Virtual or In-Person Care? Factors to Consider

Patients can connect with a clinician with a few clicks on their electronic device from the comfort of their home or other private location. Patients with mobility issues, lack of reliable transportation, job and family care responsibilities, or those who reside in areas with no local psychiatric services are able to access essential care. Convenience not only increases access but can also decrease no-show rates—telehealth visits are associated with a 30% decrease in no-shows, according to a report in the August 2023 Journal of Urban Health. In clinic, it is easy to call patients, remind them of an appointment, and have them connect within minutes. Patients can receive care with minimal disruption to their work or school schedule, which can be valuable for reducing disparities in access to care.

The importance of patient comfort is worth emphasizing. At baseline, it can be difficult for patients to discuss suicidal ideation, hallucinations, end of life, and other topics that we must commonly address. The ability to attend an appointment from a place of safety and comfort—such as a bed or couch with personal belongings nearby—can help facilitate these tough conversations. Some patients, such as those with significant anxiety or a trauma history, may feel more comfortable seeing their clinician by telepsychiatry. However, clinicians should also provide guidance to patients about the importance of connecting from a private space, having no one else in the space unless they inform their clinician, and treating this visit as they would an in-person visit to achieve clinical objectives from the visit.

Obtaining collateral information is an important part of a psychiatric assessment. With patient consent, family members or other individuals can join the visit either physically or remotely from the same or different location. Connecting with patients virtually can also offer valuable insight into their home environment and family. We have been able to meet parents, siblings, children, significant others, and pets simply because they are present in the home.

Psychiatry lends itself well to virtual care, but clinicians should discuss with patients that there may be situations where it will be recommended that they come into the office, an emergency room, or other local facility. These situations include necessary blood tests, an urgent safety assessment, or certain parts of the patient examination. There may also be factors beyond the patients’ or clinicians’ control that can impact telehealth, including a poor internet connection, malfunctioning technology, or limited technological knowledge, and clinicians should prepare alternatives in case of common issues.

Some patients may prefer in-person care if they feel that they are better able to connect with their clinician when they are in the same room. Patients with limited technology access, comfort, or proficiency may also prefer or need in-person care. At this point, it is common for telehealth practices to offer only virtual visits, but practices should incorporate patient preference and offer both in-person and virtual visits at each point in the patient’s care. In a recent study, 32% of patients reported that they did not typically receive their preferred modality, and perceived lack of choice negatively impacted patient satisfaction with their care, according to a report in the September 2023 Health Affairs.

A thoughtful approach, including consideration of patients’ perceptions of and preferences in telehealth, allows us to provide optimal care to our patients. ■