Telepsychiatry has the potential to improve access to psychiatrists, particularly in regions with low supply. However, according to a new study from the Institute for Clinical Evaluative Sciences (ICES) and Centre for Addiction and Mental Health (CAMH), telepsychiatry services in Ontario are currently underutilized and may not be supporting people with the greatest need for specialist mental health care.
Telepsychiatry is a real‐time consultation by a psychiatrist to a patient via secure videoconferencing, allowing treatment to occur when the psychiatrist and patient live in different parts of the province. There are fewer psychiatrists in rural areas of the province. Telepsychiatry is a way to provide access to the expertise of a psychiatrist in areas where few psychiatrists live and work. Existing evidence suggests that the need for access to psychiatrists is the same or greater for individuals living in rural and remote regions of Ontario compared to residents living in urban centres.
The study published today in Canadian Journal of Psychiatry is the first to examine the implementation and utilization of telepsychiatry in Ontario.
“This study is the first time anyone has looked at how telepsychiatry is being used across Ontario. This kind of evidence is needed to understand how telepsychiatry is currently being used, and how it can be modified and expanded to more effectively address access to care problems,” says Dr. Paul Kurdyak, co-author of the study, scientist at ICES and at CAMH, where he is also medical director of performance improvement, and director of health outcomes at the Medical Psychiatry Alliance.
The study looked at the psychiatrists delivering and the patients receiving telepsychiatry in Ontario to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalization.
The study found that in the fiscal year 2012‐2013:
- 3,801 people had a total of 5,635 telepsychiatry visits
- Seven per cent (138) of Ontario psychiatrists provided telepsychiatry
- Of the 48,381 people identified as in‐need of psychiatric care, 60 per cent saw a local psychiatrist, 39 per cent saw no psychiatrist, and fewer than 1 per cent saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry, within a year
- Three northern regions had more than 50 per cent of in‐need patients fail to access psychiatry within one year
“Our study found that while telepsychiatry offers an excellent opportunity to increase access to psychiatry, relatively few patients and psychiatrists use it. And patients have rarely accessed telepsychiatry for post‐hospitalization follow‐up,” says Eva Serhal, study author and manager of CAMH Telepsychiatry and ECHO Ontario Mental Health at CAMH and the University of Toronto. “Our findings suggest the need for improved planning, communication, and processes across the province to optimize alignment and utilization.”
Dr. Allison Crawford, director of the Northern Psychiatric Outreach program at CAMH and a study co-author, adds that “many urban academic centres want to act in a socially responsible way and address unmet needs across the province, but these results highlight the need to do so in an informed, integrated way that enhances the health system."
The researchers add that in light of the inequitable access to psychiatrists and mental health services within rural areas, it is pivotal that telepsychiatry is well planned and implemented, especially for those with high need. This study allows for a baseline to understand the present state of telepsychiatry, describing the current distribution and utilization of telepsychiatry services.
“Ideally, through the use of telepsychiatry, access to psychiatrists could be the same across Ontario no matter where psychiatrists work. We are falling far short of that ideal, and the current use of telepsychiatry is neither sufficient nor strategically directed to address need in regions with low supply of psychiatrists.,” adds Kurdyak.
This research is supported in part by the Medical Psychiatry Alliance (MPA), a collaborative health partnership of the Centre for Addiction and Mental Health (CAMH), the Hospital for Sick Children, Trillium Health Partners, the University of Toronto, the Ontario Ministry of Health and Long-Term Care and an anonymous donor. The MPA’s goal is to provide better access to, and coordination of, integrated health care services for patients living with co-existing mental and physical illnesses.
“Implementation and utilization of telepsychiatry in Ontario: a population‐based study,” was published today in the Canadian Journal of Psychiatry.
Author block: Eva Serhal, Allison Crawford, Joyce Cheng and Paul Kurdyak.
The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Twitter.
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