Doctors Making Virtual House Calls For Those With Special Needs
Aiming to ease the experience of visiting a doctor, a new program is allowing people with developmental disabilities to access medical and mental health care without leaving home.
In New York state, telehealth appointments in psychiatry started this fall through Premier HealthCare, part of YAI, a provider of housing and other services for people with intellectual and developmental disabilities.
“They have a hard time making appointments, they miss appointments,” Hope Levy, Premier’s executive director, said of individuals with disabilities. “(Telehealth) allows for consistency and continuity of care.”
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Although an initial diagnosis must be made in person under state law, patients in six residential homes can now video-chat with a mental health care provider for medication management and follow-up therapy. The service is available to any Premier patient in New York.
A direct service provider in the home helps the resident log on to the telehealth system through a computer. The software company Medpod provides data collection and securely stores the information.
In a recent pilot program geared toward lowering the rate of emergency room visits among people with intellectual and developmental disabilities in Long Island, N.Y., caregivers for 161 people living in group homes said 93 percent preferred the virtual appointments and had reduced anxiety, according to a 2018 survey by Medpod.
The plan is to roll out primary care and neurology appointments via computer in the next couple months, Levy said. For those appointments, a nurse in the residence will assist the provider in the clinic by taking the patient’s vital signs and performing other non-invasive tests.
The remote appointments are generally less expensive than an office visit and can fit better into a patient’s routine. Telehealth services are generally covered by Medicaid and private insurance plans, but not Medicare unless the patient lives in a rural area, Levy said.
Scheduling appointments outside of typical office hours and in a more comfortable, familiar environment is the main advantage of telehealth, said Elizabeth Ducat, a psychiatric nurse practitioner at Premier.
“Our patients often experience anxiety or agitation with long waits due to traffic issues or the clinic being overcrowded,” Ducat said. “They also need to sit in a large waiting room prior to the health care visit where they may be exposed to other patients exhibiting verbal or physical outbursts.”
It’s a modern version of the house call, Ducat said.
The patients Ducat sees on the computer screen are more relaxed compared to those in the clinic setting, she said. And she can get a better understanding of their baseline behavior when they are in their typical environment.
One disadvantage to telehealth is difficulty building a personal connection with the patient, Ducat noted. However, she said, some of those patients “may actually prefer less intimacy with their health care provider.”
While telehealth services specifically tailored to people with developmental disabilities are not widely available, some clinics now offer the service to children with autism. The Scott Center for Autism Treatment in Florida and Kids on the Move in Utah offer applied behavior analysis therapy via livestream.