Scientific and Clinical Report Session 15: Information Technology

Two excellent presentations focusing on the Internet and telepsychiatry made up this session.

PSYCKES: Web-based Access to Medicaid Data to Support the Implementation of Best Practices in Pharmacotherapy in a Large Scale Quality

Matthew Perkins, MD, MPH

Perkins began the session, stating its objectives: participants “should be able to:1) Understand the different kinds of clinicallyrelevant information that are stored in Medicaid claimsdata; 2) Understand how PSYCKES aggregates clinicalinformation stored in administrative databases to supportclinical decision making and quality improvement; 3) Tolearn about the feasibility and impact of providing nearreal-time access to Medicaid data to clinicians and qualityimprovement staff.”

The New York State Office of Mental Health has implemented the Web-based platform PSYCKES for sharing Medicaid data with the hope of improving quality improvement at the state level, explained Perkins. The program consists of two “indicator sets: psychotropic polypharmacy (PPI), and cardiometabolic (CMI). It profiles performance and provides HIPAA-compliant access to client level data,” and was put in action to see if it could impact prescribing practices among 302 mental health clinics and 61 state-operated clinics that chose to use PSYKES to identify patients who met criteria for either CMI or PPI and then implement a quality-improvement program.

Among the 302 “freestanding” clinics, participation was 92%, with use of technical assistance resources included: 986 participants at 21 Webinars, 129 prescribers completed a web-based CME course, 326 help desk calls, and 10 clinic consultations,” explained Perkins. At 9 months, those clinics that chose a PPI program had identified “3,179 positive cases and changed medication regimens for 522 (16%) so that they no longer met PPI criteria. Clinics selecting CMI identified 1217 positive cases and changed antipsychotic medications in 260 (21%) so that they no longer met CMI

criteria.” Some clinics chose both PPI and CMI, identifying 169 positive cases and changing 51 (30%).

“Overall,” continued the speaker, “12% of clinics were able to change more than 50% of their positive cases, 15% changed between 30% and 49%, 39% changed between 10% and 29% and 31% of clinics changed less than 10% of their positive cases.”

The findings made by Perkins and his team lead to the conclusion that “providing Web-based access to Medicaid claims data to psychiatrists in mental health clinics as part of a quality improvement initiative can result in decreased rates of polypharmacy and decreased use of antipsychotics with moderate to high cardiometabolic risk in patients with cardiometabolic conditions.

International Telepsychiatry in Cross-cultural Related Mental Health Care

Davor Mucic, MD

Mucic explained the objectives of this session as allowing participants to “beable to recognize alternatives tointerpreter-provided care in cross-cultural settings.”

The speaker noted that since the early 90s, “Denmark faced significant barriers in providing mental health service towards refugees and migrants on their respective mother tongue,” as only few clinicians aren’t Danish and most treatment provided to these populations is provided using interpreters.

With the above in mind, an international telepsychiatry service was put in place, using video-conferencing equipment to connect the Swedish Department of the Little Prince Psychiatric Centre with two hospitals at four locations in Denmark. The idea was that the connection would increase “access to cross-cultural expertise that was more readily available in Sweden,” said Mucic.

From May 2006 to October 2007, 21 men and nine women were treated in a total of 203 telepsychiatry sessions (average, 6.8 sessions per patient) and asked to complete a satisfaction questionnaire.

“Patients reported a high level of acceptance and satisfaction with telepsychiatry, as well as a willingness to use it again or recommend it to others,” said the presenter, proudly. “Patients expressed a wish to use telepsychiatry via their mother tongue, rather than through an interpreter in the future.” The reasoning, Mucic feels, is that “direct contact via mother tongue allowed them to express exactly what they wanted to and no need for travel in order to meet a doctor who speaks the same language.”

In the study, Mucic believes that the lack of physical contact and restricted non-verbal communication of telepsychiatry was compensated for by the ability for patients to communicate in their own language and experience similar cultural and national references with the provider.

Mucic closed the session, concluding that “mentally ill asylum seekers, refugees, and migrants are under-served in their mother tongue. The telepsychiatry project was the first to serve such a specific patient populations. Furthermore, it was the first international telepsychiatry collaboration established in Europe. The results of the survey may contribute to changes in policy and routines within cross-cultural related mental health services worldwide.”