10/16/2013. Problems in multiple domains of functioning (Qi & Kaiser, 2003) As stable as intelligence. (Olweus, 1979; Zumkley, 1994)

Transcription

1 Problems in multiple domains of functioning (Qi & Kaiser, 3) As stable as intelligence (Olweus, 1979; Zumkley, 1994) 1

2 years of research Hundreds of studies Moderate/strong effect sizes (e.g., Fabiano, et al., 8) Regional primary care data show 11-2% children with psychosocial concerns Most patients raise this concern with their primary care provider. Few patients seek specialty mental health services (Polaha & Williams, under review) Who is affected? What kinds of problems? What treatments are available? What care are patients seeking? 2

3 Provider shortages Logistical barriers Stigma Lack of awareness Treatments unacceptable (Jameson & Blank, 7; Harwood et al, 9; Kazdin, ) Increases in conduct problems among boys over the past 2 years (Collishaw, Maughan, Goodman, & Pickles, 4) Rise in concerns about bullying and violence among youth One standard deviation increase in most problem scores across past 7 years mental health problems are growing (Twenge, et al., ) 3

4 Easy To Do Two way videoconferencing demonstrations since 197 (Lewis, Martin, Over, & Tucker, 197) Dozens of demonstration projects Affordable (equipment) Reimbursed Medicare: diagnostics, medication, management, & therapy at same rate (Centers for Medicare & Medicaid Services, 9) Patients Like It 4

5 Telemental Health Satisfaction Survey (Collected for % of the sample) Question Mean Score Standard Deviation Could see doctor clearly Had no trouble hearing doctor.29.9 Able to speak freely and ask questions.76.2 Doctor was able to ask me questions.8.41 Doctor seemed to understand my problem I was comfortable with/understood what doctor told me The camera made me embarrassed Telemedicine makes care more accessible Telemedicine is as good as face-to-face encounter..82 Overall, I am satisfied with telemedicine =disagree; 6=agree Telemental Health Satisfaction Survey (Collected for % of the sample) Question Mean Score Standard Deviation Would prefer telemedicine visit rather than waiting for face-to-face Would have traveled if not used telemedicine Traveling would have cut into my work or school time Traveling would have affected my wages Traveling would have caused other inconveniences Would prefer face-to-face visit rather than telemedicine Growing Evidence Base Descriptive, pre-post, and controlled trials Telepsychiatry and telepsychology Treatments and assessments Multiple settings and presenting problems

6 Telemental Health: Clinical, Technical and Administrative Foundations for Evidence-Based Practice edited by Kathleen Myers and Carolyn L. Turvey. Elsevier Insight, Waltham, MA, 13, ISBN Can Be Delivered in Primary Care Integrated care = better patient outcomes Consistent with Patient Centered Medical Home More accessible for patients Jodi Polaha, Ph.D. Associate Professor, Psychology HRSA: Office for the Advancement of Telehealth H2AIT

7 Provide best-practice care Increase access Provide team-based care Provide greater patient-focus Improve health outcomes Southern Appalachian Telebehavioral Health Clinic Sneedville Wayne Co 7

8 2 Number of Patients Seen: First Three Months 1 Specialty Sept Oct Nov Dec Jan Feb Mar 8

9 Axis Title Axis Title /16/13 2 Number Patients Seen: Open Access Clinic start open access clinic 1 Specialty Open Open Access Sept Oct Nov Dec Jan Feb Mar 2 Number Patients Seen: Open and Specialty 1 Specialty Open Sept Oct Nov Dec Jan Feb Mar

10 Video On Site 6 Minutes Spent in Specialty Vs. Open Access Clinics 4 3 Specialty Open

11 Number Sessions /16/13 Service not maximized Add adult patients Add service providers Total Contacts : % Warm Handoffs 38.6% Follow-up Year One-- 2 Year Two Year Three-- 12 Average Number of Sessions: 1.69 (Range 1-11) Average Session Length: 3 Minutes (Range -7) 3 3 Year 1, X=7.26 patient/mo Year 2, X=9.67 patient/mo Year Telehealth In Person Date 11

12 Item M(SD) N=12 I could see the psychologist clearly during the telemedicine visit. 6(.) I had no trouble hearing the psychologist when she spoke to me..92(.28) I was able to speak freely with the psychologist and ask questions..7(.62) The psychologist was able to ask me questions..7(.62) The doctor seemed to understand my problem..92(.29) I was comfortable with and understood what the psychologist told me about my complaint. The camera or other equipment embarrassed me or made me feel uncomfortable..83(.39) 2.9(1.83) The telemedicine visit makes receiving care more accessible..67(.6) Item I would prefer a telemedicine visit now rather than waiting for a face-to-face appointment with the same doctor. I would have traveled to another city to see a specialist if I had not used telemedicine Traveling to another hospital would have cut into my work/school or my child s school time. M(SD) N= (1.16) 4.8(2.2).8(1.93) Traveling would affect my wages for that time. 3.83(2.37) I would experience other inconveniences in traveling..(1.91) I would prefer a face-to-face visit with the specialist rather than a teleconsultation with a specialist. 3.91(1.93) This telemedicine visit was as good as a face-to-face encounter..2(.7) Overall, I am satisfied with telemedicine..67 (.49) Tennessee Telehealth Network Identification of key partners and participation in meetings Identification of hardware and connectivity needs Initial conference call meeting to discuss plans and needs Assistance in grant and protocol writing Marketing development Training of staff and providers on use of technology Assistance with billing procedures and issues 12

13 Developing an office program Location for equipment Designated coordinator, but all hands on deck Shared EMR Regular care coordination meetings Creative process to keep BHC top of mind Family Check Up Team Care for Chronic Illness 13

14 Team Care for Depression and Anxiety Pediatric Practice Time Data Behavioral concerns add > min to visit (27% of all pediatric visits; Cooper et al., 6) Team based residency save 8 min per visit when behavioral concern is raised (24% of all pediatric visits; Gouge et al., under review) Team based care save min per EVERY VISIT (range <1 min to min depending on visit type; Gouge & Polaha, under review) Cost Effective Fee for Service models Originating site Provider billing Psychiatric codes Health and behavior codes Screeners 14

15 Cost Effective Fee for service models Staff models 1