Yelena Lugin, PharmD, BCPP
Psychiatric Clinical Pharmacy Specialist
Eastern Colorado Health Care System/Rocky Mountain Regional VA Medical Center
Aurora, CO

Dr. Lugin is a psychiatric clinical pharmacist working primarily with rural veterans by telehealth at the Rocky Mountain Regional VA. Board Certified in Psychiatry and Pharmacotherapy, Dr. Lugin completed her BS and PharmD degrees from the University of Georgia. She went on to complete a general PGY1 from Robley Rex VAMC followed by a PGY2 in psychiatry from the Rocky Mountain Regional VA.

Cultivate your team

One of the most important things for a successful telework experience is to continue cultivating and strengthen the relationships with your Mental Health team. The nurses, PA’s, social workers, therapists, psychiatrists, technicians, as well as pharmacists who work in the same area as you can be phenomenal resources and instrumental when challenges arise. It is important to continue fostering those relationships even when working in telehealth settings. Some of the easiest ways to do this is to be present in virtual meetings and huddles. If you have a camera then be sure to turn it on so that your team is able to see you. Doing this will help foster a sense of approachability and familiarity. If it is your first time in a meeting, be sure to introduce yourself and share what it is that you do and how you can help the team. It will be easier to work through future patient issues with collogues if a foundation has already been laid of an interdisciplinary team approach. Working with the team will be exceptionally helpful if ever dealing with a patient in a crisis or emergency, which is the next tip.

What to do in a crisis or emergency

Dealing with someone in crisis or with an emergency is always a challenge and may be even more so when utilizing telehealth. For this reason, it is always best to be prepared with the following:

  1. Know the Patient’s home address as well as their emergency contact
  2. If the patient attends the meeting from a different address, ask for their location at the very start of the appointment
  3. Have the patient’s emergency numbers on hand as well as contacts for other emergency services at your facility such as: suicide prevention team, crisis line, etc.
  4. Be ready to use your team! When dealing with a crisis, it would be prudent to remain in contact with the patient while sending a message to your team explaining the situation. You may then provide the team with contact numbers and additional information so that they can reach out to the appropriate party(s) while you remain in contact with the patient.

Additional challenges of telehealth services and how to overcome them

  • Technology failure – Unfortunately, this is inevitable. Technology will fail whether it be an issue with the system being used, internet/connectivity, servers, or the cosmic aligning that day. Therefore, there should always be a backup plan. Most of my telehealth appointments are either by Video from home or Video from one of our distant clinic sites while I work out of our main facility in the city or home. In case of video malfunction, I will try one of two things: 1. Another video option (the VA has classic VVC, or VVC NOW which I use as a backup) or 2. Switch to phone. If facility phones are not working, then can consider using other programs if appropriate such as Doximity.
  • Testing, such as AIMS exam – Even through Telehealth I will continue doing the screenings necessary for patient care. For things such as the AIMS, have the patient prop their phone/device up and move their seat back so that you may have a better view of them. Then continue with the exam as you would were they then in person. When documenting this in the chart I usually add an * stating that the exam was limited due to being conducted virtually through telehealth.
  • I am just starting out and do not know where to start! – Chances are there is someone at your facility or location who is already involved in some facet of telehealth. Reach out to those people or ask your supervisor if they know of any who you may be placed in contact with regarding telehealth at your facility. Those who have already stepped into the deep pools of telehealth can be a great resource when learning how to swim past obstacles as they come. Chances are when things go awry, seasoned telehealth users may have already dealt with similar issues and can help provide guidance as you maneuver the waters.
  • You are only as good as your lowest denominator- Our patients come with various experiences when it comes to telehealth or technology use. It is important to understand our patient’s experience and comfort with technology. You may need to allot time to help troubleshoot if it is a first-time telehealth appointment. If the patient is not seen in a scheduled video appointment, then call them for they may be having technology issues. Also reach out to your facility to understand tools you may have to access to in order to assist patient. For example, my facility has consults that can be placed to telehealth technicians who will help patients troubleshoot telehealth appointments prior to their actual appointment date.

A positive impact in patient care

How can one provide adequate care when you are not actually with the patient? I’d like to end on a positive note with some ways telehealth could impact patient care for the better.

  • A glimpse into their world – A colleague had worked with a patient who was originally diagnosed with depression and started on an antidepressant. Over the course of a month the clinician witnessed the patient’s immaculate home/surroundings become disheveled and for lack of better terms, a mess. Slightly pressured speech from an appointment could not fully portray the impact of their home life, which was evident by the video appointments from home. This in turn facilitated in that patient’s diagnostic re-evaluation.
  •  Building Rapport – With some, bonds of trust seem to be built quicker through video appointments. The patient sees you over video in their home, an environment where they mainly see friends or family members enter. Telehealth allows you to enter their homes and be present with them in their environment.
  • Access –Whether patients live in rural settings, or the weather is not cooperating, or they simply fear coming into the clinic due to certain stressors, telehealth offers a different option for patients to acquire the help needed.