Hilt Robert J, Barclay Rebecca P, Bush James, Stout Brenda, Anderson Nichole, Wignall Julia R
1 Seattle Children's PAL Program, Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.
2 Office of Health Care Financing , Wyoming Department of Health, Cheyenne, Wyoming.
Telemed J E Health. 2015 Jul;21(7):533-7. doi: 10.1089/tmj.2014.0161. Epub 2015 Mar 23.
Telepsychiatry has clinical efficacy with children, but questions remain about cost-effectiveness. State agencies and health systems need to know if a child telepsychiatry consult system can address system concerns and improve care quality while lowering costs.
To assist care in a rural state with few child and adolescent psychiatrists, an academic center coordinated a consult system of (1) televideo consults for high-needs children with Medicaid and state Multidisciplinary Team (MDT)/foster care involvement, (2) remote medication reviews for beyond guidelines prescribing, and (3) elective community provider telephone-based consults. Consult service data were collected and analyzed with Wyoming's Medicaid and Foster Care Divisions between the program start in January 2011 until March 2013.
There were 229 televideo MDT/foster care consults, 125 mandatory medication reviews, and 277 elective phone consultations supporting community providers during this period. Following implementation, the number of Medicaid children ≤5 years of age using psychotropic medications decreased by 42% (p<0.001), and the number of children using psychotropic doses >150% of the Food and Drug Administration maximum decreased by 52% (p<0.001). Televideo consults redirected 60% of children slated by caseworkers for a psychiatric residential treatment facility admission into alternative community treatment and placements. A financial return on investment was 1.82 to 1 for combined services.
This coordinated child telepsychiatry consult system for a state Medicaid division reduced outlier pediatric psychiatric medication prescribing, supported local community-delivered treatments, and reduced unnecessary hospitalizations in a financially advantageous manner that was well received by the practice community.
远程精神病学对儿童具有临床疗效，但成本效益方面仍存在疑问。州机构和卫生系统需要了解儿童远程精神病学咨询系统是否能够解决系统问题并提高护理质量，同时降低成本。
为协助一个儿童和青少年精神科医生较少的农村州提供护理，一个学术中心协调了一个咨询系统，包括：（1）为有医疗补助且州多学科团队（MDT）/寄养护理参与的高需求儿童提供视频咨询；（2）对超出指南规定的用药情况进行远程药物审查；（3）为社区提供者提供基于电话的选择性咨询。在2011年1月项目启动至2013年3月期间，收集并与怀俄明州的医疗补助和寄养护理部门分析了咨询服务数据。
在此期间，有229次视频MDT/寄养护理咨询、125次强制性药物审查以及277次支持社区提供者的选择性电话咨询。实施后，使用精神药物的5岁及以下医疗补助儿童数量减少了42%（p<0.001），使用超过美国食品药品监督管理局最大剂量150%的精神药物的儿童数量减少了52%（p<0.001）。视频咨询将个案工作者安排进入精神病住院治疗机构的儿童中的60%重新导向替代性社区治疗和安置。综合服务的投资回报率为1.82比1。
这个为州医疗补助部门协调的儿童远程精神病学咨询系统减少了异常的儿科精神药物处方，支持了当地社区提供的治疗，并以经济上有利的方式减少了不必要的住院，受到了实践社区的好评。
