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Patients Cite Illness, Transportation as Barriers Eliminated By Telehealth
(Part 2 of 3)
In this video, Mark Zimmerman, MD, Rhode Island Hospital, Providence, discusses his study that found telehealth treatment with patients who have comorbid disorders, personality disorders, and frequently engage in at-risk behavior, is safe and as effective as in-person care. These patients completed treatment at higher rates than those receiving in-person treatment and cited other illnesses and transportation as barriers eliminated by telehealth.
In the upcoming 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.
In Part 1 of this series, Dr. Zimmerman discusses the impetus for his study that found telehealth partial hospital treatment was as effective as in-person treatment.
Read the transcript:
From May through November of 2020, over 200 patients were admitted to our partial hospital program and who consented to treatment. We matched that group in terms of size and time of the year to patients who were seen in-person in our program a year prior.
This clearly was not a randomized trial, but it was a sequential delivery of treatment. The paradigm was the same. When I say the paradigm, that means it was predominantly group-based therapy. A number of precautions were taken to ensure patient safety.
I'm not going to go into details here, but those can be found in the article that we published. We were very much concerned about being able to locate patients, or locate a significant other family member or friend, in case we were having problems contacting the patient and needed to send out emergency services.
Safety was a big concern of ours. We matched the group who were seen in the virtual program to patients seen in-person. I believe it was 207 patients in each group, treated during the same time of the year. We looked at outcomes from the following different perspectives.
First, the first thing we were interested in was, did patients tend to drop out more? What was the completion rate? What was the length of stay in the program?
In fact, let me take a step back again to describe briefly what our program is. The therapeutic model is based on acceptance and commitment therapy. Patients are seen by a psychologist on a daily basis. They are seen by a psychiatrist on a daily basis, and they also participate in three groups per day.
One group is the fundamental aspects of acceptance and commitment therapy. One is more of a dynamic and personal group, and then one is a coping and mindfulness group. Then there's a fourth optional meditation group.
It's predominantly group therapy, but patients are also seen in individual treatment by both the psychiatrist and the psychologist on a daily basis. In terms of dropout, to our surprise, the rate of completion of treatment was significantly higher in the virtual program, compared to the in-person program.
About 70 percent of the patients completed the entire course of treatment, and it's not a predetermined length of treatment. We treat patients until both patient and clinician believe it is appropriate and time to transition to outpatient care.
The average length of stay had been about eight days in the in-person program. Another of the findings that we had was the average length of stay was actually longer in the telehealth program. The average length of stay was 13 days.
More patients completed treatment in the virtual program. The average length of stay, as I mentioned, was greater in the virtual program, and that was one of the only differences between the programs. No patients committed or attempted suicide during the entire course of treatment.
Less than two percent of patients were referred for inpatient level of care in both the virtual and in-person programs. Patients improved equally and significantly with effect sizes of one and greater in terms of symptom improvement or reduction in symptoms, functional improvement, improvement in coping ability, increase in aspects of positive mental health, and lastly, in general well-being.
Patients were as satisfied with virtual treatment as they were with in-person treatment. Over 90 percent of patients indicated that they were very or extremely satisfied with treatment in both ways of delivering care, and over 95 percent of patients indicated, in both ways of delivering care, that they would recommend treatment to a friend or neighbor.
We concluded that virtual treatment at a partial hospital level of care with patients who have usually comorbid disorders, frequently have personality disorders, frequently engage in at-risk behavior, is safe and as effective as in-person care. We also concluded that patients were equally well-satisfied.
In fact, several patients commented during the delivery of care by telemedicine, they commented that, had the program been in-person, they would not have attended, either because of medical illness or because of transportation difficulties.
The telemedicine approach towards delivery of care makes treatment available to individuals who might otherwise not have been able to avail themselves of such treatment.
Reference
Mark Zimmerman, MD, received his medical degree from Chicago Medical School, North Chicago, Illinois, and completed his postgraduate training at the Medical College of Pennsylvania/Eastern Pennsylvania Psychiatric Institute, Philadelphia, PA. Currently, he is a professor of psychiatry and human behavior at Brown University in the Department of Psychiatry and Human Behavior. Dr. Zimmerman is also the director of both Outpatient Psychiatric Services and Partial Hospital Services at Rhode Island Hospital, Providence, Rhode Island.
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.
