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 1.Patients are identified by AVRC 2.Patients complete required forms. AVRC staff faxes/mails forms to UCLA 3.Registration information is forwarded to ISAP psychiatrist 4.AVRC mails copies of patients’ clinical information directly to ISAP psychiatrist. 5.ISAP psychiatrist conducts the session, completes dictations, and writes prescriptions 6.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. 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. Conclusions

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