Telepsychiatry Consultation Service in Nursing Homes
- Need: To improve health status and access for rural nursing home patients in need of mental health services.
- Intervention: The University of Vermont Medical Center provides telepsychiatry care and education to nursing homes that face shortages of mental health professionals on site.
- Results: Telepsychiatry consultations ease the burden on nursing home residents by saving travel time, distance, and money involved with going to the nearest tertiary facility.
Effective (About evidence-level criteria)
Rural nursing homes can be at a disadvantage, as many have difficulty providing adequate psychiatric care for residents. Nursing homes in rural areas typically rely on primary care physicians to treat patients. These physicians may be overloaded or lack extensive training in mental health-related issues, which can result in patients being misdiagnosed or not diagnosed at all. In many cases, if a rural patient is in need of a psychiatric exam, the patient will have to travel to the closest facility that provides this service, which is often a long distance away.
In order to ensure nursing homes have access to quality mental health evaluations, the University of Vermont Medical Center initiated telepsychiatry services to the Alice Hyde Medical Center Nursing Home in Malone, New York and to the Helen Porter Healthcare and Rehabilitation Center in Middlebury, Vermont. These nursing homes worked with Dr. Terry Rabinowitz of the University of Vermont to conduct appointments through video conferencing technology, saving costs associated with traveling and providing access to mental services to a remote and often frail population.
This particular program offers psychiatric exams and medication reviews and adjustments.
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 able to be easily-detectable via video conferencing, as cameras are able to zoom in without people noticing.
Throughout numerous patient interactions using this virtual appointment format, it was revealed that mental health conditions are able to be accurately diagnosed from a distance, making it a safe, effective way to treat patients in rural nursing homes.
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.
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
New York, Vermont
May 7, 2015
June 6, 2016
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.