Department of Psychiatry sees telehealth visits rise amid pandemic

By Francie Williamson, Communications Coordinator, Department of Psychiatry

Telehealth appointments have risen nationwide since the start of the COVID-19 pandemic, and psychiatry is one area where these visits have especially increased.

At University of Iowa Hospitals & Clinics, telehealth appointments in the Department of Psychiatry have risen from a 2 percent share of appointments before the pandemic to 30 percent now.

Peggy Nopoulos, MD, chair of the Department of Psychiatry, says the expansion of telehealth has been a silver lining during the pandemic.

“We still do everything we used to do, and we feel confident that the hospital is a very safe place, but we want to be patient centered,” Nopoulos says.

It took some outreach to let patients know expanded telehealth options were available, and how to access them. Clerks and other volunteers were instrumental in reaching out to patients.

“It’s like paper bags versus plastic,” Nopoulos says. “A lot of patients didn’t know they had options, and didn’t know they could ask.”

Jodi Tate, senior vice chair for clinical services, says before the pandemic, the department only was doing telehealth appointments for a few specific populations, including patients with intellectual disabilities, geriatric patients, and students at Grinnell and Cornell colleges.

Tate says there were two big barriers to expanding telehealth appointments pre-pandemic.

“One is payment, and two is the requirement that patients needed to be at another facility, so you couldn’t do the telepsych or telehealth to their home,” Tate says.

Emergency action from the government removed these barriers, allowing for the rapid expansion of telehealth appointments.

Tate says many, but not all of the department’s services, have been available via telehealth appointments. Mostly, patients needing management of their medications, and patients in need of psychotherapy have all been able to access their providers via telehealth. Group therapy also has been available.

Reaction from patients and providers

Support from UI Hospitals & Clinics for expanded telehealth has been “awesome,” Tate says.

“We have MyChart Video and it’s been a huge undertaking to push that out,” Tate says. “Like any other new process there was a lot of hurdles. I think there’s still some hiccups to work out, but more and more patients are figuring out how to do it. So, it’s working quite well, and I’m happy with it.”

Other providers in the Department of Psychiatry are happy with the service as well.

“Telepsychiatry visits have been helpful in being able to see those patients who I would not have otherwise seen during the COVID-19 outbreak— those who are high-risk or who have increased health anxieties,” says Lauren Thomann, DNP, ARNP. “It gives me additional clinical information about patients when I am able to see them in their home environments as sometimes, they are more at ease and better able to relate symptoms.”

Keith Guess, PA-C, MPS, says the response from his patients has generally been positive.

“I have been pleasantly surprised at how well most of my patients have done with the video and certainly for some they are more communicative by video than in person,” Guess says.

For Deb Poole, PA-C, switching to telehealth visits was nothing new: she has been conducting video appointments with students from Grinnell College for the past five years.

“It was really interesting when we first started. It was a couple weeks into it where I was like, wow this doesn’t feel any different than seeing people in person. I don’t know if that population was easier because technology is nothing to them,” Poole says.

Poole says for the most part, her patients love telehealth.

“I wouldn’t say that necessarily depends on their technology comfort level, because often times I’ll have a family member that will help them get set up,” Poole says. “It’s been a broad range of experiences but mostly very positive.”

Future of telehealth

Tate says telehealth has increased access and flexibility for patients.

“It’s easier for patients. It allows them to feel more comfortable,” Tate says. “Some people don’t want to leave their house and it allows them to access the care that they need, A lot of people have issues with transportation. Telehealth helps that.”

Providers admit, though that they do miss some of the face to face interaction.

“At times, especially with telephone visits, it has been difficult to completely assess a patient's mental status, but I have found it has forced me to be a better interviewer--asking more clarifying questions, etc.,” Thomann says.  

Tate agrees that there may be some things that providers miss not actually seeing a person, “but I think it’s another great tool to have, to be able to offer patients. I’m all about patient-centered approaches and if that’s what the patient wants, that’s what I hope we can continue to do. The more that we can meet the patient where they’re at, I think the better job we’re going to do.”

Guess says many of his patients would like to continue to utilize video visits after the pandemic ends.

“I think that the further people drive for clinic visits the more inclined they are to want to have alternate access,” Guess says.

Thomann says her patients who have utilized video have only had positive things to say, “and I suspect many may have a hard time returning to the office once COVID is over due to the convenience.”

Tate says it’s still unknown if the barriers to telehealth that existed pre-pandemic will ever return.

“But I hope it’s here to stay and I think it’ll grow a little bit more,” Tate says.

Thursday, October 15, 2020