Dr Chris Pagnani: Telemedicine as a Tool for Better Mental Health Care Access

Chris Pagnani, MD, medical director and founder of Rittenhouse Psychiatric Associates in Philadelphia, emphasized the benefits of telemedicine and its role in improving accessibility, particularly in the realm of mental health care.

Through the incorporation of telemedicine, Pagnani's practice extends its services to around 10,000 patients across Pennsylvania, New Jersey, New York, Delaware, and Maryland. In a previous interview with The American Journal of Managed Care^®, Pagnani discussed how to approach telehealth without compromising the quality of care.

Transcript

With the increasing utilization of telehealth, how do you decide what cases necessitate in-person counseling compared with those that could be done effectively in virtual appointments?

There definitely are certain patients and certain types of illnesses that I do believe may really benefit from in-person, in-office visits. And some examples of that would be many individuals who struggle with addiction, with substance use disorders, whether it's alcoholism, benzodiazepine use, or opioid use, some individuals who may have a history of psychosis—or you're worried about them developing schizophrenia, or having schizophrenia, for example. And then individuals who are in crisis, or you're concerned about safety.

Eating disorders is another one where when you see someone face-to-face, it's easier to say, “Oh, have there been significant changes in their appearance in the last month or in the last several months,” and sometimes it's a little bit harder to assess that across the screen. You may need to rely on self-report, and for some individuals, they may not always be as honest as you would like, or they might be hiding something, particularly if they are actually concerned, for example, about gaining weight. So that's a good example.

With all that being said—because telemedicine has really increased access for a lot of individuals, we'll have people call the office, and they'll say, “I have difficulty with alcoholism; I have difficulty with these specific symptoms, and I understand that I would probably, in an ideal world, be seeing someone face-to-face in the office. Well, I don't have a local provider and I really can't afford to come in,” they could—and they often—work and drive 3 hours and see you. “Will you see me by telemedicine?”

Sometimes the providers have to be a little bit flexible and understand, well, this person getting this type of care—which they're telling me, and I believe, they're unable to do or would be very difficult for them to do within an in-office visit—well, they're going to be better off getting treatment from me. I just need to make sure that I go out of my way to be thoughtful about their care, and if I need to spend more time talking with the family, collaborating with their other providers, or taking other measures to make sure they're getting quality care, I'm just going to have to do that.