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Mental health crisis eased through telehealth
Dawn Brazell | MUSC News Center | August 27, 2015

telehealth psychiatry
Sarah Pack 

Dr. James Simmons shows a teen how the telehealth system works as MUSC psychiatrist M. Frampton Gwynette listens in. 

Pediatrician James Simmons hides around a hallway corner at All Children’s Pediatrics in Port Royal and then jumps out to the delighted squeal from one of his young patients.

Chuckling, Simmons heads for his next appointment. That he loves children and has found the right calling in pediatrics is obvious. So is his love of using the latest in technological advances in the medical field, one reason he has entered into a partnership with the Medical University of South Carolina’s Center for Telehealth, participating in its Virtual Tele Consultation (VTC) program.

“My philosophy is if medicine is going someplace, we’d like to get there first.”

One way he’s doing that is at the click of a mouse, which allows him to connect to several MUSC pediatric subspecialists, ranging from dermatologists to nutritionists. One of the most popular specialties getting referrals is psychiatry.

telehealth VTC MUSCSarah Pack 
Laura Langston, MUSC's VTC program coordinator, travels to sites to do set up and training for partners enrolled in the program. 

Simmons loves knowing when he has a child struggling perhaps with developmental or mental health issues that he can get MUSC psychiatrist M. Frampton Gwynette on the phone for a telehealth conference. He did this recently with a child who was struggling in school. Simmons thought he should have a telehealth psychiatry consult, and the mother was willing to give it a try, especially since their therapist had left town and they hadn’t been able to find another.

The consult was set, and Gwynette met with the child, who has attention deficit disorder, and then with Simmons. Simmons and the mom both got a surprise when Gwynette told them the child was having suicidal thoughts. The two doctors worked in tandem to set up a treatment plan. The mother said he’s doing much better, and she’s so relieved she was open to trying it.

Simmons is, too. He sees telehealth consults as one more service he can offer to his patients, and in some cases, it can be lifesaving.

“It’s the future of medicine. It’s where medicine is going. As far as marketing, it’s a service line I can offer to my patients. It makes it easier for my patients. They can see a lot more specialists, and they don’t have to take the whole day going up to Charleston. They can just come in here for an hour.”

His patients are telling him they like it. “Professionally, I look for other avenues and ways to use telemedicine. I know I have more resources at my fingertips, and I’m more willing to make referrals to my patients. I think all the millennials will prefer using this.”

Simmons sees an increasing need for mental health services, particularly given bullying and anxiety he’s seeing teens experience from the influence of technology and social media in their lives. He likes the continuity in care that Gwynette provides because his patients can have a consult without having to leave their hometown and Simmons is involved in developing the treatment plan in tandem.

“Dr. Gwynette has allowed me to see things going on in my patients that I didn’t know at the time because he spends a lot more time talking with them. He educates me and then I can go right back in the room and talk to the parents and the child. We’ve actually made up treatment plans on the spot because of things he has told us.”

Telehealth Wave of the Future

Gwynette loves the setup, as well.

There is a big need throughout the state for adult and child psychiatry, and the hub of clinical services tend to be around big towns or big medical centers that can be hard to access for some patients. “And even a large metropolitan area like Myrtle Beach has surprisingly few psychiatrists in that area.”

telemedicine Dr. GwynetteBrennan Wesley 
Dr. M. Frampton Gwynette said he likes the ease of the telehealth consultations. 

The state in general struggles to fund mental health services, he said. With scarce resources in this area and the resources being mostly being concentrated in big cities, telehealth enables providers to do a “180 with that model” so that access to care is more evenly distributed. In this sense, telemedicine becomes a great equalizer because just about every child has a primary care doctor, he said.

Gwynette sees this as a win-win scenario, especially since recent research shows that telehealth is just as effective in terms of treatment success as in-person office visits.

MUSC Center of Health Disparities Director Leonard E. Egede, M.D., was lead study author and principal investigator on a study recently published in The Lancet that received special commentary. It was the first, large randomized clinical trial showing that telehealth is equivalent in terms of treatment success to in-person office visits at one year post-treatment. 

Egede said that telehealth can offer a way to address mental health concerns without adding additional trips to the doctor’s office and in a setting where patients feel comfortable since it is often new and sometimes difficult to discuss topics like distress and depression. “This is one way we can try to increase access to mental health treatment and improve the mental health of Americans.”

The Centers for Disease Control and Prevention reports that 8 percent of the U.S. population (12 years and older) reported depression in any given two-week period. Depression was more prevalent, however, in those 40 to 59 years old. Unfortunately, only 35 percent of those reporting severe symptoms also reported seeing a mental health professional. 

“I treat a lot of older adults with diabetes. People with diabetes are twice as likely as those without diabetes to develop depression, so it is something I take into consideration every time I see a patient,” Egede said. “As depressive symptoms increase, people often lose interest in taking care of themselves and their diabetes becomes worse. The stress of managing diabetes can also increase depression and if left untreated lead to severe complications like amputations, heart attack, and stroke. It’s important for people to be aware of the symptoms of depression so they can seek care for themselves, or help those they love find appropriate care. Depression can be treated, but finding help is often the first step.”

Sarah Pack 
Dr. Samir M. Fakhry predicts telehealth will continue its fast growth. 

Samir M. Fakhry, M.D., chief of general surgery at MUSC and medical director of VTC, said some specialties seem particularly suited to telehealth and psychiatry is one. Founded by Fakhry in September 2012 with funds from a Duke Endowment grant, the VTC received 1,322 referrals as of August 2015. There have been consults done in almost 20 subspecialist areas, with more coming on board each month through the VTC. Psychiatry is one of the fastest growing areas. There have been almost 251 psychiatry referrals since that specialty was added November 2014.

“There is undoubtedly a mental health crisis in the US. We’re seeing the need for mental health services increase at a much faster pace than the resources available to give people the help they need,” Fakhry said. “In fact, the number of suicides in America has reached a record amount. There are more than 38,000 suicides per year in American right now. That’s twice as many as homicides.”

If a person is depressed or coping with other mental health issues, not having ready access to care can pose insurmountable barriers.

“If someone is in a crisis, the sooner you can get them some help, the better,” Fakhry said. “It may not be all they need, and it may not be the total package, but it would be the beginning of a conversation. It may provide an opportunity to buy some time for the very serious cases, and it may be an opportunity to turn around the less serious ones without them having to come in.”

It also keeps patients from falling through the cracks.

A 15- to 30-minute office visit with a general physician doesn’t leave much time to discuss mental health concerns. Gwynette recalls some telehealth sessions when he felt his heart rate speed up because he knew he was seeing a child who was bright enough to mask developmental and social issues. Gwynette, who has expertise in treating children on the autism spectrum, knows an early diagnosis and intervention can be critical to helping this population. It’s rewarding for him to work with the parents and pediatrician to find better support for these children.

The pediatricians and primary care physicians generally are on the right track, he said. “They know the symptoms, but saying they all point to one diagnosis is where I can help.”

Another important advantage of telehealth is continuity of care.

“There’s nothing missing. It’s so seamless. I’ve been really jazzed about the ability to talk to the patient care providers in real time, and I love being able to tell patients that I just talked to their doctors. Their eyes say this is how it is supposed to be. I’ve been excited about it, and I think we have good feedback from primary doctors that it is a win/win,” he said.

“We are sitting here in Charleston, and we are able to go out and help those we have been trying to reach and then those in the smaller towns are feeling like they have access to a tertiary care center. We’re in it together. It’s been a really great fit.”

Back Pocket Specialists

It’s been a great fit for Sarah Allen, M.D., of Waccamaw Community Care in Myrtle Beach as well.

The MUSC alumna was very interested in getting telehealth, but particularly in the area of psychiatry, where the wait for a psychiatrist in her location can be several months. She contacted Laura Langston, VTC coordinator, and in two weeks she was set up and had made her first referral. She’s been using it since April, and said it’s like having specialists in her back pocket she can use as needed.

“I love it and am a huge believer. I talk to Dr. Gwynette once or twice a week. I can’t say enough good things about it. There is no other real-time communication with another provider, feedback for the patient and such a collaborative feel. There is nothing else like that in anything I do in the outpatient community setting.”

Allen, who left MUSC to set up her private practice, said she missed the network of support she had as a physician in an academic medical center and has found telehealth lets her recapture that sense of interprofessionalism.

“For me to be able to talk to a psychiatrist in real time and have him say, ‘I think you are on the right track. Here is something else I would consider, and I am happy to see your patient again to follow up and see if the changes we have implemented are working,’ that’s such a blessing.”

Dr. Allen telemedicine psychiartry
Sarah Pack
Dr. Sarah Allen finds telehealth is a good fit for her private practice. 

She now can help those patients who didn’t pose a danger to themselves or others, but who still had a much lower quality of life than they could if their mental health issues were being addressed. She knew that some of those patients would never travel to see a psychiatrist, but they would consider doing a telehealth appointment.

“They get appropriate management in a timely manner and that has been the best thing for me.”

She also benefits in the long run because it allows her to learn more about subspecialty areas. Allen said she looks forward to expanding to other areas as well, including rheumatology, endocrinology and gastroenterology.

Fakhry, who does telehealth surgical consults, said telehealth is changing the way medicine is practiced in good ways. “Many of my referring doctors are people I haven’t met or would never meet. But now that I’ve begun interacting with them via telemedicine, I can put a face to the name.”

The VTC team will be rolling out a pilot project for general surgery for adults and children in a few months that will allow patients who are receiving surgery referrals to get a telehealth consultation with a surgeon within 60 to 90 minutes versus having to wait two weeks. “That wait can seem like forever,” he said. Under the pilot model, a patient can speak to a surgeon sooner and find out what’s involved, what the benefits and complications might be and how to get printed and video resources to help them make a decision.

For example, there’s a video for gall bladder surgeries. “For the brave patient who doesn’t mind watching a video, we can show them how the modern version of gall bladder surgery is done laparoscopically.”

The rapid development of telehealth nationally is being patient-driven. The VTC has nearly tripled the volume of consults it receives since being included in the MUSC telehealth system, and the number of specialties it offers its partners continues to rise.

“People are using technology so well that we’re bound to find out how to make it work to deliver better patient care. If you believe access to health care improves the quality of your life, then telehealth is an important tool to put in the mix,” Fakhry said. “I can only imagine us looking back in 10 years and asking why didn’t we think of this sooner. Instead of bringing the patient to us, we’re now bringing the care to the patient.”

That doesn’t mean that there’s no reason for in-person visits. It just means physicians will need to weigh what services to provide in which way. In many ways, telehealth offers substantial savings without sacrificing quality.

“It’ll decrease suffering and the cost of care, and I don’t think it’s going to do this at the expense of anything else,” Fakhry said, pausing as he tries to think of any downsides. “We might lose a little money on parking. I hope we do.”




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