The growing population of seniors can present challenges for access to psychiatric care in a rural state like Arkansas. The state’s shortage of psychiatrists is particularly acute in rural areas but bridging the gap are rural telepsych programs facilitated by the University of Arkansas for Medical Sciences (UAMS) Center of Distance Health.

One example is the River Valley Medical Center geriatric telepsych program in Dardanelle. Program Director Joe Hebert said in addition to helping patients receive the specialist care they need, it can also save money by preventing readmissions to the hospital’s inpatient geriatric psychiatric unit.

“When patients come out of the hospital, often family practice physicians do not feel comfortable adjusting psychiatric drugs,” Hebert said. “If the patient needs to be adjusted, or needs medicine switched or discontinued, no one is there to cover them. That could lead them back to the hospital for more treatment. Our program helps them transition from inpatient to outpatient services. This allows us to closely monitor the current treatment plan and prevent them from backsliding and needing readmission. The telemedicine program’s biggest benefit is that it can serve the rural communities and hospitals that need psychiatric coverage.”

Typically, patients have an in-person visit initially with a psychiatrist or physician’s assistant. This helps establish the provider-patient relationship and makes them more comfortable later on videoconferencing. However, some older people not used to having the television talk to them, can contribute to their confusion or delusions, says Hebert.

“However, it allows physicians to see how the patient is acting,” he said. “The physician can watch them interact with staff, and witness what is going on before the psychiatrist starts interacting with them. Some dementia patients are smart enough to mask their dementia. So it is a helpful tool to have direct supervision and monitoring without the patients knowing they are being observed. You get a true baseline.”

Teleconferencing allows the psychiatrist to observe if the patient is over-sedated or aggressive, which helps with medication adjustment.

Hebert finds that many community members, including physicians, are unaware that River Valley has both inpatient and outpatient clinical psychiatric services.

“Once I educate families about what we offer and do, that we don’t just lock up their spouse or loved one, they tend to love it,” Hebert said. “Most geriatrics feel like having a psychiatric condition is a big taboo. However, after they come and see that many of their peers are suffering with the same symptoms or conditions, they tend to be more compliant with treatment. It’s sometimes hard to get the older population to understand there’s nothing wrong, for example, with being depressed and getting medication to help with depression.”

The rural geriatric telepsych program is part of one of nation’s largest telehealth networks, said Roy Kitchen, business administrator for the Center for Distance Health, Arkansas e-Link Network and coordinator of the UAMS Consortium Project.

“We have a large geriatric population in these rural areas, and this technology allows them to connect to the network to get the care they need from doctors,” Kitchen said. “They don’t have to leave their facilities and travel. It is a means of bringing the physician to their patient.”

Previously, Medicaid wouldn’t allow billing for remote patient care.

“Before the bill passed that allowed billing for remote patient care, telemedicine was a hard sell because we had the capability and connectivity, but no mechanism for reimbursement,” Kitchen said.

Telemedicine may be particularly useful for dementia patients because telemedicine visits reduce chances of the patient becoming agitated, while also reducing exposure to viruses and the burden on loved ones from having to transport the patient long distances.

“They shouldn’t have to travel several hours one way when the appointment with the physician might only last ten minutes,” Kitchen said.

There aren’t enough psychiatrists in Arkansas.

“If we had 50 additional psychiatrists, we could keep them busy,” Kitchen said. “Law enforcement doesn’t know how to deal with psych patients. Typically, what happens is when law enforcement sees a patient acting irrationally, police officers aren’t sure what to do. Many times they do nothing, because if the patient is arrested, there are unlikely to be facilities in the jail to provide proper treatment. Not arresting them can also cause problems if the patient is acting in a way that could be harmful. That is where telemedicine can come into play because we have ability with software to connect with a psychiatrist remotely.”

Arkansas eLink is a statewide telemedicine network. It began with the Arkansas Neonatal Guidelines, Education and Learning System (ANGELS) consultative services and expanded to the Stroke Assistance through Virtual Emergency Support (SAVES) telemedicine program.

“Before we started SAVES, less than one percent of the population of Arkansas was getting declotting medicine for the brain after a stroke,” Kitchen said. “Now, with remote patient monitoring, at least 23 to 24 percent of the patient population are getting this drug.”

Some doctors and patients have found technical problems with teleconferencing. Kitchen said that using a program like Arkansas eLink where there is a network dedicated to video conferencing, avoids those problems. Other options, Kitchen said, are to increase broadband activity across the network to eliminate poor connectivity or give video conferencing priority on the network.

When physicians take calls at home, Kitchen recommends separate Internet connectivity with a static IP address with only the video conferencing unit running across it.

“The technology is there now where people can connect when, where and how they want to connect,” Kitchen said. The community needs to understand there is a statewide telemedicine network, anyone can ride across it, and it provides means to go to the doctor remotely. It is here and it needs to be used.”

For more information, go online to:

Arkansas eLink, Linking Health, Education, Research and Public Safety

UAMS Center for Distance Health

ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System)

AR SAVES, Stroke Assistance through Virtual Emergency System