There has been much controversy in the lay press in the last six months or so regarding telehealth as a tool for addressing the behavioral health crisis. Much of the conversation has centered on whether a video consultation with a behavioral health provider is of sufficient quality to allow decision-making regarding prescribing psychiatric medications. There’s also the question of whether an in-person visit should be required before a provider can prescribe a controlled substance to a patient, creating a further barrier to care.
Interestingly, as far back as 2005, this was reviewed in a meta-analysis that concluded that telepsychiatry was no different from in-person care in terms of accuracy and satisfaction.
Fast forward to present day, and several companies have been maligned in the mainstream media for overprescribing psychiatric medications, particularly stimulants for attention deficit hyperactivity disorder (ADHD). Most notably, Cerebral, Inc. had extensive negative coverage last year on this issue. The main focus of the media’s reporting was the company’s controversial marketing to adolescents through social media, a certainly indefensible and later corrected practice.
However, many of these same news stories also called into question the notion that a provider could effectively care for individuals with behavioral health disorders using virtual tools. We must not impeach the entire practice of telehealth for the errant behavior of a few.
Yet, many reputable publications and news outlets piled on. A Wall Street Journal article published on August 20, 2022 stated several times that the person featured in the story could get stimulants prescribed “with only a video call.” The article implied that telehealth was somehow complicit in this gentleman’s poor outcome following that prescription.
But perhaps the tide is turning? Are we, as a society, starting to understand the value of telehealth in delivering necessary care to people whenever and wherever they need it? Are healthcare providers learning to address the needs of challenging patient populations, including those requiring the virtual management of controlled substances? Are patients seeking virtual care sooner because it is more convenient and accessible and because it is helping to improve our health and our lives?
On August 27, 2022, the New York Times published an extensive piece on excessive prescribing of psychiatric medications to an adolescent, but telehealth was not mentioned. All this person’s interactions were office-based.
That’s right; it’s just not virtual care that can sometimes get it wrong.
While pondering this, an important new peer-reviewed research paper appeared, showing that telehealth services during the pandemic correlated with improved medication retention for opiate use disorder (MOUD) and a lower incidence of overdose. Thus, for opiate use disorder, it seems that telehealth is not only adequate but maybe even improves outcomes!
So, might it be that it’s just not in-person care that can get it right?
Then, on the flip side, a few days ago, the Wall Street Journal again reported on the ADHD issue but noted that overprescribing might occur in the context of both office-based care and telehealth.
These examples and clinical studies seem to indicate that both in-person and virtual care can be of variable quality. However, I think we can safely conclude:
- The practitioner should be able to decide if she gets enough information from a telehealth encounter to make a diagnosis and devise a care plan.
- We needn’t hold telehealth to a higher standard than in-office care.
I know many of you have strong opinions on this issue, and I’d love to hear from you.
This piece was written by Joseph Kvedar, MD, Senior Advisor of Virtual Care at Mass General Brigham, and Professor of Dermatology at Harvard Medical School. It was originally published on his blog page, Reinventing Healthcare.
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