For over 30 years, Harborview Medical Center’s Madison Clinic has been providing care to those in the Puget Sound region who are HIV-positive. From the beginning, the Clinic’s care providers and patients recognized that many of those living with HIV also struggled with a mental health and/or substance use disorder that significantly impacted their quality of life as well as their ability to fully engage in their medical treatment. To address this, psychiatric services were integrated directly into the Madison Clinic where, today, Christine Yuodelis-Flores, MD, serves as the primary HIV psychiatric consultant.

In an effort to improve access to care for the over 300 patients on the west side of Puget Sound, the Clinic’s medical director, Robert Harrington, MD, and his staff collaborated with the Washington State Department of Health and the Kitsap County Health District to establish the Madison-Kitsap Clinic, a weekly satellite clinic in Bremerton, WA. While the new clinic improved access to HIV and general primary care, many patients found accessing the psychiatric services based at Harborview a significant challenge, often requiring a commute across or around Puget Sound.

To address this, the Madison-Kitsap Clinic and the UW Department of Psychiatry and Behavioral Sciences sought to leverage the department’s growing telepsychiatry capacities and in October, 2017, launched a half-day per week Telepsychiatry Clinic that gives patients the option of talking with a psychiatrist, Matt Iles-Shih, MD, in a familiar and accessible setting. Dr. Iles-Shih, who provides services remotely from Harborview’s Pat Steel Building, uses a shared electronic medical record and a real-time HIPAA-compliant videoconference platform to assess patients who are seated in the Madison-Kitsap Clinic’s new telepsychiatry room. In addition, Dr. Iles-Shih makes one, in-person visit every month to see non-rural, Medicare patients (a population not eligible for reimbursable telehealth services).

“Patients really appreciate being able to receive care for both their general medical and mental health conditions in the same place, often on the same day, with providers that collaborate and communicate with each other,” says Dr. Iles-Shih. “Every patient thus far has said he/she felt very comfortable with the virtual encounter and looked forward to continuing treatment using telepsychiatry. I feel very connected to the clinic and its mission.”