Presented at: Addiction Health Services Research Conference, Portland OR

1. The Impact of Telepsychiatry for Patients with Co-morbid Disorders at a Rural County-Run Residential Treatment Clinic Presented at: Addiction Health Services Research Conference, Portland OR Desiree A. Crevecoeur-MacPhail, Ph.D. October 2013

2. Telemedicine/Telepsychiatry Overview • What is Telemedicine? • “the practice of health care delivery… 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 practiced by UC system since the late 1990’s • Since 1996 UC Davis has provided over 5000 consultations

3. Telepsychiatry Allows the psychiatrist to meet with and monitor patients via a secured web-based application.

4. 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).

5. Project ECHO (NM) • Used telemedicine extensively • Ophthalmology • Pediatrics including asthma care • Allows neurosurgeons and neurologists to consult with rural hospitals • Provide audiology services • Train and obtained certification for over 100 physicians to administer buprenorphine

6. Targeting Unmet Needs • As much as 33%-50% of patients in substance use disorder (SUD) 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).

7. Current LA County Project • Started in April 2011 • Collaboration 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.

8. Background: UCLA/AVRC Telepsychiatry program • The AVRC is located in the high desert of LA County • Patients with severe and persistent mental illness (SPMI) and are eligible LA County Department of Mental Health (DMH) • Other patients with less severe symptoms are seen by UCLA psychiatrist • UCLA provides psychiatric care to patients one day/week (4 hours)

9. UCLA/AVRC Telepsychiatry Protocol • Patients are identified by AVRC • Patients complete required forms. AVRC staff faxes/mails forms to UCLA • Registration information is forwarded to ISAP psychiatrist • AVRC mails copies of patients’ clinical information directly to ISAP psychiatrist. • ISAP psychiatrist conducts the session, completes dictations, and writes prescriptions • AVRC picks up prescription at local pharmacy

10. Clinical Activities To Date • As of October 1, 2013: 171 unique patients have been treated. • 66% - Depressive Disorders • 28% - Anxiety Disorders • 6% - Psychotic Disorders • Using a low-cost medication formulary, psychotropic medications are prescribed.

11. Patient Characteristics (n = 171)

12. Telepsychiatry Patient Satisfaction

13. Prefers Telepsychiatry • Those who reported that they preferred telepsychiatry differed somewhat by primary drug • Methamphetamine = 61.5% • Alcohol = 55.2% • Opiates = 50% • Marijuana = 33.3% • Cocaine = 28.6%

14. Staff and Patient Comments Staff: • Prefer the faster timeline for patients to be seen versus Department of Mental Health • Appreciate being able to have case conferences with Dr. Dickerson Patients • Easier to talk to the TV than in person – less pressure • Like that they do not have to travel

15. Conclusions • This project has resulted in a number of positive outcomes • Reduced barrier to psychiatric • Increased access to psychiatric care and prescribed medications • Patients like it • Other benefits include opportunities for enhanced cultural competency (i.e. increased interaction with traditionally under served ethnic groups) and inter-and intra-agency collaboration.

16. Any questions? Desiree A. Crevecoeur-MacPhail, Ph.D. desireec@ucla.edu 310-267-5207