Transcript PPT – Loretta Denering - UCLA Integrated Substance Abuse

Telepsychiatry for Patients with Co-morbid Psychiatric and Substance
Use Disorders.
A UCLA Integrated Substance Abuse Programs (ISAP) and
Los Angeles County Pilot Project
ADP Training Conference
Integration in the Field: County Initiatives
August 22, 2012
Sacramento, CA
Loretta L. Denering, M.S.
Project Director
Telemedicine/Telepsychiatry Overview
• Telemedicine: “the practice of health care delivery,
diagnosis, consultation, treatment and transfer of
medical data and interactive tools using audio, video
and/or data communication with a patient at a location
remote from the provider.”
• Has been in use for over 20 years.
• Telepsychiatry/Telemental Health is a potentially
important application of telemedicine (Rost et al. 2002).
• Telepsychiatry has been practiced within the University
of California (UC) system since the late 1990’s and since
1996 UC Davis has provided over 5000 clinical
consultations and has been awarded 10+ grants in this
area.
Telepsychiatry
Telepsychiatry allows the psychiatrist to meet with and
monitor patients via a secured web-based application.
Telepsychiatry is accomplished though the use of special software
and/or a freestanding mobile cart that includes a computer connect
to the Internet, a camera and a microphone.
Telepsychiatry
Studies thus far have demonstrated comparable levels of
efficacy compared to routine live clinical visits (Hilty et al. 2004;
Hyler et al. 2005; Norman 2006; Richardson et al. 2009).
Targeting Unmet Needs
• Research suggests that 33%-50% of patients in
substance use disorder (SUD) rehabilitation programs
often have co-morbid psychiatric problems (Drake et al.
2007).
• Very few rehabilitation programs (and even fewer rural
programs) have on-site psychiatrists (Hilty, 2008).
• This project started in April 2011 is an innovative
partnership between UCLA ISAP, the Los Angeles
County Department of Public Health and the Los
Angeles County Department of Health Services .
• Telepsychiatry services are provided for patients
admitted to the County operated Antelope Valley
Rehabilitation Center (AVRC) in Acton, CA.
Background: UCLA/AVRC
Telepsychiatry program
• The AVRC is located in the high desert of LA County
where access to psychiatric services is limited due to the
remoteness of the facility.
• Currently, UCLA provides psychiatric care to patients one
day/week (4 hours).
• Patients with severe and persistent mental illness (SPMI)
and are eligible for services via the LA County
Department of Mental Health (DMH) are transported to
a DMH-operated clinic in Palmdale.
• Patients in this project all have a DSM-IV-R SUD plus
significant psychiatric co-morbidity, but do not qualify as
(SPMI).
UCLA/AVRC Telepsychiatry Protocol
1. Patients are identified by the AVRC psychologist or
LCSW as appropriate to receive telepsychiatry
services.
2. Patients complete telemedicine information sheet,
telemedicine consent form, and multi-consortium
consent form. AVRC staff faxes via a secure line and
mails hard copies to UCLA Neuropsychiatric
Hospital.
3. Patient registration is processed and UCLA medical
record numbers are issued.
UCLA/AVRC Telepsychiatry Protocol
4. Registration information is forwarded via secure line to ISAP
psychiatrist.
5. AVRC mails copies of patients’ clinical information directly to
ISAP psychiatrist.
6. ISAP psychiatrist conducts the session and completes
dictations which are stored with the patients’ UCLA patient
record.
- Copies are sent via a secure line to the medical personnel
at the Acton facility for placement in the patient’s AVRC
file.
7. Prescriptions are written by the UCLA psychiatrist and filled
at a local Acton pharmacy.
Clinical Activities To Date
• As of August 1, 2012: 120 unique patients have been
registered and 106 have had at least 1 session.
• 71 diagnosed with Major Depressive Disorder (MDD)
• 5 diagnosed with Bipolar Mood Disorder
• 38 diagnosed with Anxiety Disorders (Generalized
Anxiety Disorder and Panic Disorder)
• 6 diagnosed with Psychotic Disorders (Drug-induced
psychosis vs. Schizophrenia)
• Using a low-cost medication formulary, psychotropic
medications are prescribed.
Outcomes Thus Far
Telepsychiatry Satisfaction Survey n=25
20
Number of Patients
15
10
5
0
Good Quality of Good Picture
Care
Quality
Strongly Agree
Good Sound
Quality
Agree
Prefers Face-to Mental Health
Face Sessions
Needs Met
Neutral
Disagree
Privacy
Respected
Able to Speak
Freely
Strongly Disagree
This project has also been well-received by UCLA and AVRC staff
Outcomes Thus Far
Telepsychiatry Overall Rating n=25
Outstanding
12%
44%
Good
44%
Adequate
So far, this project has resulted in a number of positive outcomes
including: a reduced barrier to access for those in remote areas and
an increase in efficiency for the AVRC and UCLA systems.
Next Steps
• We hope that improved mental health
outcomes will be noted as a result of the
continuous care.
• Other potential benefits include opportunities
for enhanced cultural competency (i.e.
increased interaction with traditionally under
served ethnic groups).
• A report will be written in the next year to
discuss SUD and mental health outcomes and
results of the satisfaction survey.
Thank you! Any Questions?
Loretta L. Denering, M.S.
Project Director
[email protected]