Telemedicine prescribing: A national, cross-sectional survey of U.S. mental health care providers (Preprint)

BACKGROUND In the post-pandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term policy decisions related to telemedicine, some have raised questions about the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. OBJECTIVE Our objective was to assess U.S. telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. METHODS We conducted a web-based, cross-sectional survey of telemental health providers who prescribe via telemedicine, using non-probability, availability sampling of the TelehealthEngage research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by provider licensure type (Physician v. Non-physician) and specialty (Psychiatry v. Non-psychiatry) using the Mann-Whitney U test. RESULTS Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in-person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8-19.1% of providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. For scheduled medications, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. CONCLUSIONS These providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (Physician v. Non-physician) and Specialty (Psychiatry vs. Non-psychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for Schedule IV and Schedule V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy-making in the U.S. CLINICALTRIAL N/A