•  Rural and Remote Practice Settings
•  Donald M. Hilty, M.D.

Telepsychiatry’s evidence base – including outreach to rural and remote areas – is substantial in the U.S., Canada, Australia, and now in many war-torn parts of the world. Care to these underserved patients and communities has been one of the best successes of telemedicine. Outcomes have been positive in terms of satisfaction, validity/reliability, and clinical care relative to in-person care.

• Satisfaction has been superior for patients, families, and providers – many had no access to care or would have had to travel hours or hundreds of miles.
• A variety of disorders have been effectively treated, starting with depression in the late 1990s and extending to anxiety, dementia, difficult behaviors (i.e., agitation) and even psychosis.
• Telepsychiatry to primary care has been done with a variety of treatment models, including direct psychiatric care, consultation care and collaborative care.

Telepsychiatry to rural settings requires broad medical, social and health system perspectives:

• The “patient”: the actual patient, family, local mental health clinician, social worker, and primary care provider may pose the question or initiate the consultation.
• The context: local health, mental health and substance care may or may not be adequate and acute services (e.g., psychiatric emergency or inpatient settings) may be hours away.
• Culture, language and other social determinants of health may have significant impact.
• Public and population health: prevention, distributing specialty expertise to the “most”, and the community’s march toward better health are all important.

Highlights of rural and remote telepsychiatry include:

• Teamwork: the clinician is part of an interdisciplinary team, a composite of outpatient allied mental health and social work professionals, primary care providers and others.
• Cultural, ethnic and language matching: many special populations like American Indians, non-English proficient Hispanics, migrant workers and now refugees have been served according to descriptive studies.
• Empowering the community: by investing in the primary care provider, telepsychiatry leverages expertise across populations, particularly through collaborative care.

References

• Hilty DM, Ferrer D, Parish MB, et al. The effectiveness of telemental health: A 2013 review. Tel J e-Health. 2013;19(6):444-54.
• Yellowlees PM, Odor A, Iosif A, et al. Transcultural psychiatry made simple: Asynchronous telepsychiatry as an approach to providing culturally relevant care. Tel e-Health. 2013;19(4): 1-6.
• Hilty DM, Yellowlees PM, Parish MB, et al. Telepsychiatry: Effective, evidence-based and at a tipping point in healthcare delivery. Psych Clin N Amer. 2015;38(3):559-592.
• Shore JH, Brooks E, Savin D, et al. Acceptability of telepsychiatry in American Indians. Telemedicine J e-Health. 2008;14(5), 461-466.