment period, 23.5 percent for the six-month period, and 12.6 percent for the whole year. CONCLUSIONS: Antidepressants are used in the treatment of children and adolescents who have a wide array of mental health problems. As with adults, continuation of treatment among children and adolescents declines dramatically after an initial period. In addition to studies of the clinical efficacy of antidepressant use among children and adolescents, future research is needed to assess adherence to practice guidelines and health outcomes in childhood and adolescent mental health.

A randomized, controlled trial of panic disorder treatment initiation in an emergency department chest pain center.

STUDY OBJECTIVE: We examine the effect of a protocol for panic disorder recognition and treatment initiation on medication initiation rates and medication continuation rates at 1- and 3-month follow-up. METHODS: Enrolled participants, all at low to moderate risk for acute coronary syndrome, completed a 6-hour emergency department chest pain evaluation and panic disorder screen. Participants who had results positive for panic disorder completed the Panic Disorder Module of the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) by the research psychiatrist and the treating emergency physician, each blinded to the other's rating. Participants with panic disorder were randomized to either paroxetine initiation at 20 mg/d for 1 month or usual care with telephone follow-up at 3 months. RESULTS: Fifty (32%) of 156 enrolled participants met criteria for panic disorder. All 25 (100%) participants in the paroxetine group initiated treatment, compared with 6 (24%) in the usual care group initiating any form of treatment (P =.006, relative risk [RR] 2.58, 95% confidence interval [CI] 1.20 to 5.58). Fourteen (56%) participants continued paroxetine treatment for at least 1 month, and at 3 months, 9 (36%) continued on some antipanic medication, compared with 2 (8%) for the usual care group (P =.05, RR 3.57, 95% CI 0.84 to 15.8). CONCLUSION: Panic disorder is common and severe in this sample of patients with chest pain. A screening measure and a brief (5-minute) structured interview allowed emergency physicians with no extra training to reliably diagnose panic disorder and initiate pharmacologic treatment.