Dr Chris Pagnani: Bridging Gaps in Mental Health Care With Telemedicine

Chris Pagnani, MD, PC, is the medical director and founder of Rittenhouse Psychiatric Associates based in Philadelphia, and with the integration of telemedicine, his practice serves about 10,000 patients across Pennsylvania, New Jersey, New York, Delaware, and Maryland. In this interview with The American Journal of Managed Care^® (AJMC^®), he shares how telemedicine is transforming mental health care by making psychiatry accessible for patients, especially for those in health care deserts.

Transcript

Can you share an overview of how telehealth has impacted mental health care including the benefits and challenges?

The biggest change that's happened in the last several years really is access to mental health care. In many different areas, including just over the bridge from Philadelphia, southern New Jersey, and western Pennsylvania, there are a lot of rural areas or areas where there just have not been many mental health providers available, or even areas where there are no psychiatrists available. Or there have not been any psychiatrists available to patients within, let's say, an hour or 2-hour drive.

When I first started the practice about 12 years ago, 90% of my patients lived within a half an hour drive of Philadelphia, but almost every day, I would have at least 1 patient that drove an hour or even 2 hours to come to see me for their appointment. And so with the changes that have happened with telemedicine, now I'm seeing patients who live in a lot of those rural areas or areas several hours away from the city, and I can give them the same type of quality care that I would give them if they were sitting in my office, if they had taken a whole day off from work, for example, taken time away from their families, and also had to deal with those additional expenses for driving into the city for a couple of hours.

In terms of health equity concerns, how would you approach telehealth without compromising the quality of care for specific patients?

I very much believe that providers need to be diligent about individualizing care. There's no one-size-fits-all for all patients, and there are certain things that we're not able to do if we're seeing a patient via telemedicine. An easy example to understand is check a patient's vital signs. So in the past, if I was seeing patients only in the office, and let's say that I started them on a medication, there are certain antidepressants, for example, or medications that treat ADHD [attention-deficit/hyperactivity disorder] where I'm going to want to check their heart rate and their blood pressure.

Well now I have to be very diligent and say, you know if I can't do this over the screen, I need to make sure that I'm really making an additional effort to call this person's primary care provider to ask them, "Hey, when was your last physical examination?" And to ask them to get a blood pressure cuff to have at home and maybe check their blood pressure a couple of times a week before they take their medication, and maybe an hour after taking the medication to make sure there's no significant change.

So, I've had to put a little bit more thought into how I would handle those specific situations. But in general, patients understand. They know that you want to treat any medical condition or medications that you take and potential side effects very seriously, and they're able to take these additional steps to make sure they're still getting quality care.