Telehealth can improve access to care in the most isolated places—an obvious need in huge, sparsely populated Western states, but even in Rhode Island not everyone can get to the doctor easily.
“Everyone thinks everyone has access to a vehicle, and they don’t,” says Tracey Guthrie RES’99, MD, the director of the General Psychiatry Residency Program at Butler Hospital and an associate professor of psychiatry and human behavior. When, in addition to a car, you need a boat or a plane to see your physician, access really becomes problematic.
Until eight years ago any resident of Block Island—which lies about 13 miles off Rhode Island’s southern coast—who needed psychiatric care had to take a full day and multiple modes of transportation to get it. Then Brown’s psychiatry residency program launched a telepsychiatry service, a secure, two-way video link that connects a resident at Butler with adult patients on the island.
“I’ve been a patient of the program from its beginning,” says Patrick Tengwall, 63, who had been trekking to Barrington, RI, once a month to get his psychiatric medicines refilled. Compared to in-person appointments, he says, “it’s not that much different. … The relationship you develop with the doctor, I’d say, is more important than the medium by which you’re talking to the doctor.”
The telepsychiatry room in the Block Island Medical Center is cozy, with comfortable chairs and a couch. “It is like being in a counselor’s office,” Tengwall says. One major difference is the large computer monitor with two-way cameras. The other is the presence of the case manager, Tracy Fredericks.
Fredericks has been facilitating the program from the island since its inception. She’s there to connect the patient and physician, fix technical issues, schedule appointments, and fill out paperwork. Also, “I’m part of the [patient’s] support group,” she says. “They know I’m on the island and they know they can call me whenever.”
There’s a shortage of psychiatrists nationwide, particularly those who treat kids. Jeffrey Hunt, MD, the director of the Child and Adolescent Psychiatry Fellowship Program, is working to duplicate the telepsych service for his trainees. “Communities have developed workarounds. Most of the time, it’s the primary care docs who have had to figure out how to manage [adolescents],” says Hunt, a professor of psychiatry and human behavior.
With telehealth, one specialist can see more patients in more places, he adds. “It’s a more efficient way of treating people.”