Background

Though evidence for telepsychiatry shows good patient satisfaction, physician concerns regarding patient acceptability may impede implementation of such services. This quality improvement project improved understanding of physician attitudes toward telepsychiatry to facilitate expansion of telepsychiatry services at a large, multi-campus tertiary care health network.

Methods

A validated survey assessing family physician attitudes, beliefs, and use of telehealth was modified and emailed to all physicians in the Network’s departments of Emergency Medicine, Internal Medicine, Family Medicine, Pediatrics, and Psychiatry. “Users” were defined as those who used or referred patients for telepsychiatry in the last 12 months. Descriptive statistics compared users to nonusers and differences between departments.

Results

Fifty-three emergency physicians, 24 internists, 26 family physicians, 27 pediatricians, and 13 psychiatrists completed the survey (N=143). Overall, 29.7% of respondents identified as “users,” and 78.3% reported they would use telepsychiatry if it were available. Use was most common among emergency physicians (62.0%) and psychiatrists (61.5%). Many respondents indicated uncertainty; 32.0% of all responses regarding attitudes and beliefs were “I don’t know.” Most respondents felt telepsychiatry improves access to care (82.3%) and continuity of care (69.2%) while reducing patient travel time (50.8%). Most physicians felt that patients prefer to see their doctors in person (67.7%) and receive better quality of care in person (64.5%). Both users and nonusers identified lack of training (50.7%) as a barrier to telepsychiatry use, while the strength of telepsychiatry’s evidence base was of greater con sescern for users (88.6%) compared to nonusers (22.3%). A majority of psychiatrists (71.4%) reported concern regarding potential loss of personal contact associated with telepsychiatry, but only 31.4% of all respondents using telepsychiatry reported this concern. Seventy-nine percent of physicians answered “I don’t know” regarding adequacy of Medicare reimbursement and 54.4% for potential of malpractice lawsuits.

Discussion

Though physicians may consider telepsychiatry useful in improving continuity of and access to care, most contradicted current evidence by asserting it is not better than traditional care in terms of quality or patient satisfaction. Among departments, psychiatrists seem most concerned about the impact of telepsychiatry on therapeutic rapport, although this finding should be interpreted with caution due to measurement limitations.

Conclusion

Many Network physicians lack general knowledge of telepsychiatry, indicating a need for provider education. However, Network physicians appear to be open to using telepsychiatry despite existing perceived barriers. These insights will guide the implementation of pilot programs for tele - behavioral health consultations in the Network.