Clinical and Information Services Needed by Telemental Health Providers

Abstract

Purpose:

To identify clinical and informational services that telemental health (TMH) providers need to be more successful in their practice.

Methods:

In February–March 2021, 472 TMH providers completed a cross-sectional survey. Providers indicated the degree to which they need clinical (e.g., build therapeutic alliances) and informational (e.g., learn about regulatory changes) services. Independent samples t-tests were conducted to examine differences in needs according to when telemedicine was adopted.

Results:

TMH providers neutrally-to-somewhat agreed they could benefit from clinical (M = 3.24; standard deviation [SD] = 0.78) and informational (M = 3.66; SD = 0.82) services. Prepandemic TMH providers reported a greater need for services that help them cultivate relationships with patients, monitor health conditions, and to remain updated about reimbursement processes.

Conclusion:

All TMH providers could benefit from information about the latest trends and best practices in telemedicine. Prepandemic providers could benefit most from policy-related updates and patient-engagement services.

Introduction

Telemental health (TMH) provides numerous benefits for patient access, provider convenience, and clinical outcomes equal to or better than in-person care.^1–5 More than 80% of mental health care sessions have been conducted remotely since the onset of the COVID-19 pandemic.^6,7 This trend is expected to persist, as 90% of TMH providers intend to continue using telehealth after the pandemic subsides.^6,8,9 Providers are most likely to continue using telemedicine after the pandemic if they are supported in becoming more successful with remote practice.¹⁰ However, little is known about the additional services that providers need to be successful in their TMH practice. The purpose of this report is to better understand the clinical and informational services that TMH providers believe they need to be more successful. There may be important differences in needs depending on whether telemedicine was an established health care delivery solution before the pandemic. Therefore, we also investigate the clinical and informational needs of TMH providers based on when they adopted telemedicine, in relation to the COVID-19 pandemic.

Methods

Data for this study were obtained in February and March 2021 from 472 TMH providers registered with Doxy.me, Inc., a commercial telemedicine company. We conducted a Web-based survey to measure providers' personal and professional demographics, as well as their duration of telemedicine use (before March 2020; March 2020 and later), the methods and results of which are reported elsewhere.¹¹ Seven survey items assessed providers' perceived need for services to support building patient–provider relationships, understanding patient needs, communicating with multilingual patients, and engaging patients in treatment, monitoring, and adherence (alpha = 0.82). Four items assessed the perceived need for informational services (e.g., telemedicine security, reimbursement considerations, trends/best practices, and online patient resources; alpha = 0.78). Providers rated their perceived need for each service on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The study was reviewed and deemed exempt by the University of South Florida Institutional Review Board (IRB No. 002053).

Analyses were conducted using SPSS v28 and listwise deletion procedures were used to manage missing data. We computed frequency statistics to describe the sample. Independent samples t-tests were conducted to investigate the relationship between the perceived need for clinical and informational services (dependent variables) and when providers adopted telemedicine in relation to the COVID-19 pandemic (independent variable). We conducted post hoc analyses to examine specific clinical and informational services needed according to each provider group.

Results

Providers were, on average, 53.19 years old (standard deviation [SD] = 13.16), predominantly female (n = 384; 81.4%), white (n = 380; 80.5%), and non-Hispanic (n = 430; 91.1%). Occupational titles included mental health counselor (n = 224; 47.5%), psychologist (n = 147; 31.1%), social worker (n = 67; 14.2%), and marriage and family therapist (n = 33; 7.0%). Providers commonly worked in an individual practice (n = 356; 75.4%) or small clinic/network of providers (n = 87; 18.4%), treated adults (n = 396; 83.9%), and received payment through private insurance (n = 312; 66.1%). Most providers (n = 319; 67.6%) reported adopting telemedicine before the pandemic, whereas the remaining 30.5% (n = 144) began using it during the pandemic.

TMH providers “neither agreed or disagreed” that they needed additional clinical services to make their practice more successful (M = 3.24; SD = 0.78). However, this level of need was statistically higher among providers who began using telemedicine before the pandemic (M = 3.38; SD = 0.84; SE = 0.08) as opposed to those who adopted telemedicine during it (M = 3.18; SD = 0.74; SE = 0.04), t (409) = 2.30, confidence interval (95% CI) = 0.03, 0.35, p < 0.05, Cohen's d = 0.25. Figure 1 shows that TMH providers who adopted telemedicine before the pandemic were more likely to report needing additional clinical services that would help them to: (1) build stronger relationships with their clients (p < 0.05; 95% CI = 0.03, 0.50; Cohen's d = 0.24); (2) understand their patients' needs before their appointment (p < 0.01; 95% CI = 0.08, 0.54; Cohen's d = 0.28); and (3) monitor clinical signs of conditions such as blood pressure (p < 0.05; 95% CI = 0.03, 0.50; Cohen's d = 0.23). The latter service (i.e., monitor clinical signs) received the lowest “need” score out of all services.

Fig. 1.

Perceived need of clinical services to support telemental care delivery. Error bars indicate SE; ESL; *p < 0.05 and **p < 0.01. ESL, English second language; SE, standard error.

TMH providers “somewhat agreed” that they needed informational services to increase the success of their telemedicine practice (M = 3.66; SD = 0.82). Figure 2 demonstrates the desired need for such services. Services to help them keep up with regulatory issues and best practices, and to make it easier to share online health resources with patients had greater priority than services to help them know what makes their telemedicine platform secure. TMH providers who began using telemedicine before the pandemic reported greater need for services that would help them keep up to date on regulatory issues (e.g., health insurance reimbursement; M = 3.86; SD = 1.08; SE = 0.10 vs. M = 3.60; SD = 1.07; SE = 0.06), t (409) = 2.30, 95% CI = 0.04, 0.49, p < 0.05, Cohen's d = 0.25. There were no other statistically significant differences in informational service needs according to when providers adopted telemedicine in relation to the pandemic.

Fig. 2.

Perceived need of informational services to support telemental care delivery. Error bars indicate SE; *p < 0.05.

Discussion

TMH providers believe they could benefit from services that provide the latest news and best practices in telemedicine. The perceived need for sophisticated clinical services to support patient engagement varies according to when providers began using telemedicine in relation to the COVID-19 pandemic.

Providers who adopted telemedicine before the pandemic reported a greater need for services to help them build relationships and understand their patients' needs before a session. Services to monitor clinical signs (e.g., blood pressure) received less priority, which may be due to growing, but still uncommon use of physiological measures in mental health therapies.^12,13 Self-expression and relational connections may manifest differently than in-person appointments, and more experienced TMH providers recognize the potential limitations that telemedicine can impose on therapeutic alliances.^14,15

Providers also desire services to help direct patients to reputable, reliable, and relevant online resources. While this acknowledges that TMH providers have found the internet as a useful health information resource, it also suggests that TMH providers may not have the time or skills to identify online health resources to benefit their patients.¹⁶ Future research is needed to understand how TMH providers use supplemental online resources during telemedicine appointments. Such inquiry could provide insight to future interventions or clinical solutions to improve the access and use of mental health information.

Providers want to be informed of best TMH care practices and regulatory concerns about reimbursement processes. However, a service to help TMH providers understand what makes their telemedicine platform secure received the lowest priority. TMH providers are most likely to select their telemedicine platform because it is Health Insurance Portability and Accountability Act (HIPAA) compliant, and receiving assistance with reimbursement processes is a predictor of continuing to use telemedicine in the future.¹⁰ Therefore, it can be concluded that providers have considerable trust in their telemedicine platform to maintain its privacy and safety features.

Providers who used telemedicine before the pandemic reported the greatest need for up-to-date regulatory information, including insurance reimbursement. This difference in provider needs may be due to the acceleration of telemedicine in direct response to the pandemic. Before COVID-19, coverage for telemedicine services was limited to specific locations, less than in-person services, and varied across regions.^17,18 TMH providers who had to navigate these policies before the pandemic would likely have more policy concerns than those who began using TMH after COVID-19, when coverage became standard and widespread.¹⁹ Health care providers often cite the complexity of insurance regulations as a major source of frustration.²⁰ Health care providers and researchers should continue advocating for solutions like telemedicine that help remove barriers to care.

This study has several limitations. This is a cross-sectional study and cannot be generalized to the entirety of the COVID-19 pandemic. Furthermore, this was a quantitative study, and we were unable to ask providers the contextual circumstances surrounding the desire for these services. This limitation brings attention to the value that a qualitative study would bring to better understand the support and services that would be useful to TMH providers.

In conclusion, there are important differences in TMH providers' needs depending on whether they began using telemedicine before or during the pandemic. More experienced TMH providers express the need for services to strengthen therapeutic alliances with patients and to understand their patients' needs before appointments. However, all TMH providers could benefit from services that keep them updated about the latest news and best practices in telemedicine. This study serves as a needs assessment for TMH providers, and results should pave the way for future advancements in telemedicine.

Authors' Contributions

S.R.P.: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing—Original Draft Preparation. T.O.: Data curation, Writing—Original Draft Preparation. H.W.: Methodology, Visualization, Writing—Original Draft Preparation. J.F.B.: Writing—Review and Editing. B.E.B.: Supervision, Writing—Review and Editing. B.M.W.: Writing—Review and Editing.

Disclosure Statement

B.M.W. is a shareholder, and all other authors are employees of Doxy.me, Inc., a commercial telemedicine company. The authors declare no other conflicts of interest.

Funding Information

B.E.B. was funded by the National Institute of Mental Health (Grant Nos. K23MH118482 and R41MH126734) and B.M.W. was funded by the National Cancer Institute (Grant No. K07CA211786).