Themes and quotes from patient, psychiatrist and staff interviews
| Example quote from patient | Example quote from psychiatrist/clinic staff | |
| Advantages to telepsychiatry | ||
| Relative advantage over in person care | ‘Honestly, I probably would opt for the virtual care, just because I mean, gas prices are going up. And a lot of the time these appointments are pretty far away from where I'm living. So that’s probably one good reason why, is just to save money’ | ‘Patient doesn't have to spend a lot of time and money to travel in, doesn't have to worry about childcare as much or leaving their own support system…you know, getting a hotel or something like that…So from that perspective… it’s time and money saving … I think I think it just helps with broader access.’ |
| Ease of use | ‘I guess I'm just kind of used to video calls at this point and with other stuff, so it just seemed pretty easy to log in and then have the doctor log on, too.’ | ‘I think for some of them who are a little more tech savvy, it can be easier. And some of them have already used MyChart before. So, they know how it works.’ |
| Barriers to telepsychiatry care | ||
| Technology | ‘And then also, just sometimes, like the internet difficulties, can just cause a little bit of frustration, you know, if it cuts in and out, you know, while you're trying to have a meaningful conversation, it can be frustrating.’ | ‘… the hesitation might be around not being familiar with the technology, .Fear about security surrounding the technology.’ ‘I think the one disadvantage is you lose maybe a little bit of the personal contact.’ |
| Preference for in person care | ‘I'm not getting that person-to-person connection. I'm not being able to fully read the body language of the other person.’ ‘I guess the communication…the body language and just knowing facial expressions …it’s a little bit more personal when you're in person.’ | ‘I think sometimes it can be a bit limiting, right? Like, I can't ask them to get labs that same day …for example, I want to get a urine drug screen or some other labs that I'm concerned about.’ |
| Barriers specific to perinatal context | ‘I think the only other thing that was kind of a snag for me with all this was that at first with my hectic life right now. I couldn't even figure out what this appointment was for, at first.’ (patient who did not attend appointment) ‘… our apartment flooded. And then we've been homeless, and it’s just it’s been extremely overwhelming and crazy…out here I don't really know anybody. …it’s just been super stressful. I had to reschedule a lot.’ | ‘I think that most people referred to this service have so many different things going on in their life that even if it’s provided once it might not be, you know, there’s so many other things that they're balancing and might not be something that they're able to hear at that moment.’ ‘And then sometimes, if they are having technical issues, or if they are, like, at Walmart, or trying to take care of their kids, as they're talking with me, I think that just limits the encounter.’ |
| The importance of communication between care staff and patients | ||
| Setting expectations | ‘I wish I would have known just a little bit more before, not that it would have mattered, but I guess I would have been mentally more prepared to know what to expect knowing that it would just be like, a one-time thing with a provider who would like and then she would evaluate me’ | ‘And I try to make sure they understand what the program is for what the appointment is for, especially because of the ongoing care. I think that’s a big one that they need to be notified of maybe ahead of time.’ ‘If the referral comes primarily from a provider, like they are kind of initiating it, then sometimes the patients are just sort of like, what’s this for? What are we supposed to talk about, like, that kind of thing?’ ‘… there were definitely people who weren't familiar with Zoom. And so the navigators had some scripting on testing…send them, hey, here’s a link to how to use Zoom, you want to practice that now…. So sometimes that could be a barrier, for sure.’ |
| Importance of navigator role in appointment making and completion | ‘You guys have been always really nice and just super, super sweet to me about… like the girl that I've talked to a couple times she’s always just like, 'are you gonna be able to make it this time?', like she was just really nice about my situation and how everything’s been going she, nobody’s been rude because I haven't made it, or because it’s been such a struggle trying to get it done.’ | ‘And I know that the navigators really find value in this work. It’s rewarding to be serving this population in particular…There’s something to be said for the navigators themselves as the front door, feeling good about the work, that means they're, hopefully really working hard to engage patients when they reach out to them.’ |
| The use of technology to facilitate appointment attendance | ||
| Appointment reminders to facilitate appointment attendance | ‘The thing that I really liked that, um, I mean, through text messages, like somebody was communicating with me through text message, and that was really easy and helpful.’ | ‘It’s based on patients listed communication preferences in Epic, I think. So if my preference is MyChart, then I would get reminders by my chart, or if it’s text, … And then sometimes the navigators were doing it.’ |
| Suggestions for improving telepsychiatry access | ||
| Suggestions for improvement | ‘Having appointment times in like, evenings or weekends, could make it more accessible for me personally.’ | ‘Maybe knowing ahead of time if this person is in ongoing care or not as far as therapy, mental health, ongoing care. And, you know, part of my other jobs within these programs is mental health navigation as far as connecting them to therapists so maybe that could be another part of this where we do a search for therapists for them.’ |