Turning to telehealth

COEUR d’ALENE —  An increase in need for services led Kootenai Health’s adult inpatient behavioral health unit to recently transition to using virtual physicians and advanced practice providers.

Dr. Karen Cabell, chief physician executive, said it ultimately means more timely and faster access to care.

“We’re able to care for more patients,” she said.

In 2022, to help solve coverage challenges, Kootenai Health began using a hybrid model of care, some in-person providers and some virtual.

But that alone was not the answer.

“Moving fully to virtual care will create a centralized response and capacity to care for more patients in a timely manner,” according to a statement from Kootenai Health.

The virtual care model with Access Telecare will include a medical director and core providers who will work specifically for Kootenai Health across the adult continuum, including the adult inpatient behavioral health unit. 

Access Telecare already provides behavioral health services in Kootenai Health’s emergency department, medical surgical unit, transfer center and evening coverage in the adult behavioral health unit. 

The virtual care model is also in use in Kootenai Health’s behavioral health youth acute unit.

The change to virtual care resulted in a reduction of four positions. 

Cabell said a shortage of psychiatrists nationwide was identified about 12 years ago. Even as the number of psychiatric resident programs was expanded, it couldn’t keep pace with those leaving the field to retire or work elsewhere as behavioral health concerns rose across the country.

That sparked a national move toward telehealth that grew during the COVID-19 pandemic and has since continued.

According to Becker's Behavioral Health website, the U.S. may face a shortage of 54,100 to 139,000 physicians by 2033, and access to care in every specialty, including mental health services, is a national issue. 

Nationally, there are about 57,000 practicing psychiatrists, according to the Becker's site. It said 10 states were considered to be officially designated health professional shortage areas due to a lack of mental health providers, with Idaho being No. 1.

Idaho has one psychiatrist for every 16,294 people, Becker's Behavioral Health reported. In comparison, Massachusetts, the state with the most psychiatrists per capita, has one for every 2,377 people, Becker's reported.

Kootenai Health, as a regional center for behavioral health, has seen service requests rise from throughout North Idaho.

Through Kootenai Health's transfer center, 56 transfers were accepted and 237 were not taken due to capacity issues.

Over the past 12 months, Kootenai Health cared for 665 adults hospitalized for behavioral health.

"In other words, we cared for 665 patients, but there were another 237 who needed care but we could not accept," wrote Kim Anderson, Kootenai Health spokeswoman.

Patients might be facing stress, anxiety, depression or schizophrenia. Their treatment could include a supportive environment, medication management and group therapy. 

Telehealth is a growing part of the equation with the goal "to discharge the patient safety back into the community."

Kelly Espinoza, chief nursing officer, said they are also seeing an increase in people coming in with physical issues, but also “significant behavioral health needs."

She said a chronic or acute condition that brought them to the hospital in the first place can exasperate their mental state.

"Virtual care consultation has enhanced our ability to treat the whole person," Espinoza said. “We can connect with more patients quickly."

Sandy Mueller, Kootenai Health director of behavioral health services, said telehealth has been used in a variety of areas at Kootenai Health for some time. 

Mueller said telehealth creates a centralized system that's critical for patient success.

“The continuity of care is extremely important," she said.

Telehealth is widely used in more remote, rural areas where transportation can be a challenge, Mueller said.

“It’s not unfamiliar for many people to be getting psychological support through telehealth across the nation,” she said.

According to the nonprofit Mental Health America, Idaho ranks 42nd in access to mental health care and 39th in prevalence of mental illness, meaning it's among the highest, and 50th for youth who have higher prevalence of mental illness and lower rates of access to care. 

Nationwide, 54.7% of adults with a mental illness do not receive treatment, totaling over 28 million individuals, per Mental Health America. 

"This is a problem everybody is trying to solve right now," Anderson said. "Everyone is looking at creating ways to open access so people who need it can get the care they need.”

Cabell said Kootenai Health will be reviewing its models of care.

"We’ll continue to evaluate it and make sure we have a high-quality service that we’re able to keep as many patients from Idaho in Idaho for their care,” she said.