A timely paper in Psychotherapy and Psychosomatics illustrates the importance of telemedicine during the COVID-19 pandemic.
Two leading experts, Dr. Jesse Wright and Dr. Robert Caudill, stress how due to the containment efforts for the COVID-19 pandemic requiring social distancing, health care providers are confronted with major challenges in delivery of care.
The use of telemedicine and other technologies represents a unique tool to overcome this major challenge. However, most clinicians have not used telemedicine as a routine part of their daily work.
In addition, several key administrative issues for implementation such as licensure requirements which usually dictate that the provider must be licensed in the state where the patient is located, malpractice insurance for telemedicine, status of insurance coverage etc. represent barriers to a rapid and broad implementation of telemedicine. For this reason, governmental agencies in the USA have issued an emergency waiver allowing the use of popular applications for video chats, such as Apple FaceTime and Facebook Messenger video chat.
Telemedicine is considered to be an especially good fit for psychiatric treatment and has been found to be effective, while reducing cost and improving access to care. There are no absolute contraindications; however, it is recommended that patients be assessed for suitability for videoconferencing and that emergency protocols be developed for situations such as heightened risk for suicide or aggression toward others.
Although telemedicine offers a great potential for delivering treatment during the COVID-19 pandemic, older technologies offer immediate and easy-to-use ways of providing care remotely. For example, research on telephone-delivered psychotherapy has found no decline in effectiveness compared to face-to-face therapy, in addition to an advantage for telephonic treatment in completion rates. Meta-analyses of computer-assisted cognitive-behavioral therapy (CCBT) for depression have found evidence for effectiveness.
Clinician support can be provided via telemedicine, telephone, and/or email, thus providing a useful alternative during the COVID-19 crisis. CCBT programs that have been studied in multiple randomized controlled trials and much more rigorously than mobile apps for behavioral health. Nevertheless, there are many apps developed by reliable sources such as the USA Department of Defense and university-based researchers that are showing promise in clinical use that could help patients manage anxiety and stress related to the COVID-19 outbreak.
Authors concluded pointing out that in a time of great uncertainty and danger, we need all the resources we can gather to help our patients and ourselves manage the crisis. New and old technologies need to be mustered without delay and put into action. Barriers such as confidentiality requirements, lack of technology expertise, and reimbursement issues need to be identified and solved with compassionate zeal.
Wright, J.H & Caudill, R. (2020) Remote Treatment Delivery in Response to the COVID-19 Pandemic. Psychotherapy and Psychosomatics. doi.org/10.1159/000507376.