Improvement of postinpatient psychiatric follow-up for veterans using telehealth

Abstract

Purpose: To describe the implementation and initial outcomes of a pilot interdisciplinary telehealth clinic, Allied Transitional Telehealth Encounters post-iNpatient Discharge (ATTEND), providing clinical pharmacy specialist follow-up for veterans transitioning from inpatient to outpatient mental healthcare in a Department of Veterans Affairs (DVA) hospital.

Summary: The ATTEND clinic's primary intervention was providing medication management appointments through clinical video telehealth (CVT) to patient discharge locations through a DVA-provided tablet. An interdisciplinary team supported care through on-unit inpatient training, secure messaging, and self-help applications. Clinical outcomes were measured through readmission rates, wait times, self-report measures, and follow-up interview at the completion of ATTEND services. Twenty patients completed on-unit training, and 16 unique patients were seen for at least 1 outpatient appointment. Inpatient readmission rates were lower for ATTEND patients than with standard care (5% versus 19%, respectively). Wait times until first postdischarge mental health appointment were reduced by a mean of 18.6 (S.D., 8.8) days. The pharmacist made medication interventions, including dosing changes, education on incorrect administration, and medication discontinuation. Self-reported psychological symptoms decreased during ATTEND participation. Post-ATTEND interviews indicated high levels of acceptance and interest in continued tablet-based care. Primary challenges included unique technological limitations and effective care coordination.

Conclusion: The ATTEND telehealth clinic provided postinpatient mental health follow-up that was more prompt and convenient than conventional on-site appointments. Psychiatric self-report improved during ATTEND-facilitated transition to outpatient care, and the recidivism rate for ATTEND patients was lower than the general inpatient rate during the same time period.

Keywords: access; mHealth; mental health; remote; telemedicine; veterans.