Telepsychiatry: an overview for psychiatrists

Feasibility of telecognitive assessment in dementia

Videoconferencing (VC) technology has been used successfully to provide psychiatric services to patients in rural and otherwise underserved settings. VC-based diagnostic interviewing has shown good agreement with conventional face-to-face diagnosis of dementia in several investigations, but extension of this technology to neurocognitive assessment has received little attention. To this end, the authors administered a brief battery of common neuropsychological tests via VC technology (telecognitive) and traditional face-to-face methods to 14 older persons with mild cognitive impairment (MCI) and 19 persons with mild to moderate Alzheimer's disease (AD). Highly similar test scores were obtained when participants were tested in-person or via VC. Telecognitive assessment appears to be a valid means to conduct neuropsychological evaluation of older adults with cognitive impairment. Furthermore, continued development of VC technology has implications for expanding neuropsychological assessment options in under-served populations.

Rural jail telepsychiatry: a pilot feasibility study

New York State has a large rural population, and many of the jails in rural areas have minimal or no psychiatric services available on site. Cost of transport to off-site psychiatric services and the safety issues related to moving inmates from a secure building may limit inmate access to appropriate psychiatric services. This feasibility study describes a project that provided telepsychiatric consultation to increase access to psychiatric treatment in an underserved rural jail in upstate New York. Subjects were consenting jail inmates who requested or were found to be in need of psychiatric care. The project provided interactive two-way audio-video communication between the psychiatrist located in an urban university medical center and subjects who were incarcerated 182 miles away. During the project period, 15 inmates were assessed and treated in 37 consultations. Subjects were predominantly young white males with anxiety, mood, and substance use disorders. Services were readily accepted by inmates and staff. Telepsychiatric examination and treatment appears to be a feasible method to increase access to mental health care in rural jails. Future advocacy for increased mental health services in rural areas in criminal justice setting is likely to depend on further evidence of favorable cost benefit.

Telepsychiatry and e-mental health services: potential for improving access to mental health care

Reforming mental health care is a focus of many ongoing initiatives in the United States, both at the national and state levels. Access to adequate mental health care services is one of the identified problems. Telepsychiatry and e-mental health services could improve access to mental health care in rural, remote and underserved areas. The authors discuss the required technology, common applications and barriers associated with the implementation of telepsychiatry and e-mental health services.

Telepsychiatry Program for Rural Victims of Domestic Violence

Domestic violence is a significant public health problem and is correlated with serious mental and physical disorders. Victims' fear and isolation seriously limit access to psychiatric evaluation and treatment. Telemedicine provides a means to overcome these obstacles. This article describes a telemedicine program that provides psychiatric screening, evaluation, treatment, and referral for ongoing care to clients of a rural women's crisis center. Psychiatric evaluation and treatment were provided to a rural women's shelter program using telepsychiatry. The shelter program had difficulty accessing traditional mental health service. All new clients entering the program were screened for mental health problems. Those requiring further evaluation received a physical examination with medical history and initial psychological interview on site, followed by psychiatric evaluation by videoconference. Appropriate treatment was initiated, and referral for ongoing psychiatric care through the local community mental health clinic was arranged. Of the 38 women referred for mental health services by clinic staff, 35 completed a psychiatric evaluation using telepsychiatry and 31 entered treatment. The most commonly identified disorders were anxiety and major affective disorders, followed by substance use disorders. Telepsychiatry can provide rapid crisis intervention and effective mental health services to victims of domestic violence in a rural setting.

Update on Personal Digital Assistant Applications for the Healthcare Provider

OBJECTIVE:

To review the common general drug information applications and specialty drug information applications available for personal digital assistants (PDAs).

DATA SOURCES:

The literature was accessed through MEDLINE (2003–June 2004). Other information was obtained through secondary sources, such as Web sites describing common PDA applications as well as actual product trials. The key search terms used were handheld, PDA, personal digital assistants, drug information, pharmacokinetics, medical information, and medical applications.

STUDY SELECTION AND DATA EXTRACTION:

Articles or studies that provided a review of drug information references for the PDA since 2002 were included. Data pertaining to cost and application size were obtained from product or vendor Web sites.

DATA SYNTHESIS:

There are numerous medical applications available for the PDA including general drug information references, specialty drug information references (eg, pediatrics, cardiology, infectious diseases, oncology, psychology, herbals), diagnostic applications, medical calculators, nursing references, and patient tracking databases. Due to the huge array of programs, as well as factors such as cost and memory requirements, the healthcare provider must be selective in the medical applications that are placed on the PDA.

CONCLUSIONS:

There are many excellent PDA drug information applications that provide fast and accurate drug information and other features that assist the healthcare provider.

Willingness to use telemedicine for psychiatric care

The aim of this study was to assess potential users' willingness to use telepsychiatry and its correlates within a theoretical framework guided by the principles of social-cognitive models. The conceptual model proposed willingness to use telepsychiatry to be associated directly to attitudes toward telemedicine, attitudes toward the patient-physician relationship, and satisfaction with current medical care, and indirectly to anxiety to technology. Phone interviews were conducted with a representative sample of 1,204 Jewish, noninstitutionalized adults in Israel (mean age = 58; 51% female). Structural equation modeling was used to examine hypothesized relationships. Willingness to use telepsychiatry was relatively high and was affected by the participants' attitudes toward telemedicine, the patient-physician relationship, and by the level of anxiety toward technology. Efforts aimed at encouraging the use of telemedicine for psychiatric care should target potential users' attitudes, as well as feelings of uneasiness and anxiety regarding technology.

Videokonferenzen in Organisationen: Chancen, Risiken und personalpsychologisch relevante Anwendungsfelder

Zusammenfassung. Arbeit mit verschiedenen Formen von Videokonferenzsystemen nimmt stetig zu. Neben der Teilnahme an Konferenzen ermöglichen insbesondere pc-basierte Systeme vielfältige Interaktionsprozesse (z. B. Beratung, Befragung, Anweisung, Datentransfer), die sowohl zwischen organisationsinternen (Vorgesetzte, Mitarbeiter, Teleheimarbeiter etc.) als auch zwischen organisationsexternen Akteuren wie z. B. Kunden, Klienten, Bewerbern oder Patienten stattfinden können. Weil Videokonferenzen (VK) im Vergleich zu herkömmlichen Kommunikationssituationen (z. B. Brief, Telefon, E-Mail) komplexere Interaktionsformen unterstützen und mit multimedialen VK nachhaltigere Wirkungen erzielt werden können, ergeben sich für die Personalpsychologie interessante neue Anwendungsmöglichkeiten. In diesem Übersichtsartikel wird zusammengefasst, was man über die aktuelle Verbreitung und allgemeinen Wirkungen (Chancen, Risiken) von VK weiß. Ferner wird bilanziert, welche Erkenntnisse mit Blick auf vier personalpsychologisch relevante Anwendungsgebiete - Mitarbeiterführung, Beratung, Personalentwicklung und Personalmarketing - heute vorliegen. Wenngleich der schon häufig vorhergesagte Boom von VK in der organisationalen Praxis noch auf sich warten lässt, ist es Zeit, die besonderen Probleme und Chancen dieser neuen Technik in der personalpsychologischen Arbeit mehr zu beachten.

Clinical and educational telepsychiatry applications: a review

OBJECTIVE

Telepsychiatry in the form of videoconferencing brings enormous opportunities for clinical care, education, research, and administration. Focusing on videoconferencing, we reviewed the telepsychiatry literature and compared telepsychiatry with services delivered in person or through other technologies.

METHODS

We conducted a comprehensive review of telepsychiatry literature from January 1, 1965, to July 31, 2003, using the terms telepsychiatry, telemedicine, videoconferencing, effectiveness, efficacy, access, outcomes, satisfaction, quality of care, education, empowerment, and costs. We selected studies for review if they discussed videoconferencing for clinical and educational applications.

RESULTS

Telepsychiatry is successfully used for various clinical services and educational initiatives. Telepsychiatry is feasible, increases access to care, enables specialty consultation, yields positive outcomes, allows reliable evaluation, has few negative aspects in terms of communication, generally satisfies patients and providers, facilitates education, and empowers parties using it. Data are limited with regard to clinical outcomes and cost-effectiveness.

CONCLUSIONS

Telepsychiatry is effective. More short- and long-term quantitative and qualitative research is warranted on clinical outcomes, predictors of satisfaction, costs, and educational outcomes.

Personal digital assistant applications for the healthcare provider

OBJECTIVE

To review some common medical applications available for personal digital assistants (PDAs), with brief discussion of the different PDA operating systems and memory requirements. Key search terms included handheld, PDA, personal digital assistants, and medical applications.

DATA SOURCES

The literature was accessed through MEDLINE (1999-August 2002). Other information was obtained through secondary sources such as Web sites describing common PDAs.

DATA SYNTHESIS

Medical applications available on PDAs are numerous and include general drug references, specialized drug references (e.g., pediatrics, geriatrics, cardiology, infectious disease), diagnostic guides, medical calculators, herbal medication references, nursing references, toxicology references, and patient tracking databases. Costs and memory requirements for these programs can vary; consequently, the healthcare provider must limit the medication applications that are placed on the handheld computer.

CONCLUSIONS

This article attempts to systematically describe the common medical applications available for the handheld computer along with cost, memory and download requirements, and Web site information. This review found many excellent PDA drug information applications offering many features which will aid the healthcare provider. Very likely, after using these PDA applications, the healthcare provider will find them indispensable, as their multifunctional capabilities can save time, improve accuracy, and allow for general business procedures as well as being a quick reference tool. To avoid the benefits of this technology might be a step backward.