Evaluating Clinical Outcomes in Patients Being Treated Exclusively via Telepsychiatry

BackgroundDepression and anxiety are highly prevalent conditions in the US. Despite the availability of suitable therapeutic options, limited access to high quality psychiatrists represents a major barrier to treatment. Although telepsychiatry has the potential to improve access to psychiatrists, treatment efficacy in the telepsychiatry model remains unclear. ObjectivesOur primary objective was to determine whether there was a clinically meaningful change in one of two validated outcome measures of depression and anxiety --the Patient Health Questionnaire-8 (PHQ8) or the Generalized Anxiety Disorder Questionnaire-7 (GAD7) -- after receiving at least 8-weeks of treatment in an outpatient telepsychiatry setting. MethodsTreatment-seeking patients enrolled in a large outpatient telepsychiatry service that accepts commercial insurance. All analyzed patients completed GAD7 and PHQ8 prior to their first appointment, and at least once after 8 weeks of treatment. Treatments included comprehensive diagnostic evaluation, supportive psychotherapy, and medication management. Results1826 treatment-seeking patients were evaluated for clinically meaningful changes in GAD7 and PHQ8 scores during treatment. Mean treatment duration was 103 days (SD =34). At baseline, 58.8% and 60% of patients exhibited at least moderate anxiety and depression, respectively. In response to treatment, mean change for GAD7 was -6.71 (95% CI -7.03, -6.40) and for PHQ8 was -6.85 (95% CI -7.18, -6.52). Patients with at least moderate symptoms at baseline, showed 45.7% reductions in GAD7 scores and 43.1% reductions in PHQ8. Effect sizes for GAD7 and PHQ8, as measured by Cohens d for paired samples, were d = 1.30 (P<.001) and 1.23 (P<.001) respectively. Changes in GAD7 and PHQ8 scores correlated with the type of insurance held by the patients. Greatest reductions in scores were observed among patients with commercial insurance (45.0% and 43.9% reductions in GAD7 and PHQ8, respectively). Although Medicare patients did exhibit statistically significant reductions in GAD7 and PHQ8 scores from baseline, these improvements were attenuated compared to those in patients with commercial insurance (29.2% and 27.6% reduction in GAD7 and PHQ8, respectively). Pairwise comparison tests revealed significant differences in treatment responses in patients with Medicare vs. commercial insurance (P < .001). Responses were independent of patient geographic classification (urban vs rural; P = .475 for GAD7 and P = .065 for PHQ8). The findings that treatment efficacy was comparable among rural and urban patients indicated that telepsychiatry is a promising approach to overcome treatment disparities that stem from geographical constraints. ConclusionIn this large retrospective data analysis of treatment seeking patients utilizing a telepsychiatry platform, we found robust and clinically significant improvement in depression and anxiety symptoms during treatment. The results provide further evidence that telepsychiatry is highly effective and has the potential to improve access to psychiatric care.