Telemedicine Prescribing by US Mental Health Care Providers: National Cross-Sectional Survey

In the postpandemic 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 telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances.

Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine.

We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth 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 health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test.

A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of health care 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% (17/115) to 19.1% (30/115) of health care 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. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications.

These health care 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 vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and 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 United States.