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Effectiveness, Safety Compared Between In-Person and Partial Hospital Treatment
In this video, Mark Zimmerman, MD, Rhode Island Hospital, Providence, discusses the impetus for his study that found telehealth partial hospital treatment was as effective as in-person treatment. Telehealth treatment is as effective in relation to patient satisfaction, symptom reduction, suicidal ideation reduction, and improved functioning and well-being, the study published in the Journal of Clinical Psychiatry found.
In the upcoming Part 2 and Part 3, Dr. Zimmerman discusses the study methods, key and surprising findings, practical implications for clinicians, and the future of telehealth post-pandemic in his program and beyond.
Hello, everyone. My name is Mark Zimmerman. I'm a psychiatrist, director of the Outpatient Division and the Partial Hospital Program at Rhode Island Hospital, Providence, and professor of psychiatry and human behavior at Brown University, Providence, Rhode Island.
I've been the director of our Partial Hospital Program for nearly 7 years. Over that time, we've increased the growth of the program significantly, so that prior to COVID-19 hitting, we were seeing approximately 60 patients per day in our program.
Obviously, the pandemic had a significant impact, and a little bit more than a year ago, we transitioned from an in-person program to a telehealth program. We did that with a fair amount of concern as to how it would come off.
We were unsure whether or not we could provide treatment in a safe manner because individuals in a partial hospital program are much more severely ill than outpatients. We also were unsure whether or not the treatment would be as effective as in-person treatment, because it's predominantly, though not exclusively, a group therapy-based program.
We didn't know how satisfied patients would be in transitioning from an in-person to a virtual program. Now, it's important to note that, before our transition, we had always been collecting outcomes data in our program.
That afforded us the opportunity to compare in-person treatment to virtual treatment, because we planned on, after making the transition, to continue to collect outcomes data. We went through our institutional review board to get permission and consent to do the research.
After we transitioned to a completely virtual program, we continued to collect outcome data by virtue of having patients fill out some questionnaires online. As I said, the three primary goals of our study were to compare in-person and partial hospital level of treatment in terms of effectiveness, safety, and patient satisfaction.
Let me just take a brief moment to talk about the prior existing literature on telehealth delivery of behavioral health services. That has been exclusively focused, or almost exclusively focused, on outpatient care, and most of the studies that have been done have been on individuals with single diagnoses.
Very few studies have examined patients with more than one diagnosis, and not infrequently, individuals who had suicidal ideation would be excluded from telehealth delivery of care. Well, those patients, those with comorbid conditions, those who might be at risk for self-injury or suicidal behavior formed the basis of individuals who were referred to a partial hospital program.
As individuals referred to our program are acutely ill, they are frequently referred from our emergency room, referred from outpatient clinicians upon patients' either deterioration in their status, functioning, or symptom levels, or just not responding to outpatient care, or referred as a step-down from the inpatient units at our hospital.
We're treating a pretty severely ill group of individuals. The average number of diagnoses per patient is 3, so comorbidity is the rule, rather than the exception. The most frequent diagnoses are major depressive disorder and anxiety disorder.
About one-quarter of our patients are diagnosed with borderline personality disorder, slightly less than one-quarter. Our primary outcome measure was a modification of a measure that I had published a few years ago called the Remission from Depression Questionnaire.
That questionnaire was developed in response to data showing that patients consider multiple domains as being important in evaluating the effectiveness of treatment.
It's not just symptom improvement that patients care about, but they also care about improvement in functioning, improvement in coping ability, the resumption of positive aspects of mental well-being, such as optimism and energy levels, and also general well-being and life satisfaction.
We modified that questionnaire, adding items assessing symptoms of anxiety, symptoms of pain, and added some items to our scales assessing coping ability and functional status so that it would apply to the heterogeneous group of patients diagnostically whom we see in our program.
Dr. Zimmerman is the author of more than 300 articles and serves on the editorial board of 10 journals including the Journal of Affective Disorders and the Journal of Psychiatric Research.
