Linda Godleski

Linda S. Godleski

Associate Chief of Staff for Education, Director's Office at Department of Veterans Affairs

Location:
810 Vermont Avenue, NW, Washington, D.C., District of Columbia, United States
HQ Phone:
(800) 827-1000

General Information

Education

J. Edwin Nieves M.D.  - 

Affiliations

Board Member  - VA Connecticut Healthcare System

Psychiatrist  - Yale University

Secretary, Associate Chief of Staff for Education  - VACHS

Recent News  

"This is the first large-scale study to show that telemedicine dramatically reduced hospital admissions and total hospitalized days," Dr. Linda S. Godleski said May 6 at the annual meeting of the American Psychiatric Association.
"The decreased hospitalization rate may be explained by increased access to services. Patients do not wait [to get mental health sessions] until they are completely decompensated" when mental health care services are more readily available by telemedicine, said Dr. Godleski, director of the national telemental health center for the Department of Veterans Affairs and a psychiatrist at Yale University in New Haven, Conn.

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"This is the first really large-scale outcomes study with really positive outcomes in terms of decreased hospitalization," principal investigator Linda Godleski, MD, director, National Telemental Health Center, US Department of Veterans Affairs (VA), and associate professor of psychiatry, Yale School of Medicine in New Haven, Connecticut, told delegates attending the American Psychiatric Association's 2012 Annual Meeting.
Dr. Linda Godleski Dr. Godleski pointed out that TMH has been around for more than 50 years and had its genesis in the United States at the University of Nebraska. However, she added, it is only in the last decade that technological advances have made it a viable, widely available, cost-effective treatment that has enabled the VA to undertake a major nationwide TMH initiative. "In the past decade, the technology has become so great - the video screens are in high-definition, and the high-speed quality of the transmission allows you to see fine facial movements, tears forming in a patient's eyes, so that within the first few minutes of the interaction, you almost forget that you're not sitting in the same room with the patient," said Dr. Godleski. She noted that from 2003 to 2011, the number of TMH annual encounters in the VA increased approximately 10-fold - from 14,000 per year to over 140,000. Over the same period, there was a 6-fold increase in the number of TMH annual unique patients, the number jumping from 8000 to over 55,000. With 50 medical centers and 530 clinics receiving TMH since 2003, the VA has a database with a total of 500,000 TMH encounters. Despite this rapid growth, research on TMH outcomes has been limited to feasibility studies and small-scale randomized control studies, which have shown that TMH is equivalent to face-to-face treatment, but there have been no national studies reporting outcomes of TMH services among large populations, said Dr. Godleski. "This study is the first to report or describe telemental health programs on a large scale, and the VA is really uniquely positioned to do this because we have 500,000 visits, and we have an incredible database because we have electronic medical records, so we can capture, collect, and analyze information on outcomes," said Dr. Godleski. "Our hypothesis is that the decreased hospitalization rates may be explained by increased access to services by remote care delivery, so patients aren't waiting until they are completely decompensated before they show up in the emergency room. They can come to close-by clinics and get more routine and regular care; the services may lead to closer management, increased treatment adherence, and the need for hospitalization may ultimately be prevented," she added. Further, she said if there is a question of hospitalization, clinicians can see a patient remotely via TMH and determine whether remote intervention is feasible or whether they need to be hospitalized. The investigators also compared the decreases in psychiatric hospital utilization in the VA among mental health patients receiving TMH to that of the general VA mental health population and found "that the decrease in hospitalization seemed to be unique to the telemental health population, as the overall VA population of mental health patients did not demonstrate similar decreases during this period. In fact, there were some slight increases," said Dr. Godleski. Although medication management was the primary paradigm for TMH, the researchers found that this is being replaced by growing rates of all types of psychotherapeutic modalities as well as diagnostic evaluations. Preliminary findings from the 2011 data indicate decreased hospitalization rates of about 20% among TMH patients, said Dr. Godleski. However, she added, these rates increased in female patients and in patients with substance use disorders. The reason for this is unclear, but it may be that TMH is reaching groups of patients that in the past have gone undetected, she said. Dr. Godleski noted that in its infancy, there were questions about whether TMH could match the efficacy of face-to-face physician-patient encounters. However, she added, the emerging evidence suggests that TMH may ultimately provide patients with more rapid and frequent access to mental health services. She added that the VA is moving towards providing TMH services in a one-on-one scenario in patients' homes. Dr. Godleski and Dr. Ritchie have disclosed no relevant financial relationships.

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"This is the first large-scale study to show that telemedicine dramatically reduced hospital admissions and total hospitalized days," Dr. Linda S. Godleski said May 6 at the annual meeting of the American Psychiatric Association.
"The decreased hospitalization rate may be explained by increased access to services. Patients do not wait [to get mental health sessions] until they are completely decompensated" when mental health care services are more readily available by telemedicine, said Dr. Godleski, director of the national telemental health center for the Department of Veterans Affairs and a psychiatrist at Yale University in New Haven, Conn. Dr. Linda S. Godleski She and her associates reviewed 98,609 VA patients who required mental health services and were new to the agencys telemental health program during 2007-2010. They found that the telemental health patients had 24% fewer psychiatric hospital admissions during, on average, their first 6 months in the program, compared with their immediately preceding 6 months of care by conventional, face-to-face encounters with mental health clinicians, Dr. Godleski reported at the meeting and in a journal article by she and her associates (Psychiatr. Serv. 2012;63:383-5). The analysis also showed that the first 6 months of telemedicine management produced a 27% reduction in total days of psychiatric hospitalization for these patients during 2007-2010, compared with their management history during the 6 months before each patient entered the telemental health program. These shifts were specific to patients who entered the telemental health program. During the same 4-year period, VA patients who did not switch to telemental health had no changes in their rate of psychiatric hospitalization or days hospitalized, she said. In her talk, Dr. Godleski also described the rapid growth that VA telemental health had during 2003-2011. In 2003, 8,000 VA patients received mental health care via telemedicine in a total of 14,000 clinical encounters. Nine years later, in 2011, the numbers jumped to more than 55,000 patients treated in about 140,000 telemedical sessions. The 2011 rate more than doubled compared with 2008. Last year, the VA system provided telemental health at about 50 medical centers and about 530 remote VA sites throughout the United States. The VAs telemental health program began in the early 2000s by delivering remote medication management, but today it offers essentially every facet of mental health care to the entire spectrum of mental health patients, Dr. Godleski said. Patients can freely choose between the convenience of telemedicine or traditional face-to-face mental health care, and in general patients opt for telemedicine, especially those under age 65, Dr. Godleski said. When resistance to wider telemedicine exists, its usually from clinicians, she noted.* The next frontier is providing telemental health to patients at home or other patient-selected sites via personal computers and mobile phones. Having this option widely available and documenting its efficacy "will be a game changer," Dr. Godleski predicted. Dr. Godleski said she had no relevant financial disclosures.

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