Hybrid Models of Care Offer Treatment Flexibility

Despite an uptick in telehealth visits since the onset of the COVID-19 pandemic, some clinicians may still find occasional in-person visits necessary. How do clinicians balance the extra information and patient face-time gleaned from in-person visits with the accessibility of telehealth care? Ipsit Vahia, MD, associate chief of the division of geriatric psychiatry at McLean Hospital, recommends using a hybrid model that mixes in-person with virtual care depending on the patient and their current circumstances.

Dr Vahia recently spoke at the virtual Psych Congress Regionals on this topic and other frequently asked questions about the ever-evolving field of technology and telehealth. To stay up to date on more conference news, insights, and updates, visit our newsroom.

Ipsit Vahia, MD, is a geriatric psychiatrist, clinician, and researcher. He is medical director of geriatric psychiatry outpatient services at McLean Hospital and the McLean Institute for Technology in Psychiatry. He is also director of the Technology and Aging Laboratory. His research focuses on the use of technology and informatics in the assessment and management of older adults and currently, he oversees a clinical and research program on aging, behavior, and technology. He has published extensively in major international journals and textbooks.

Dr Vahia serves on the American Psychiatric Association (APA) Council on Geriatric Psychiatry and the Geriatric Psychiatry Committee of the American Board of Psychiatry and Neurology. He has served on the board of directors of the American Association for Geriatric Psychiatry (AAGP) and on the editorial boards of 5 journals including his current role as social media editor of the American Journal of Geriatric Psychiatry. He is a recipient of several prestigious awards including the 2016 AAGP Barry Lebowitz Award and the 2014 APA Hartford Jeste Award.

Read the Transcript:

Ipsit Vahia, MD: Hello, my name is Ipsit Vahia. I'm a geriatric psychiatrist. I serve as the associate chief of geriatric psychiatry at McLean Hospital in Belmont, Massachusetts. I'm also an assistant professor of psychiatry at Harvard Medical School and in addition to my divisional role, I serve as the medical director of the Institute for Technology and Psychiatry at McLean, and I'm also the director of McLean's Technology and Aging lab. I divide my time between patient care, administrative work and running my research lab.

Psych Congress Network: What is a hybrid model of care and where is it appropriate In psychiatry?

Vahia: A hybrid model of care is essentially providing care to someone where some of their carers provided in person and physically at a medical center or a brick and mortar clinic and some parts of the care are provided virtually through telemedicine or other digital platforms. A hybrid model basically implies that care should be provided to each patient in the format that suits their clinical need best, but is also tailored to their own convenience where we can, we're able to provide virtually based care when that's appropriate and physical in-person care when that's necessary.

Psych Congress Network: What are the pros and cons of hybrid models of care? Is telehealth or any other aspect of these models contraindicated for any disease states?

Vahia: The two plus years of the pandemic have in some ways taught us important lessons about what are the scenarios where in person care is essential and scenarios where virtual care is best suited. I think as such a good way to think about it is that you want to have the ability to see someone in person conduct a physical examination, even conduct a face-to-face interview, because having someone physically present allows a clinician to observe things other than just what you talk to them about. You can, for example, observe how they walk in the hallway. You might be able to observe how they interact with other staff members in a clinic space. You might be able to observe how they interact with their caregivers or another person accompanying them in ways that are difficult to capture virtually. The benefits of virtual care though tend to be more practical and it provides a degree of convenience.

For older adults, for example, in certain parts of the country, virtual care may allow them to have clinic visits while not having to negotiate things like weather or transportation or in a big urban environment. It often saves people time spent in traffic. We found that while there isn't an absolute indication or contra indication for virtual care versus in-person care in a hybrid model of care, if someone is showing signs of say, a tremor that needs a physical examination or if a clinician may decide that they want to physically inspect someone's medications to make sure that they have the right medications, if they want to observe gait, then an in-person visit may be important or helpful. We often recommend in-person intake visits for the first time someone is seeing their clinician because that sets a more accurate baseline understanding for the clinician. But for routine visits or follow up visits or especially for psychotherapy, virtual care may work just as adequately. So while every clinical condition in psychiatry may pose specific challenges that need an in-person examination or an in-person assessment, there are other scenarios for just about every condition where a virtual visit will do. Hence the idea of hybrid care where our clinicians and patients are able to switch from one to the other depending on what's best at a particular visit.