Accelerated by the COVID-19 pandemic, telehealth has experienced an exponential increase in adoption over the past year. 20% of all medical visits in 2020 were conducted by telehealth; the number of patients reporting at least one telehealth visit grew by 57% and chronic illness patients’ use jumped to 77%. Among both patient populations, 86% say they had never had a telehealth appointment before. This dramatic rise in utilization has highlighted the value of telehealth across all medical fields – including but not limited to primary care, post-acute care, or behavioral care – and providers and patients alike have embraced telehealth services. Within the skilled nursing facility (SNF) setting, telehealth allows providers to continue care and maintain resident services while also preserving the safety of patients and staff. Telehealth has even been proven to lessen the experimental over-prescribing of unnecessary medications within the elderly community in SNFs.
Antipsychotic Use Within SNFs
SNFs have been closely watched – and subsequently in the news – for their use of high-risk and antipsychotic medications amongst residents. A 2018 report estimated that 179,000 people in U.S. nursing facilities are inappropriately given antipsychotic drugs, and a 2020 report estimated that 20% of residents received some form of antipsychotic medication, though only 2% of these residents were qualified to receive them. Though a CMS initiative has resulted in a decline in nationwide antipsychotics use amongst long-term care residents – from 23.9% in 2011 to 15.7% in 2017 – the inappropriate use of antipsychotic and other high-risk medications is an ongoing issue.
Impact of Telehealth Access on Medication Use and Reliance
There are immeasurable benefits of implementing telehealth services for behavioral health conditions amongst elderly populations within long-term care facilities. Increased access to care and behavioral health sessions via telehealth is correlated with better clinical outcomes and improved success with Gradual Dose Reduction of antipsychotic medications.
When examining SNF residents specifically, the use of behavioral telehealth services has been found to yield positive outcomes. In examining a population of more than 4,500 residents in over 50 skilled nursing facilities, approximately 1,350 residents received behavioral telehealth services that resulted in significantly reduced overall rates of inappropriate and unnecessary psychotropic medication use. These residents were treated regularly on at least a 90 to 180-day protocol of telehealth sessions, with an interdisciplinary team of psychologists and medical providers such as psychiatrists and nurse practitioners.
The patients’ interdisciplinary team was often able to discontinue high-risk medications such as antipsychotics and hypnotics, successfully transitioning to either less dangerous medications or to non-pharmacologic options such as talk therapy to safely and effectively manage behavioral health conditions. Reducing the use of high-risk medications such as antipsychotics in turn may reduce negative health outcomes – including falls with injury or other serious adverse drug events – thereby lessening unnecessary healthcare costs and improving quality of care for the elderly population.
Facilities within this studied cohort averaged 7.21% antipsychotic use – just half of the 2019 national average of 14.3% – by using behavioral telehealth services. In two states, cohort facilities’ rates dropped more than 70% below state averages. In every one of the cohort group facilities, clinicians were able to achieve and maintain results significantly better than the state average. In a subgroup of over 300 resident-patients within the overall cohort, antipsychotic use among long-stay resident-patients was even more pronounced, ranging from 32% to 64% reductions.
What the Future Holds for Telehealth and Antipsychotics
Looking to lower the overuse of high-risk antipsychotic medications within the elderly community is an increasingly critical initiative for SNFs. As families entrust their loved ones with well-rounded care, there should be a holistic care management approach that addresses the patient as a whole. Behavioral health conditions can be safely managed via telehealth services that allow for the minimization of high-risk medications – specifically antipsychotics. The reliable combination of greater access to behavioral health specialists, with a team that scientifically understands evidence-based treatment protocols, results in positive outcomes amongst a vulnerable resident-patient population.
Reducing riskier medications – and providing direct access to behavioral telehealth services and clinicians who understand the full spectrum of options and safer alternative medicines – should be a priority for SNFs. This can significantly reduce the overall rate of inappropriate and unnecessary psychotropic medication use and offer residents a better quality of life.
Jessica Badichek, PharmD, is chief informatics and compliance officer at MediTelecare, which provides telehealth services to skilled nursing and assisted living facilities. She is also a board certified geriatric pharmacist. Badichek completed her undergraduate studies at Fairfield University and received her PharmD from the University of the Sciences in Philadelphia.