University of Vermont Medical Center's Nursing Home Telepsychiatry Service

Evidence-level

Effective (About evidence-level criteria)

Description

Rural nursing homes can be at a disadvantage in providing adequate psychiatric care for residents. Typically, they rely on primary care physicians to treat both primary care and mental health issues. But these physicians may be overloaded or lack extensive training in mental healthcare, which can result in patients being misdiagnosed or undiagnosed. In many cases, rural nursing home residents needing mental healthcare have to travel a distance for psychiatric exams.

In order to ensure nursing homes have access to quality mental health evaluations, the University of Vermont Medical Center (UVM Medical Center) established a telepsychiatry service to be used in nursing homes in New York and Vermont. Through a referral from their primary care provider, nursing home residents can connect with a psychiatrist at the UVM Medical Center who conducts appointments through video conferencing technology. These virtual visits save on costs associated with traveling and providing access to mental services to a remote and often frail population.

Currently, UVM Medical Center has a partnership with the Alice Hyde Medical Center Nursing Home in Malone, New York. This telepsychiatry service is funded by the UVM Medical Center.

Services offered

This telepsychiatry program offers psychiatric exams and medication reviews and adjustments.

Recently, UVM Medical Center has started using different video conferencing instrumentation than they had originally used. Equipment purchased at a local retailer proved inexpensive but produced the same results. The change allowed the program to save on cost while maintaining quality of service.

Results

In order to better assess the value of this alternative form of consultation service, a study was conducted that examined 278 telepsychiatry encounters with 106 nursing home residents in New York and Vermont. The findings supported that telepsychiatry is a medically acceptable, cost-effective solution for rural nursing homes. The data collected revealed:

• Travel time savings of 843.5 hours
• Travel distance savings of 43,000 miles
• Personnel cost savings of approximately $33,739 to $67,477
• Physician travel-related cost savings of approximately $84,347 to $253,040

During a virtual consultation, psychiatrists are able to make use of remote camera control capabilities and camera angles to pick up on things that may be missed during an in-person consultation. Subtleties in body language are often easily-detectable via video conferencing using zoom features.

Throughout numerous patient interactions using this virtual appointment format, mental health conditions were able to be accurately diagnosed from a distance.

The study has been referenced in 78 other journal publications. The service is known in Vermont and New York as being successful, and other nursing homes have contacted UVM Medical Center requesting to be a telepsychiatry site.

For more detailed program results:

Rabinowitz, T., Murphy, K.M., Amour, J.L., Ricci, M.A., Caputo, M.P, & Newhouse, P.A. (2010). Benefits of telepsychiatry consultation service for rural nursing home residents, 2010. Telemedicine Journal and E-health, 16(1), 34-40.

Hilty et al. (2018) An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care, Psychosomatics, 59(3), 227-250.

Challenges

While some assume that elderly people may be more skeptical about using telehealth technology for medical care, residents involved in this program were very willing to try it. Because more elderly people use technology to connect with family members, it has become more natural for them to do the same for their medical care.

Replication

Considerations that organizations should be mindful of before implementing this type of program are:

• Ensure adequate digital bandwidth for data transfer
• Evaluate equipment costs
• Familiarize staff and patients on how to use equipment
• Develop strong encryption methods
• Prepare for data security concerns
• Be aware of restricted HIPAA-compliant software applications
• Understand the hesitation of patients and families to trust the technology

Key steps that should be taken in order to set up a similar program include:

• Determine locations and sites with the greatest need
• Evaluate data port availability
• Obtain proper licensing, credentialing, and insurance
• Create an action plan and a clinical protocol
• Use Minimum Data Set (MDS) as a standardizing assessment measure
• Identify key issues relating to elder care
• Invite other professionals, such as social workers, to sit in on appointments
• Encourage family members to participate in appointments
• Complete assessments and additional studies
• Set up follow-up visits

Contact Information

Terry Rabinowitz, MD, DDS, MS
University of Vermont College of Medicine
University of Vermont Medical Center
802.847.4727
Terry.Rabinowitz@uvm.edu