Caitlin McCarthy, PharmD, BCPP
Clinical Associate Professor, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ
Clinical Pharmacist, Henry J. Austin Health Center, Trenton, NJ
What is Telehealth and What are the Benefits of Telehealth?
Telehealth is defined by the Health Resources Services Administration as "the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health.” These technologies can include the internet, video conferencing, store-and-forward imaging, media streaming, and land and wireless communications.1
Extensive research in a variety of patient care environments has shown that telehealth can increase access to care and improve outcomes. Established benefits of telehealth include enhanced convenience of care and access to specialty providers and remote services, limited transmission of communicable disease, and improved patient and clinician satisfaction.2,3 Given the benefits of telehealth, many professional medical societies, including professional pharmacy organizations, endorse telehealth.4-8
What Impact has Telehealth Had on Treatment of Mental Disorders?
Telehealth increases access to screening, assessment, treatment, recovery support, crisis support, and medication management across diverse behavioral health and primary care settings. Implementation of telehealth services has been growing steadily over the years, with a rapid increase in utilization seen during the COVID-19 pandemic. For example, during the acute phase of the COVID-19 pandemic (March 13, 2020, to December 17, 2020), telehealth visits for mental health increased by 1019.3% compared to the previous year, an increase that was sustained throughout the postacute phase (December 18, 2020 to August 31, 2022).9
Types of pharmacy services delivered via telehealth for the treatment of mental health conditions vary, but they are similar to what is seen in more traditional in-person practice settings. For example, services include, but are not limited to10-13:
Common disease states for which psychiatric pharmacy services via telehealth are provided are depression, anxiety, post-traumatic stress disorder, and bipolar disorder. However, the scope of telehealth for treatment of mental health continues to expand. For example, while the utility of telehealth for treatment of serious mental illness (SMI) and substance use disorder (SUD) has been questioned, a growing body of evidence supports the use of telehealth as an appropriate mode for service delivery for patients experiencing either. Various types of treatments, including behavioral activation therapy, cognitive behavioral therapy, cognitive processing therapy, medications for opioid use disorder (MOUD), pharmacotherapy, and medication monitoring, have been successfully delivered via telehealth with modes of delivery including teleconferencing, web-based applications, and telephonic communication.
Modalities for providing medication management for SMI and SUD range, including automated text messages, smart pill containers, mHealth apps, and direct consultations. Multidisciplinary teams often provide such care, incorporating the expertise of mental health and substance use clinicians, MOUD providers, case managers, peers, and pharmacists and pharmacy staff. Outcomes achieved through use of telehealth to provide treatment of SMI and SUD are like those seen for other disease states, including improved health, reduction in symptoms, treatment satisfaction, retention in care, and improved therapeutic alliance. Specifically, pharmacotherapy for SMI and SUD delivered via telehealth has been shown to reduce length of hospitalization and symptomology and improve medication adherence.14
What Steps Can be Taken to Implement Telehealth Services?
While research and clinical experience supports the adoption of telehealth, several challenges can deter clinicians from engaging in such. For example, potential barriers to telehealth include interstate licensure challenges, regulatory issues that vary by state, situations in which in-person visits are more appropriate, challenges of addressing sensitive topics, limited access to technological devices and connectivity issues, variable levels of digital literacy, cultural acceptance, lack of organizational support, and inconsistent funding for telehealth. Therefore, when planning to implement telehealth services, it is important have a clear vision for the services, and consider the following steps to create a successful program:
Telehealth is a rapidly expanding modality for the provision of care with a large body of evidence to support its use across a variety of treatment settings and disease states. Despite the potential challenges clinicians may face when implementing telehealth services, by taking intentional steps to implement those services that are in demand and align with patient, institutional, and clinical goals, new telehealth services can be successfully created to meet patient needs.
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