Discharge planning from urban psychiatric facilities to rural communities using telehealth

Abstract

Coordinating care is of particular concern in Alaska due to expansive geography, difficulty of travel, and often limited behavioral health care resources. This study explored how individual, organizational, and systemic factors influence clinicians' use of video teleconferencing to conduct "live" discharge plans from urban psychiatric facilities to rural communities.

Semi-structured key informant interviews were conducted, in person and by telephone, with urban clinical staff (n = 10), urban administrative staff (n = 6), and rural outpatient staff (n = 14). Two researchers analyzed the transcribed interviews in a recursive manner using a grounded theory methodology.

Participants described infrequent, but generally positive experiences with live discharge planning: connecting patients to providers, temporarily joining treatment teams, evaluating patients for appropriate placement, engaging patients in their own care, addressing medication issues, and coordinating with family and village resources. Providers recommended hiring interns or dedicated staff, installing equipment "on unit," or using wireless tablets. Rural participants ascribed a greater value to emergency psychiatric consultations at admissions than coordination at discharge.

Continued selective use of live discharge plans is indicated with patient length of stay being an important consideration in determining feasibility. Future implementation should involve dedicated resources and use video teleconferencing to formally enhance other transitional services. Once issues of organizational readiness are addressed, a Knowledge-Attitudes-Behavior framework may be useful for managing providers' underuse. Future research could evaluate rural, village-based intensive case management supported by consultation with the psychiatric hospital via video teleconferencing.