Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits

Hello Professor and classmates,

            As COVID-19 took the world by storm in March 2020, U.S. doctors had to limited in-person appointments and many patients avoided them, due to fear of infection (Wolfson, 2020).  Therefore, telehealth may be preferred over an in-person medical visit during a pandemic to ensure social distancing, quarantine, and isolation measures can be taken (Wolfson, 2020). The telehealth preference was evident by the huge increase in the volume of remote medical and behavioral health visits, during the pandemic (Wolfson, 2020). Other situations that may result in telehealth being favored over in-person office visits are as follows: patients that have a compromised immune system, patients that live in rural locations that may also have rough terrain, during natural disasters that may limit or make travel and access difficult or impossible and public health emergency declaration, for follow-up visits and nonemergent illnesses such as to review labs, refill medications, provide therapy services like psychotherapy (CBT), and treat conditions like migraines and UTIs (Wolfson, 2020).(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

          Throughout my PMHNP program, I have had the opportunity in clinics to experience providing telepsychiatry using telehealth platforms. I have provided psychiatric evaluations, therapy (individual, group, and family), patient education, and pharmacologic and nonpharmacologic management (Duncan et al., 2020). According to Duncan et al. (2020), a telehealth visit is best suited for stable patients that require maintenance treatment (Duncan et al., 2020). Therefore, PMHNPs should consider telehealth utilization based on the patient’s disease phases (preferably for prevention, preterm intervention, active treatment, maintenance or preventing recurrences) and I plan to utilize telehealth in clinical practice (Duncan et al., 2020). A telehealth visit can be utilized for the screening, assessment, treatment, recovery supports, crisis support, and medication management of stable patients (Duncan et al., 2020). Patients that are in an acute or deteriorating phase of disease that may be manic, unstable, worsening in condition, or at risk for harm to themselves or others, they would require a hands-on physical assessments; so they should be ruled-out for a telehealth visit and an in-person visit should be required to ensure that proper assessment and diagnostic testing can conducted to determine an accurate diagnosis and the best treatment outcomes (Duncan et al., 2020).(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

References

Duncan, C., Serafica, R., Williams, D., Kuron, M., & Rogne, A. (2020). Telepsychiatry during the COVID-19 pandemic. The Nurse Practitioner, 45(12), 6–9. https://doi.org/10.1097/01.NPR.0000722356.37937.9aLinks to an external site.

Bromwich, M., & Bromwich, R. (2016). Privacy risks when using mobile devices in health care. CMAJ: Canadian Medical Association Journal, 188(12), 855–856. https://doi.org/10.1503/cmaj.160026Links to an external site.

Wolfson, B. J. (2020, October 26). Telemedicine or in-person visit?. Pros and cons. California Healthline. https://californiahealthline.org/news/telemedicine-or-in-person-visit-pros-and-cons/

CLASSMATE 2

Unit 14 Discussion – Telehealth Practice for ALL Patients

What are your thoughts (supported by evidence) for the exclusive use of telehealth in psychiatric mental health care or for a balance between in-person and telehealth visits for all patients?

Telehealth services should be used in conjunction with conventional in-person consultations rather than in place of them. Nevertheless, Telehealth is a wonderful way to improve the caliber of care and the number of people who have access to it. Telehealth is a valuable tool for the delivery of healthcare, but it has limitations and risks (Cristofalo, 2020). Telehealth does not allow for a comprehensive assessment because taking a patient’s history and assessing them involves all senses. Stable patients who have already established care are most suitable. According to a meta-analysis, telehealth effectively treats major depression and anxiety disorders like phobias (Varker et al., 2019). However, studies indicate that telehealth is inappropriate and ineffective for patients with substance use disorder and schizophrenia who require close monitoring of symptoms and medication management (Varker et al., 2021). Patients with SUD require frequent in-person visits to promote abstinence and treatment adherence.(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

What have your experiences been in clinicals throughout your PMHNP program been in preparing you for the use of telehealth platforms?

The majority of my clinical experiences have been face-to-face. In one course, my preceptor utilized Telehealth exclusively because her patients lived more than 50 miles from her office. While I prefer Telehealth due to reduced exposure to respiratory diseases and viruses, there are both positive and negative aspects to utilizing Telehealth platforms. Positive in that the likelihood of coming into contact with someone with flu or COVID is eliminated. Negative in that you may not have a successful session if your patient has poor reception. I intend to use Telehealth as much as possible to assist those in rural areas receive quality care.(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

What does your intention of telehealth use once in active clinical practice as a PMHNP, why?

I want to use telemedicine in addition to in-person consultations when I start working as a PMHNP. Telehealth is an excellent tool for increasing patient access to care and improving the standard of that care. Unfortunately, due to difficulties with transportation, work schedules, and family obligations brought on by living in a rural area, a large number of patients do not receive adequate physical or mental health care and Telehealth may be favored over in-person medical care for a variety of reasons. First, cost-effectiveness, convenience, and the ability to provide care to rural residents with mobility limitations have been demonstrated (Mahtta et al., 2021). Second, Telehealth may reduce medication abuse, unnecessary visits to the emergency room, and prolonged hospitalizations (Gujranwala & Polkowski, 2021). Third, having access to Telehealth for healthcare visits can lower patients’ travel expenses. Finally, Telehealth increases patient satisfaction through improved accessibility, increased convenience, and reduced stress (Gujranwala & Polkowski, 2021).(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

References

Cristofalo, M. A. (2020). Telehealth, friend, and foe for health care social work. Qualitative Social Work, 20(1–2), 399–403. https://doi.org/10.1177/1473325020973358Links to an external site.(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Gujranwala, S. N., & Polkowski, J. N. (2021). Telehealth Benefits and Barriers. The Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013Links to an external site.(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Mahtta, D., Daher, M., Lee, M. T., Sayani, S., Shishehbor, M., & Virani, S. S. (2021). Promise and Perils of Telehealth in the Current Era. Current Cardiology Reports, 23(9). https://doi.org/10.1007/s11886-021-01544-wLinks to an external site.(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services, 16(4), 621–635. https://doi.org/10.1037/ser000023(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits Essay Example

Response to Classmate 1

Hello,

Thank you for an educative and insightful discussion. Before the Covid-19 pandemic, telehealth use was limited because most people had not established its need or efficacy, gaining little acceptance. However, research evidence was already established that telehealth could help increase access to care, especially for marginalized populations. During the Covid-19 pandemic, the government restricted people’s movement and encouraged people to avoid contact with other people to control the spread of the virus (Monaghesh & Hajizadeh, 2020). Telehealth emerged as a solution because healthcare providers would provide health services and engage patients remotely. Despite the increased use of telehealth, it cannot be used exclusively because it is favorable in some conditions but can limit health outcomes in others. Healthcare providers should determine which services or circumstances can better be served using telehealth and which are better addressed using in-person patient visits (Gajarawala & Pelkowski, 2021). I agree that you can use telehealth to help patients manage their disease, educate them, and offer psychiatric evaluations.(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

References

Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The journal for nurse practitioners: JNP, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC public health, 20(1), 1193. https://doi.org/10.1186/s12889-020-09301-4(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Response to Classmate 2

Hi,

Your discussion is exciting and immensely informative. Telehealth is increasingly becoming integral to healthcare delivery as efforts to increase healthcare services access and reduce unnecessary in-person visits increase (Gajarawala & Pelkowski, 2021). I concur that, currently, it is impossible to use telehealth exclusively and should be used in conjunction with in-person patient visits to optimize results. Both approaches are effective in different situations and should be used together to complement each other. Indeed telehealth is beneficial, and legislative initiatives should push for further telehealth advancements, particularly to increase people’s capacity to use telehealth technologies through increased internet access in remote areas (Gajarawala & Pelkowski, 2021). Most patients I have also faced in my clinical have been through in-person visits. Still, I have had the opportunity to interact with telehealth platforms like video conferencing and patient portals, where I can communicate with patients remotely. I agree that telehealth reduces healthcare providers’ exposure to communicable diseases and Covid-19, which is still happening, though suppressed significantly (Monaghesh & Hajizadeh, 2020). I concur that you can adopt telehealth to increase access to care and improve disease management.  (Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

References

Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The journal for nurse practitioners: JNP, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)

Monaghesh, E., & Hajizadeh, A. (2020). The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC public health, 20(1), 1193. https://doi.org/10.1186/s12889-020-09301-4(Exclusive Use of Telehealth in Psychiatric Mental Healthcare Over in Person Visits)