Assessing the benefits and drawbacks of telehealth for tardive dyskinesia exams is critical as healthcare evolves to include both in-person and virtual visits.
“Telehealth, which typically involves real-time or store-and-forward audio, text messaging, or video communication, was recommended by the CDC in February 2020 as part of the federal response to the COVID-19 pandemic,” Rif S. El-Mallakh, MD, and colleagues wrote. “This uptake of telehealth was particularly evident in psychiatry: 81% of respondents to an American Psychiatric Association (APA) member survey indicated that they were continuing to use telehealth for 75% [to] 100% of patients as of January 2021.”
However, the potential benefits and drawbacks of telehealth are influenced by many factors, including clinicians’ concerns, patients’ needs, and the reason for the visit, whether it’s for an initial diagnosis, a follow-up visit, or an assessment of medication, according to the researchers.
Dr. El-Mallakh and colleagues convened a panel of experts to improve clinicians’ understanding of how telehealth can be used in the evaluation, diagnosis, and treatment of tardive dyskinesia (TD). The 12-member panel included neurologists, psychiatrists, and psychiatric nurse practitioners who participated in semi-structured interviews. The researchers then held two virtual roundtables to consolidate the findings from interviews and published their results in Telemedicine and e-Health.
Improving Outcomes for Patients
The panel indicated several challenges associated with a virtual TD exam, including issues related to technology, the inability to see a patient’s entire body, and difficulty
completing a thorough neurology exam. However, they also highlighted benefits, including fewer missed appointments, less time and cost required, and better access to family and caregiver feedback.
Providing clinician education about the differential diagnosis of TD “may be the best tool for improving patient outcomes, as this would ensure that TD is appropriately identified and treated with the right medications in both in-person and virtual settings,” Dr. El-Mallakh and colleagues wrote. “In addition, alignment within the movement disorder community, particularly with regard to terminology and diagnostic protocols, is needed to help multidisciplinary clinicians (eg, general practitioners) identify patients who have or are at risk for developing [drug-induced movement disorders]. Finally, open communication among patients, caregivers, and [clinicians] about the benefits, challenges, and best practices of telehealth for TD can facilitate effective virtual diagnosis and treatment.”
Ensuring Quality Care & Access in Tardive Dyskinesia
In their conclusion, the study team noted that “the future of psychiatric and neurological care may be moving toward hybrid models of care that balance in-office visits with virtual visits.” They provided suggestions to help ensure that patients with TD receive high-quality care.
“Future policy for telehealth should weigh the benefits and risks of audio-only telehealth, improve access to appropriate video technology during virtual visits (an estimated 45% to 50% of telehealth visits during the pandemic were audio-only), and safeguard continued access to and proper incentives for in-person visits,” Dr. Mallakh and colleagues wrote. “In addition, future studies should evaluate outcomes resulting from hybrid care delivery models. Finally, the development of new technologies, such as wearable devices or sensors, may enhance future virtual visits.”
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