In many rural areas of the United States, psychiatrists and addiction treatment specialists are few and far between. For AltaPointe Health Systems, a provider of mental health services in Mobile, Ala., virtual visits have become a key part of its approach to providing psychiatric assessments to hospital emergency departments, and now that telemedicine is being applied to opioid addiction treatment as well.
Sandra Parker, M.D., chief medical officer at AltaPointe, is dual-certified in adult psychiatry and child/adolescent psychiatry. In a recent webinar put on by the American Telemedicine Association, Parker described how AltaPointe got into telehealth several years ago. “We cannot attract many psychiatrists to Alabama,” she said. They have built a strong relationship working with residents from the University of South Alabama College of Medicine, so they try to retain those psychiatrists trained locally. But about five years ago, they decided to make telemedicine part of their strategy. AltaPointe had contracts with five hospitals in Mobile, but their psychiatrists would be driving back and forth to do consults, which soon became overwhelming for the physicians. In collaboration with health IT vendor Netsmart, AltaPointe created a setup with a telemedicine cart at in the hospital emergency department (ED) and one in the intensive care unit. Instead of driving from hospital to hospital, the psychiatrist does consults via telemedicine.
Now if the physician in the ED or in the ICU has a patient with a psychiatric problem, they can consult with the psychiatrist via an iPad. “The patients love it and the staff loves it,” Parker said. “If you are an emergency room doctor, you don’t want to be the one to say a patient can go home if they present with suicidal thoughts. In the old days, it might take three days for a psychiatrist to see that patient in person. Now they are usually seen after 30 minutes in a virtual waiting room. The hospitals like it because they don’t have to admit patients who don't need it.”
Over the past several years, attending psychiatrists have seen a huge increase in the number of patients presenting with SUD issues. A Harvard study a year ago looked at SUD patients by congressional district across the United States and two of the top five were in Alabama, Parker noted. “We have a huge problem here. In fact, we determined that about two-thirds of patients we do consults on have SUD and 15 percent are addicted to opioids,” she said. They decided to use the telemedicine system to do in-depth assessments of these patients who have a positive urine drug screen or said they were addicted or wanted help or came in with an overdose. “We are able to start engaging with those patients immediately to start to getting them off their opioid in the hospital, so then we can set them up with appointments at our outpatient clinics to start on Suboxone,” she said. “We have seen a huge increase in patients willing to start treatment in the hospital.”
This effort is providing the EDs with better access to addiction specialists and allows remote providers to use medication-assisted treatments (MAT) in the ED.
So what’s next for AltaPointe Health? Parker says they are engaging in a big project with a hospital two hours away, providing SUD consults to their hospital and educating residents on how to treat patients with Suboxone. The AltaPointe attending psychiatrist will go behind them and verify diagnoses and treatment recommendations. “Our focus is increasing access to opioid treatment. That will increase access tremendously,” she said.
