Rural Versus Suburban Primary Care Needs, Utilization, and Satisfaction With Telepsychiatric Consultation

The Journal of Rural Health (Impact Factor: 1.45). 02/2007; 23(2):163 - 165. DOI: 10.1111/j.1748-0361.2007.00084.x


 Context and Purpose: Rural and suburban populations remain underserved in terms of psychiatric services but have not been compared directly in terms of using telepsychiatry. Methods: Patient demographics, reasons for consultation, diagnosis, and alternatives to telepsychiatric consultation were collected for 200 consecutive, first-time telepsychiatric consultations at rural and suburban clinics. Findings: Rural patients were more likely than suburban patients to be younger than 18 years, using Medicaid, and needing treatment planning (lest they be referred out of the community). Rural patient and primary care physician satisfaction was higher than that of suburban counterparts. Conclusion: Telepsychiatry programs may enhance access, satisfaction, and quality of rural care.

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Available from: Christina Slee, May 12, 2014
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    • "While patient acceptance of telemedicine has been high (Gutske et al. 2006, Hilty et al. 2007), its adoption rate is likely to be slow without physicians willing to bring patients in (Hilty et al. 2007, Hu et al. 1999). Public and private reimbursement remains a concern as well, with a recent survey revealing that very few state Medicaid offices reimburse for telepsychiatry or other real-time encounters with physicians (Center for Telemedicine Law 2003). "
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    ABSTRACT: Introduction. Disease management modules (DMM), including education, tracking, support, and medical care, have improved health for patients with asthma and diabetes. For rural patients, novel ways of delivery are needed to access clinical expertise from urban or academic specialists. Telemedicine (telephone and televideo) could be instrumental in this process, though no randomized, controlled trials have assessed their effectiveness.Methods. Self-report and structured psychiatric interviews were used to screen potential depressed subjects. Subjects were randomized to: 1) usual care with a DMM using telephone and self-report questionnaires; or 2) a DMM using telephone, questionnaires, and monthly televideo psychiatric consultation emphasizing primary care physician (PCP) skill development. Subjects' depressive symptoms, health status, and satisfaction with care were tabulated at three, six, and 12 months after study entry.Results. There was significant clinical improvement for depression in both groups, with a trend toward significance in the more intensive module. Satisfaction and retention was superior in the more intensive group. There was no overall change in health functioning in either group.Conclusions. Intensive modules using telepsychiatric educational interventions toward PCPs may be superior, but the most critical ingredient may be administrative tracking of patients, prompted intervention by PCPs, and (when necessary) new ideas by a specialist.
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