1
|
Kaasgaard DM, Sørensen MK, Christiansen RB, Breum UN, Asiamah N, Friis LBT, Hjorth P. Video consultation and treatment in the community smoking cessation therapy success rates in patients with mental illness: a randomized controlled trial. Nord J Psychiatry 2024; 78:272-280. [PMID: 38385357 DOI: 10.1080/08039488.2024.2318305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Smoking is the single factor with the highest impact on reducing life expectancy of patients with mental illness. Patients experience difficulty in participating in smoking cessation programs but are concerned about the impact of tobacco on their health and finances. Smoking cessation advice via videoconferencing might be an alternative to an ordinary in-person consultation. MATERIAL AND METHOD Randomized controlled trial with follow-up at 6 months. We included patients with diagnoses of schizophrenia and affective disorder from psychiatric outpatient clinics. Intervention 1 involved daily video consultations; intervention 2 was treatment as usual. RESULTS Seventy patients were included. For both/all groups/interventions, rates of smoking cessation were 45% and predictors for a 50% reduction in smoking were antipsychotic medication load [odds ratio (OR) 0.54; p = 0.045] and number of nicotine patches (OR 1.02; p = 0.06). Predictors for a reduction in the number of cigarettes to < 10 were antipsychotic medication load (OR 0.52; p = 0.04), number of nicotine patches (OR 1.01; p = 0.02) and number of cigarettes at baseline [OR 0.95 (p = 0.09); adjusted OR 0.94 (p = 0.02)]. Patients prevented weight gain during the cessation period. CONCLUSION The smoking cessation rate was high. One of the reasons for the high cessation rate was that the intervention was carried out by highly experienced and professionally qualified staff. In addition, we used free nicotine patches to increase the patients' motivation to quit smoking. It is very important that we introduce these results into our clinical work with the patients.
Collapse
Affiliation(s)
- Didde Marie Kaasgaard
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Knudsgaard Sørensen
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Odense, Denmark
| | | | | | - Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Colchester, UK
- Department of Health Promotion, Africa Centre for Epidemiology, Accra, Accra North, Ghana
| | - Lone Bülow Toft Friis
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Odense, Denmark
| | - Peter Hjorth
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Kishimoto T, Kinoshita S, Kitazawa M, Hishimoto A, Asami T, Suda A, Bun S, Kikuchi T, Sado M, Takamiya A, Mimura M, Sato Y, Takemura R, Nagashima K, Nakamae T, Abe Y, Kanazawa T, Kawabata Y, Tomita H, Abe K, Hongo S, Kimura H, Sato A, Kida H, Sakuma K, Funayama M, Sugiyama N, Hino K, Amagai T, Takamiya M, Kodama H, Goto K, Fujiwara S, Kaiya H, Nagao K. Live two-way video versus face-to-face treatment for depression, anxiety, and obsessive-compulsive disorder: A 24-week randomized controlled trial. Psychiatry Clin Neurosci 2024; 78:220-228. [PMID: 38102849 DOI: 10.1111/pcn.13618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
AIM Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication. METHODS This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. RESULTS A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction. CONCLUSION Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care.
Collapse
Affiliation(s)
- Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Kinoshita
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Momoko Kitazawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
- Psychiatric Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shogyoku Bun
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Sato Hospital, Yamagata, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Takamiya
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Akasaka Clinic, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Ryo Takemura
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Kengo Nagashima
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Takashi Nakamae
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinari Abe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yasuo Kawabata
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Abe
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Seiji Hongo
- Himorogi Psychiatric Institute, Tokyo, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Aiko Sato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Asaka Hospital, Fukushima, Japan
| | | | - Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Tochigi, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Woon LSC, Maguire PA, Reay RE, Looi JCL. Telepsychiatry in Australia: A Scoping Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237116. [PMID: 38462906 DOI: 10.1177/00469580241237116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation.
Collapse
Affiliation(s)
- Luke Sy-Cherng Woon
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| |
Collapse
|
4
|
Dhaliwal R, Yap S, Talarico F, Al-Shamali H, Mcweeny R, Reeson M, Shalaby R, Chen T, Spronk E, Snodgrass R, Tu E, Erick T, Marshall T, Kennedy M, Greenshaw AJ, Winkler O, Burback L. Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review. J Med Internet Res 2023; 25:e40710. [PMID: 37921863 PMCID: PMC10656669 DOI: 10.2196/40710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
Collapse
Affiliation(s)
- Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sidney Yap
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Mcweeny
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Teresa Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rayven Snodgrass
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eileen Tu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Taylor Erick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
5
|
Shaker AA, Austin SF, Storebø OJ, Schaug JP, Ayad A, Sørensen JA, Tarp K, Bechmann H, Simonsen E. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2023; 10:e44790. [PMID: 37277113 PMCID: PMC10357375 DOI: 10.2196/44790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. OBJECTIVE This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. METHODS A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. RESULTS A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). CONCLUSIONS This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.
Collapse
Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Jakob Storebø
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Julie Perrine Schaug
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - Alaa Ayad
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - John Aasted Sørensen
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Bechmann
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
| |
Collapse
|
6
|
Brunt TJ, Gale-Grant O. Telepsychiatry: what clinicians need to know about digital mental healthcare. BJPSYCH ADVANCES 2023; 29:230-238. [PMID: 37521104 PMCID: PMC10374879 DOI: 10.1192/bja.2022.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.
Collapse
Affiliation(s)
- Thomas J. Brunt
- Psychiatry core trainee at South London and Maudsley NHS Foundation Trust, London, UK, with an interest in telehealth and the use of technology in healthcare
| | - Oliver Gale-Grant
- Conducts research in the MRC Centre for Neurodevelopmental Disorders and Department of Forensic and Neurodevelopmental Science at King's College London, London, UK, focusing on computational modelling of brain development
| |
Collapse
|
7
|
Lu M, Crooks RE, Pricop DF, Cox E, Anghelescu B, Hamilton M, Martino D, Bruno V, Josephson CB, Patten S, Smith EE, Roach P. Patient experiences of virtual care across specialist neuroscience and psychiatry clinics related to the second wave of the COVID-19 pandemic in Calgary, Alberta. HEALTH AND TECHNOLOGY 2023; 13:523-533. [PMID: 37303978 PMCID: PMC10152010 DOI: 10.1007/s12553-023-00754-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/25/2023] [Indexed: 06/13/2023]
Abstract
Purpose The emergence of the COVID-19 (SARS-CoV-2) pandemic has led to public health restrictions and a shift towards virtual care and telehealth. The aim of this study was to explore barriers and facilitators of virtual care from the perspective of neurological and psychiatric patients. Methods One-on-one interviews were conducted remotely using telephone and online video teleconferencing. There was a total of 57 participants, and a thematic content analysis was conducted using NVivo software. Results The two main themes were (1) virtual health service delivery and (2) virtual physician/patient interaction, with subthemes around how virtual care improved accessibility of care for patients and improved patient-centered care; how privacy and technical issues impact patients using virtual care; and the need for relationality and connection between health care providers and patients while using virtual care. Conclusions This study showed that virtual care can increase accessibility and efficiency for patients and providers, indicating its potential for ongoing use in the delivery of clinical care. Virtual care was found to be an acceptable mode of healthcare delivery from the perspective of patients; however, there is a continued need for relationship-building between care providers and patients.
Collapse
Affiliation(s)
- Michelle Lu
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1 AB Canada
| | - Rachel E. Crooks
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1 AB Canada
| | - Diana F. Pricop
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, T2N 2T9 AB Canada
| | - Emily Cox
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
| | - Beatrice Anghelescu
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
| | - Mark Hamilton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Veronica Bruno
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Colin B. Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB 3D10, T2N 4Z6 Canada
| | - Scott Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, T2N 2T9 AB Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB 3D10, T2N 4Z6 Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4 Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1 AB Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, Health Research Innovation Centre, University of Calgary, Room 1A10, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB 3D10, T2N 4Z6 Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| |
Collapse
|
8
|
Won GH, Lee HJ, Lee JH, Choi TY, Hong HL, Jung CY. Impact of a Psychiatric Consultation Program on COVID-19 Patients: An Experimental Study. Psychiatry Investig 2023; 20:471-480. [PMID: 37253473 DOI: 10.30773/pi.2022.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Following the coronavirus disease-2019 (COVID-19) outbreak, the importance of addressing acute stress induced by psychological burdens of diseases became apparent. This study attempted to evaluate the effectiveness of a new mode of psychiatric intervention designed to target similar psychological crises. METHODS Participants included 32 out of 114 COVID inpatients at a hospital in Daegu, Korea, who were assessed between March 30 and April 7, 2020. Multiple scales for screening psychological difficulties such as depressed mood, anxiety, insomnia, acute stress, and suicidality were done. Psychological problem evaluations and interventions were conducted in the form of consultations to alleviate participants' psychological challenges via telepsychiatry. The interventions' effects, as well as clinical improvements before and after the intervention, were analyzed. RESULTS As a result of screening, 21 patients were experiencing psychological difficulties beyond clinical thresholds after COVID-19 infection (screening positive group). The remaining 11 were screening negative groups. The two groups differed significantly in past psychiatric histories (p=0.034), with the former having a higher number of diagnoses. The effect of the intervention was analyzed, and clinical improvement before and after the intervention was observed. Our intervention was found to be effective in reducing the overall emotional difficulties. CONCLUSION This study highlighted the usefulness of new interventions required in the context of healthcare following the COVID-19 pandemic.
Collapse
Affiliation(s)
- Geun Hui Won
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hye Jeong Lee
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jong Hun Lee
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Tae Young Choi
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Chi Young Jung
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
9
|
de Las Cuevas C, Gutiérrez-Rojas L, Alvarez-Mon MA, Andreu-Bernabeu Á, Capitán L, Gómez JC, Grande I, Hidalgo-Mazzei D, Mateos R, Moreno-Gea P, De Vicente-Muñoz T, Ferre F. Evaluating the Effect of a Telepsychiatry Educational Program on the Awareness, Knowledge, Attitude, and Skills of Telepsychiatry Among Spanish Psychiatrists during COVID-19 Pandemic. Telemed J E Health 2023; 29:102-108. [PMID: 35549720 DOI: 10.1089/tmj.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: The COVID-19 pandemic has renewed the interest in telepsychiatry as a way to help psychiatrists care for their patients, but mental health providers' unfamiliarity and concerns may impede implementation of such services. This study aimed to determine the effect of an online educational intervention on awareness, knowledge, attitude, and skills (AKAS) of telepsychiatry among psychiatrists. Methods: The study used a pre-post-test design to compare AKAS of telepsychiatry among psychiatrists participating in an online course of practical telepsychiatry. The telemedicine AKAS questionnaire adapted to telepsychiatry was applied before and after the educational intervention, during the months of October to December 2020. Results: Responses from 213 participants were analyzed before the educational intervention and from 152 after it. The knowledge showed by Spanish psychiatrists before the educational intervention was good in 61% of participants, fair in 37%, and inadequate in 2%. With respect to attitudes toward telepsychiatry, 62% self-reported a high attitude, 33% moderate, and 5% low. With regard self-reported skills, 57% of the participating psychiatrists were highly skilled or experts, 22% moderately skilled, and 9% unskilled in handling telepsychiatry equipment. Despite the high baseline values, the educational intervention significantly improved psychiatrists' awareness, knowledge and attitudes toward telepsychiatry although not their skills. Conclusions: Online course of practical telepsychiatry was effective although future editions need to improve its focus on skills. This educational intervention represents an effort to promote the implementation of telepsychiatry as a health care alternative.
Collapse
Affiliation(s)
- Carlos de Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), University of La Laguna, Canary Islands, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, Hospital Universitario San Cecilio, Granada, Spain.,Department of Psychiatry, University of Granada, Granada, Spain
| | - Miguel A Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Luis Capitán
- Department of Psychiatry, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Juan Carlos Gómez
- Global Head of Medical Science, Shionogi & Co, London, United Kingdom
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Raimundo Mateos
- Psychogeriatric Unit, Department of Psychiatry, University of Santiago de Compostela, CHUS University Hospital, Santiago de Compostela, Spain
| | | | | | - Francisco Ferre
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|
10
|
Sato T, Ishimaru H, Takata T, Sasaki H, Shikano M. Application of Internet of Medical/Health Things to Decentralized Clinical Trials: Development Status and Regulatory Considerations. Front Med (Lausanne) 2022; 9:903188. [PMID: 35733872 PMCID: PMC9207273 DOI: 10.3389/fmed.2022.903188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe need for a new style of clinical trials, called decentralized clinical trials (DCTs), has been increasing as they do not depend on physical visits to clinical sites. DCTs are expected to provide a new opportunity to patients who cannot participate in a clinical trial due to geographical and time limitations. For the adoption of DCTs, it is essential that medical devices with Internet of Medical Things (IoMT) and Internet of Health Things (IoHT) based technologies are developed and commercially adopted. In this study, we aimed to identify the regulatory considerations when IoMT/IoHT-based technologies are used in DCTs or products developed using DCTs.MethodTo understand the study and development field of IoMT/IoHT comprehensively and panoramically, relevant papers published in Web of Science were searched online. Subsequently, a citation network was obtained and characterized as a cluster using a text mining method to identify IoMT/IoHT-based technologies expected to be utilized in DCTs or products developed using DCTs.Result and DiscussionUpon analysis of the top 15 clusters and subsequent 51 sub-clusters, we identified the therapeutic areas (psychology, neurology) and IoMT/IoHT-based technologies (telemedicine, remote monitoring, and virtual reality) that are expected to be used in DCTs. We also identified several considerations based on the current regulatory guidance.ConclusionIoMT/IoHT-based technologies that are expected to be used or products developed using DCTs and key considerations made when they are used in DCTs were identified. The considerations could encourage conducting DCTs using IoMT/IoHT-based technologies.
Collapse
Affiliation(s)
- Takahiro Sato
- Astellas Pharma Inc., Tokyo, Japan
- Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan
- *Correspondence: Takahiro Sato
| | - Hikaru Ishimaru
- Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan
| | - Takuya Takata
- Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan
| | - Hajime Sasaki
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Mayumi Shikano
- Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan
| |
Collapse
|
11
|
Kamath J, Leon Barriera R, Jain N, Keisari E, Wang B. Digital phenotyping in depression diagnostics: Integrating psychiatric and engineering perspectives. World J Psychiatry 2022; 12:393-409. [PMID: 35433319 PMCID: PMC8968499 DOI: 10.5498/wjp.v12.i3.393] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/23/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Depression is a serious medical condition and is a leading cause of disability worldwide. Current depression diagnostics and assessment has significant limitations due to heterogeneity of clinical presentations, lack of objective assessments, and assessments that rely on patients' perceptions, memory, and recall. Digital phenotyping (DP), especially assessments conducted using mobile health technologies, has the potential to greatly improve accuracy of depression diagnostics by generating objectively measurable endophenotypes. DP includes two primary sources of digital data generated using ecological momentary assessments (EMA), assessments conducted in real-time, in subjects' natural environment. This includes active EMA, data that require active input by the subject, and passive EMA or passive sensing, data passively and automatically collected from subjects' personal digital devices. The raw data is then analyzed using machine learning algorithms to identify behavioral patterns that correlate with patients' clinical status. Preliminary investigations have also shown that linguistic and behavioral clues from social media data and data extracted from the electronic medical records can be used to predict depression status. These other sources of data and recent advances in telepsychiatry can further enhance DP of the depressed patients. Success of DP endeavors depends on critical contributions from both psychiatric and engineering disciplines. The current review integrates important perspectives from both disciplines and discusses parameters for successful interdisciplinary collaborations. A clinically-relevant model for incorporating DP in clinical setting is presented. This model, based on investigations conducted by our group, delineates development of a depression prediction system and its integration in clinical setting to enhance depression diagnostics and inform the clinical decision making process. Benefits, challenges, and opportunities pertaining to clinical integration of DP of depression diagnostics are discussed from interdisciplinary perspectives.
Collapse
Affiliation(s)
- Jayesh Kamath
- Department of Psychiatry and Immunology, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Roberto Leon Barriera
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Neha Jain
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Efraim Keisari
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Bing Wang
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, United States
| |
Collapse
|
12
|
Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
Collapse
Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| |
Collapse
|
13
|
Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study. Glob Ment Health (Camb) 2022; 9:26-36. [PMID: 36618733 PMCID: PMC9806979 DOI: 10.1017/gmh.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. METHODS Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. RESULTS The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92-39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61-25.57, p = 0.008)]. CONCLUSION Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings.
Collapse
|
14
|
Bulkes NZ, Davis K, Kay B, Riemann BC. Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. J Psychiatr Res 2022; 145:347-352. [PMID: 34799124 PMCID: PMC8595951 DOI: 10.1016/j.jpsychires.2021.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022]
Abstract
The heightened acuity in anxiety and depressive symptoms catalyzed by the COVID-19 pandemic presents an urgent need for effective, feasible alternatives to in-person mental health treatment. While tele-mental healthcare has been investigated for practicability and accessibility, its efficacy as a successful mode for delivering high-quality, high-intensity treatment remains unclear. This study compares the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment prior to the COVID-19 pandemic (N = 1,192) to the outcomes of a distinctive group of patients who received telehealth treatment during the pandemic (N = 1,192). Outcomes are measured with respect to depressive symptoms (Quick Inventory of Depressive Symptomatology-Self-Report; QIDS-SR) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Q-LES-Q). There were no significant differences in admission score on either assessment comparing in-person and telehealth groups. Patients in the partial hospitalization level of care stayed longer when treatment was remote. Results suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups. Future research is needed to replicate these findings in other healthcare organizations in other geographical locations and diverse patient populations.
Collapse
|
15
|
Roncero C, Remon-Gallo D, Casado-Espada N, Aguilar L, Gamonal-Limcaoco S, Gallego MT, Bote B, Montejo AL, Buch-Vicent B. Healthcare professionals' perception and satisfaction with mental health tele-medicine during the COVID-19 outbreak: A real-world experience in telepsychiatry. Front Psychiatry 2022; 13:981346. [PMID: 36405902 PMCID: PMC9673754 DOI: 10.3389/fpsyt.2022.981346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The use of telemedicine is increasingly being implemented, showing numerous benefits over other methods. A good example of this is the use of telemedicine following the breakdown caused by the COVID-19 pandemic. Previous experiences with telemedicine (TM) have not been significantly explored in relation to the professionals' own perspectives. OBJECTIVE Identify and explore the perceptions and interests of mental health professionals who have performed TM during the period of pandemia. METHODS A questionnaire on mental health professionals' perceptions of and satisfaction of TM, the Font Roja Work Satisfaction Questionnaire, was adapted and used. Data collected included 112 Psychiatric Service professionals who conducted TM in March 2020, after the country had been under lockdown for 10 weeks. Over 12.000 medical consultations were carried out by the phone, showing an overwhelming response to this method. RESULTS High levels of satisfaction were recorded amongst professionals. TM would function as a complement to the traditional system of face-to-face visits (n-112, f-109, 96.5%). Only 9.7% (f-11) believed that digital or virtual interventions would completely replace face-to-face visits. 60.8% did not consider this monotonous work. The older the health workers were, the more satisfied they felt during their follow-up telephone consultation. The greater the previous experience, the more satisfaction was shown. There were gender differences: female mental health workers reported a greater level of comfort. CONCLUSION TM can be implemented with less effort, but it requires time, methods, and resources to be managed. Satisfaction among professionals is high, especially among those with more clinical experience. Patient satisfaction must be contrasted against this.
Collapse
Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Diego Remon-Gallo
- Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Nerea Casado-Espada
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Lourdes Aguilar
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Sinta Gamonal-Limcaoco
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain
| | - María Teresa Gallego
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain
| | - Berta Bote
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Angel Luis Montejo
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain.,School of Nursing, University of Salamanca, Salamanca, Spain
| | - Barbara Buch-Vicent
- Salamanca Institute of Biomedicine, University of Salamanca, Salamanca, Spain.,Faculty of Psychology, University of Salamanca, Salamanca, Spain
| |
Collapse
|
16
|
Kishimoto T, Kinoshita S, Bun S, Sato Y, Kitazawa M, Kikuchi T, Sado M, Takamiya A, Mimura M, Nakamae T, Abe Y, Kanazawa T, Kawabata Y, Tomita H, Abe K, Hishimoto A, Asami T, Suda A, Watanabe Y, Amagai T, Sakuma K, Kida H, Funayama M, Kimura H, Sato A, Fujiwara S, Nagao K, Sugiyama N, Takamiya M, Kodama H, Azekawa T. Japanese project for telepsychiatry evaluation during COVID-19: Treatment comparison trial (J-PROTECT): Rationale, design, and methodology. Contemp Clin Trials 2021; 111:106596. [PMID: 34653648 PMCID: PMC8511868 DOI: 10.1016/j.cct.2021.106596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/25/2022]
Abstract
Introduction The COVID-19 pandemic has had a profound impact on the mental health of people around the world. Anxiety related to infection, stress and stigma caused by the forced changes in daily life have reportedly increased the incidence and symptoms of depression, anxiety disorder and obsessive-compulsive disorder. Under such circumstances, telepsychiatry is gaining importance and attracting a great deal of attention. However, few large pragmatic clinical trials on the use of telepsychiatry targeting multiple psychiatric disorders have been conducted to date. Methods The targeted study cohort will consist of adults (>18 years) who meet the DSM-5 diagnostic criteria for either (1) depressive disorders, (2) anxiety disorders, or (3) obsessive-compulsive and related disorders. Patients will be assigned in a 1:1 ratio to either a “telepsychiatry group” (at least 50% of treatments to be conducted using telemedicine, with at least one face-to-face treatment [FTF] within six months) or an “FTF group” (all treatments to be conducted FTF, with no telemedicine). Both groups will receive the usual treatment covered by public medical insurance. The study will utilize a master protocol design in that there will be primary and secondary outcomes for the entire group regardless of diagnosis, as well as the outcomes for each individual disorder group. Discussion This study will be a non-inferiority trial to test that the treatment effect of telepsychiatry is not inferior to that of FTF alone. This study will provide useful insights into the effect of the COVID-19 pandemic on the practice of psychiatry. Trial Registration jRCT1030210037, Japan Registry of Clinical Trials (jRCT).
Collapse
Affiliation(s)
- Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, #7F Roppongi Hills, North Tower 6-2-31 Roppongi, Minato-ku, Tokyo 106-0032, Japan.
| | - Shotaro Kinoshita
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, #7F Roppongi Hills, North Tower 6-2-31 Roppongi, Minato-ku, Tokyo 106-0032, Japan; Graduate School of Medicine, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo 107-8402, Japan
| | - Shogyoku Bun
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Sato Hospital, 948-1 Kunugizuka, Nanyo, Yamagata 999-2221, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Momoko Kitazawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takashi Nakamae
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Kyoto, Kyoto 602-8566, Japan
| | - Yoshinari Abe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Kyoto, Kyoto 602-8566, Japan
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Yasuo Kawabata
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan; Department of Psychiatry, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Koichi Abe
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Akira Suda
- Department of Psychiatry, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Yoshinori Watanabe
- Himorogi Psychiatric Institute, Ichigaya-Asukara Bldg. 1F2F, 2-31-3 Ichigayatamachi, Shinjuku, Tokyo 162-0843, Japan
| | - Toru Amagai
- Amagai Mental Clinic, Kitami Bldg. 3F, 1-4-20 Kamiooka-nishi, Konan, Yokohama, Kanagawa 233-0002, Japan
| | - Kei Sakuma
- Asaka Hospital, 45 Kyotan, Sasagawa, Asakamachi, Koriyama, Fukushima 963-0198, Japan
| | - Hisashi Kida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Asaka Hospital, 45 Kyotan, Sasagawa, Asakamachi, Koriyama, Fukushima 963-0198, Japan
| | - Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi 326-0843, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Gakuji-kai Kimura Hospital, 6-19, Higashi Honcho, Chuo-ku, Chiba, Chiba 260-0004, Japan; Department of Psychiatry, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan
| | - Aiko Sato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba 286-8686, Japan
| | - Shuichiro Fujiwara
- Kanazawabunko Yell Clinic, Kanazawa Bunko Park Homes 102, Kamariyahigashi, Kanazawa, Yokohama, Kanagawa 236-0042, Japan
| | - Kiichiro Nagao
- Neyagawa Sanatoriumu, 2370-6 Neyagawakoen, Neyagawa, Osaka, Osaka 572-0854, Japan
| | - Naoya Sugiyama
- Numazu Chuo Hospital, 24-1 Nakase-cho, Numazu, Shizuoka 410-8575, Japan
| | - Maki Takamiya
- Takamiya Hospital, 1931 Omachikou, Yoshimura, Miyazaki, Miyazaki 880-0841, Japan
| | - Hideyuki Kodama
- Takamiya Hospital, 1931 Omachikou, Yoshimura, Miyazaki, Miyazaki 880-0841, Japan
| | - Takaharu Azekawa
- Shioiri Mental Clinic, 2-7-1 Shioiri, Yokosuka, Kanagawa, 238-0042, Japan
| | | |
Collapse
|
17
|
Jakubowski KP, Jhamb M, Yabes J, Gujral S, Oberlin LE, Bender FH, Steel JL. Technology-assisted cognitive-behavioral therapy intervention for end-stage renal disease. Transl Behav Med 2021; 10:657-663. [PMID: 31131853 DOI: 10.1093/tbm/ibz077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Technology-assisted cognitive-behavioral therapy (CBT) interventions have been conducted for symptoms including depression, pain, and fatigue in patients with chronic illnesses but not in end-stage renal disease (ESRD). The purpose of this study was to pilot the feasibility and acceptability of a technology-assisted CBT intervention in ESRD patients on hemodialysis (HD), share design and implementation lessons learned, and provide preliminary results on changes in select patient-reported symptoms. This was a single-center pilot feasibility study of adult ESRD patients on HD. Study eligibility required clinically elevated levels of at least one symptom (depression, pain, or fatigue). Patients met weekly with a CBT therapist for eight sessions, each 45-60 min, during HD sessions via a video-conferencing platform. Symptom questionnaires were completed at baseline and 3 months follow-up. Of 10 patients screened, 100% screened positive for at least one symptom, 100% of eligible patients consented, and eight (of 10) completed the intervention (mean age 59 years, 50% male, 50% African American). Patient adherence and satisfaction was high, and seven of the eight patients completed all eight prescribed sessions. Minimal interference with HD was reported. Preliminary results indicate no statistically significant changes in depression, fatigue, or pain at follow-up. However, there was small improvement in SF-36 Physical Component score [t(7) = -2.60, p = .035], and four of the six patients (67%) with clinically elevated pain at baseline reported improvement at follow-up. A technology-assisted CBT intervention for ESRD patients was feasible, well-accepted, and required minimal additional resources in the HD setting. Larger, adequately powered clinical trials are needed to evaluate the effect on ESRD patient-reported outcomes.
Collapse
Affiliation(s)
| | - Manisha Jhamb
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Yabes
- Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Swathi Gujral
- Pittsburgh VA Healthcare System, Pittsburgh, PA, USA
| | - Lauren E Oberlin
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Filitsa H Bender
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
18
|
Bellanti DM, Kelber MS, Workman DE, Beech EH, Belsher BE. Rapid Review on the Effectiveness of Telehealth Interventions for the Treatment of Behavioral Health Disorders. Mil Med 2021; 187:e577-e588. [PMID: 34368853 DOI: 10.1093/milmed/usab318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The Psychological Health Center of Excellence conducted a rapid review of the literature to investigate the effectiveness of behavioral health treatments (i.e., evidence-based psychotherapy and psychiatry) delivered in person compared to telehealth (TH; i.e., video teleconference and telephone). MATERIALS AND METHODS The rapid review methods included a systematic search of a single database (PubMed), hand-searching of relevant systematic reviews, dual screening, single-person data abstraction verified by a second person, and dual risk of bias assessment. Due to heterogeneity across studies, no quantitative analyses were conducted. RESULTS Twenty-two randomized controlled trials (RCTs), eight of which were non-inferiority trials, evaluated the effectiveness of TH via telephone or video teleconferencing compared to in-person (IP) delivery for patient populations with posttraumatic stress disorder, depression, and mixed diagnoses. The majority of RCTs and all but one of the eight non-inferiority trials found that clinical outcomes did not differ between TH and IP treatment delivery. Two studies found that subgroups with higher symptom severity (hopelessness and anxiety disorders, respectively) in the TH group had worse treatment-related outcomes than IP participants with similar symptom profiles. The majority of studies found no significant differences in satisfaction with care, quality of the therapeutic alliance, or study discontinuation between TH and IP groups. CONCLUSION Based on evidence from 22 RCTs, the use of TH platforms, including video conference and telephone modalities, generally produces similar outcomes as face-to-face provision of psychotherapy and psychiatry services.
Collapse
Affiliation(s)
- Dawn M Bellanti
- Psychological Health Center of Excellence (PHCoE), Research Branch, Research & Development Division (J-9), Defense Health Agency, Silver Spring, MD 20910, USA
| | - Marija S Kelber
- Psychological Health Center of Excellence (PHCoE), Research Branch, Research & Development Division (J-9), Defense Health Agency, Silver Spring, MD 20910, USA
| | - Don E Workman
- Veterans Health Administration, Office of Research Development, Washington, DC 20402, USA
| | - Erin H Beech
- Psychological Health Center of Excellence (PHCoE), Research Branch, Research & Development Division (J-9), Defense Health Agency, Silver Spring, MD 20910, USA
| | - Brad E Belsher
- Phoenix VA Health Care System, Carl T Hayden Veterans Medical Center, Phoenix, AZ 85012, USA
| |
Collapse
|
19
|
Gude J, Subhedar RV, Zhang MH, Jain P, Bhela J, Bangash F, Veluri N, Hsieh YC, Sheikh BZ, Shah MR, Mansuri Z, Aedma K, Patel UK, Parikh T. Emerging Needs and Viability of Telepsychiatry During and Post COVID-19 Era: A Literature Review. Cureus 2021; 13:e16974. [PMID: 34540384 PMCID: PMC8423321 DOI: 10.7759/cureus.16974] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 12/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in nationwide stay-at-home orders in an effort to slow the spread severely impacting the healthcare sector. Telepsychiatry provides a platform bridging the gap through advanced technologies connecting mental health providers and patients who need their services, overcoming previous barriers of great distances, lack of transportation, and even time constraints. The most obvious benefit is increased accessibility to mental healthcare, especially in underserved and remote areas where there is no easy access for in-person care. It is important to note that benefits are not limited to patients, but also allow clinicians greater flexibility in scheduling and reduced practice overhead costs, both of which aid with physician burnout and burden. Telepsychiatry during COVID-19 provides its own unique advantages over in-person visits. The risk of exposure to healthcare workers and patients receiving care is reduced, allowing immunocompromised patients to receive much-needed psychiatric care. Without the need to meet in person, self-isolating psychiatrists can still provide care, decreasing strain on their co-workers. Although telepsychiatry is relatively new, it has already exhibited considerable success in its effectiveness at treating psychiatric conditions and widespread corollary benefits. Telepsychiatric consults may be carried out synchronously and asynchronously, each having benefits and setbacks. Different mobile application interventions have been explored, which are available for the purpose of both monitoring/assessing patients and/or providing treatment. The scope of conditions these applications address is broad, from anxiety disorders to schizophrenia to depression. As promising and beneficial telepsychiatry may seem, it is necessary to recognize that building the program can be challenging. It involves adapting to new methods in medicine. We highlighted barriers to general telepsychiatry, the most prominent being technological literacy of both physician and patient, and possible negative effects of eliminating the in-person patient-doctor interaction.
Collapse
Affiliation(s)
- Jayasudha Gude
- Psychiatry, Northwell Health, Zucker Hillside Hospital, New York, USA
| | | | - Michelle H Zhang
- Psychological & Brain Sciences and Biology, Johns Hopkins University, Baltimore, USA
| | - Pratik Jain
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Jatminderpal Bhela
- Psychiatry, Case Western Reserve University/Metrohealth system, Cleveland, USA
| | - Fariha Bangash
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Nikhila Veluri
- Psychiatry, American University of Integrative Science School of Medicine, St. Michael, BRB
| | - Ya-Ching Hsieh
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Batool Z Sheikh
- Psychiatry, Dow University of Health Sciences, Karachi, PAK
- Psychiatry, Brookdale University Hospital Medical Center, New York, USA
| | - Mansi R Shah
- Psychiatry, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Zeeshan Mansuri
- Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, USA
| | | | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tapan Parikh
- Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, USA
| |
Collapse
|
20
|
Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
Collapse
Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
21
|
Tse J, LaStella D, Chow E, Kingman E, Pearlman S, Valeri L, Wang H, Dixon LB. Telehealth Acceptability and Feasibility Among People Served in a Community Behavioral Health System During the COVID-19 Pandemic. Psychiatr Serv 2021; 72:654-660. [PMID: 33957769 DOI: 10.1176/appi.ps.202000623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the acceptability and feasibility of telehealth services shortly after their rapid introduction into a community behavioral health agency as part of the response to the COVID-19 pandemic. METHODS Individuals receiving services during May 8-18, 2020, from behavioral health programs that had introduced telehealth in March 2020, were invited to participate in a survey regarding their perceptions of the telehealth services. Ordinal logistic regressions were used to test for differences in survey responses in three ways: between program types, between the 2020 sample and a 2018 sample, and between individuals reported by staff to be distressed or not distressed by the COVID-19 pandemic. RESULTS Of 1,482 survey respondents, >80% reported that their ability to connect to staff, receive support, and get an appointment was at least as great as before the pandemic. Among 80% of respondents indicating interest in continuing remote services after the pandemic ended, 83% preferred a mix of remote and face-to-face services. From February 2020 to April 2020, total service utilization remained stable for treatment, outreach, and housing programs. In addition, mental health-related hospital utilization did not increase. CONCLUSIONS The findings of this study suggest that telehealth, including telephone-based services, is an acceptable and even preferred service delivery mode for clients with severe mental illness. Continued investigation into the optimal dosing of face-to-face versus remote services in various settings is needed to inform service practice during and after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jeanie Tse
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Drew LaStella
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Elisa Chow
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Emily Kingman
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Shoshannah Pearlman
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Linda Valeri
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Hao Wang
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Lisa B Dixon
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| |
Collapse
|
22
|
Fernandez E, Woldgabreal Y, Day A, Pham T, Gleich B, Aboujaoude E. Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clin Psychol Psychother 2021; 28:1535-1549. [PMID: 33826190 DOI: 10.1002/cpp.2594] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/14/2022]
Abstract
In-person psychotherapy (IPP) has a long and storied past, but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP versus IPP or other comparison groups. A literature search identified k = 56 within-group studies (N = 1681 participants) and 47 between-group studies (N = 3564). The pre-post effect size of VDP was large and highly significant, g = +0.99 95% CI [0.67-0.31]. VDP was significantly better in outcome than wait list controls (g = 0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and posttraumatic stress disorder (PTSD) (each with k > 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g = 0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy being most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.
Collapse
Affiliation(s)
- Ephrem Fernandez
- Department of Psychology, University of Texas at San Antonio, USA
| | | | - Andrew Day
- School of Social & Political Sciences, University of Melbourne, Melbourne, Australia
| | - Tuan Pham
- Department of Psychology, University of Texas at San Antonio, USA
| | - Bianca Gleich
- Department of Psychology, University of Texas at San Antonio, USA
| | - Elias Aboujaoude
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, USA
| |
Collapse
|
23
|
Tönnies J, Hartmann M, Wensing M, Szecsenyi J, Peters-Klimm F, Brinster R, Weber D, Vomhof M, Icks A, Friederich HC, Haun MW. Mental Health Specialist Video Consultations Versus Treatment-as-Usual for Patients With Depression or Anxiety Disorders in Primary Care: Randomized Controlled Feasibility Trial. JMIR Ment Health 2021; 8:e22569. [PMID: 33709931 PMCID: PMC7998325 DOI: 10.2196/22569] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/13/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most people affected by depression or anxiety disorders are treated solely by their primary care physician. Access to specialized mental health care is impeded by patients' comorbidity and immobility in aging societies and long waiting times at the providers' end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in primary care settings. OBJECTIVE The study aims to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression or anxiety disorders. METHODS Participants were recruited by their primary care physicians during regular practice visits. Patients who had experienced at least moderate symptoms of depression and/or anxiety disorders were considered eligible for the study. Patients were randomized into 2 groups receiving either treatment-as-usual as provided by their general practitioner or up to 5 video consultations conducted by a mental health specialist. Video consultations focused on systematic diagnosis and proactive monitoring using validated clinical rating scales, the establishment of an effective working alliance, and a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment, and attendance at sessions. Effectiveness outcomes included depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale-12), recovery (Recovery Assessment Scale-German [RAS-G]), and perception of chronic illness care (Patient Assessment of Chronic Illness Care), which were measured at baseline and 16 weeks postallocation by assessors blinded to the group allocation. RESULTS A total of 50 patients with depression and/or anxiety disorders were randomized, 23 in the intervention group and 27 in the treatment-as-usual group. The recruitment yield (number randomized per number screened) and the consent rate (number randomized per number eligible) were 69% (50/73) and 86% (50/58), respectively. Regarding acceptability, 87% (20/23) of the participants in the intervention group completed the intervention. Of the 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 96% (22/23) and 85% (23/27) for the intervention and control groups, respectively. The change from baseline scores at postmeasurement for the No Domination by Symptoms domain of recovery (RAS-G) was somewhat higher in the intervention group than in the control group (Mann-Whitney U test: rank-biserial r=0.19; 95% CI -0.09 to 0.46; P=.18). We did not detect any notable differences between the intervention and control groups in terms of other effectiveness outcomes. We did not observe any serious adverse events related to the trial. CONCLUSIONS The intervention and study procedures were found to be feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate their effectiveness in routine care. TRIAL REGISTRATION German Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812.
Collapse
Affiliation(s)
- Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Regina Brinster
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
24
|
Bettenhausen JL, Hall M, Doupnik SK, Markham JL, Feinstein JA, Berry JG, Gay JC. Hospitalization Outcomes for Rural Children with Mental Health Conditions. J Pediatr 2021; 229:240-246.e1. [PMID: 33010261 PMCID: PMC7855022 DOI: 10.1016/j.jpeds.2020.09.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based on location of hospitalization. STUDY DESIGN This is a retrospective cohort analysis of US rural children aged 0-18 years with a mental health hospitalization between January 1, 2014, and November 30, 2014, using the 2014 Agency for Healthcare Research and Quality's Nationwide Readmissions Database. Hospitalizations for rural children were categorized by children's hospitals, metropolitan non-children's hospitals, or rural hospitals. Associations between hospital location and outcomes were assessed with logistic (readmission) and negative binomial regression (length of stay [LOS]) models. Classification and regression trees (CART) were used to describe the characteristics of most common hospitalizations at a rural hospital. RESULTS Of 21 666 mental health hospitalizations of rural children, 20.6% were at rural hospitals. After adjustment for clinical and demographic characteristics, LOS was higher at metropolitan non-children's and children's hospitals compared with rural hospitals (LOS: adjusted rate ratio [aRR], 1.35 [95% CI 1.29-1.41] and 1.33 [95% CI, 1.25-1.41]; P < .01 for all). The 30-day readmission was lower at metropolitan non-children's and children's hospitals compared with rural hospitals (aOR, 0.73 [95% CI, 0.63-0.84] and 0.59 [95% CI, 0.48-0.71]; P < .001 for all). Adolescent males living in poverty with externalizing behavior disorder had the highest percentage of hospitalization at rural hospitals (69.4%). CONCLUSIONS Although hospitalizations at children's and metropolitan non-children's hospitals were longer, patient outcomes were more favorable.
Collapse
Affiliation(s)
- Jessica L Bettenhausen
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO; Children's Hospital Association, Lenexa, KS
| | - Stephanie K Doupnik
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - James A Feinstein
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Jay G Berry
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James C Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
25
|
Yoon MS, Martin KB, Marraccini RL, Norris ER. Provider Satisfaction from a New Telepsychiatry Inpatient Consultation Service. Telemed J E Health 2021; 27:1129-1135. [DOI: 10.1089/tmj.2020.0317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Michael S. Yoon
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Katherine B. Martin
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Rory L. Marraccini
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Edward R. Norris
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
26
|
Fowler JC, Skubiak T, Engelhardt K, Furst B, Zhao S, Nyilas M, Profit D, Carson W. Feasibility of a Noninterventional Decentralized Clinical Trial Model in Adults with Major Depressive Disorder. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2021. [DOI: 10.29024/jsim.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
27
|
Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
Collapse
Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
| |
Collapse
|
28
|
Di Carlo F, Sociali A, Picutti E, Pettorruso M, Vellante F, Verrastro V, Martinotti G, di Giannantonio M. Telepsychiatry and other cutting-edge technologies in COVID-19 pandemic: Bridging the distance in mental health assistance. Int J Clin Pract 2021; 75:10.1111/ijcp.13716. [PMID: 32946641 PMCID: PMC7536971 DOI: 10.1111/ijcp.13716] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS In this paper, we discuss the potential role of telepsychiatry (TP) and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS Telemental health services may be particularly feasible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION Telepsychiatry is a promising and growing way to deliver mental health services but is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.
Collapse
Affiliation(s)
- Francesco Di Carlo
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Antonella Sociali
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Elena Picutti
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Valeria Verrastro
- Department of Medical and Surgical SciencesUniversity “Magna Graecia” of CatanzaroCatanzaroItaly
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
- Department of Clinical, Pharmaceutical and Biological SciencesUniversity of HertfordshireHertsUK
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| |
Collapse
|
29
|
Ros-DeMarize R, Chung P, Stewart R. Pediatric behavioral telehealth in the age of COVID-19: Brief evidence review and practice considerations. Curr Probl Pediatr Adolesc Health Care 2021; 51:100949. [PMID: 33436319 PMCID: PMC8049735 DOI: 10.1016/j.cppeds.2021.100949] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Considerable efforts over the last decade have been placed on harnessing technology to improve access to behavioral health services. These efforts have exponentially risen since the outbreak of the Coronavirus disease 2019 (COVID-19), which has prompted a move to novel systems of care, largely based on telehealth delivery. This article aims to provide a broad review of evidence for telehealth assessment and treatment of externalizing disorders and internalizing disorders in children and discuss practice considerations and established guidelines for telehealth delivery. Existing literature supports the promise of behavioral health interventions including behavioral parent training and combination approaches for externalizing disorders as well as cognitive-behavioral based interventions for internalizing disorders. There is a scarcity of work on assessment via telehealth compared with the available treatment literature. While treatment may be most pressing given the COVID-19 circumstances to continue delivery of care, movement toward establishing evidence-based assessment via telehealth will be of increased importance. Lastly, practice guidelines have been set forth by national associations, professional societies, and supported by the development of national Telehealth Centers of Excellence. These guidelines and practice considerations are discussed within the context of COVID-19.
Collapse
Affiliation(s)
| | - Peter Chung
- University of California, Irvine, United States
| | - Regan Stewart
- Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
30
|
Batastini AB, Paprzycki P, Jones ACT, MacLean N. Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clin Psychol Rev 2020; 83:101944. [PMID: 33227560 DOI: 10.1016/j.cpr.2020.101944] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.
Collapse
Affiliation(s)
- Ashley B Batastini
- University of Southern Mississippi, USA; University of Mississippi Medical Center Department of Psychiatry, USA.
| | - Peter Paprzycki
- University of Southern Mississippi, USA; Mississippi Center for Clinical and Translational Research, USA; University of Toledo, USA
| | | | - Nina MacLean
- Michigan Department of Health & Human Services - Center for Forensic Psychiatry, USA
| |
Collapse
|
31
|
Simpson S, Guerrini L, Rochford S. Telepsychology in a University Psychology Clinic Setting: A Pilot Project. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Shirley Rochford
- Rural and Remote Network, Country Health SA Mental Health Service,
| |
Collapse
|
32
|
Simpson SG, Rochford S, Livingstone A, English S, Austin C. Tele‐web Psychology in Rural South Australia: The Logistics of Setting Up a Remote University Clinic Staffed by Clinical Psychologists in Training. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Shirley Rochford
- Rural and Remote Network, Country Health SA Mental Health Service,
| | | | | | - Carly Austin
- Psychology Clinic, University of South Australia,
| |
Collapse
|
33
|
Gopalan P, Shenai N, Dunn S, Bilderback A. Healthcare utilization in patients pre-and post-telepsychiatry consultation compared to in-person consultation-liaison sites. Gen Hosp Psychiatry 2020; 67:154-155. [PMID: 32451088 DOI: 10.1016/j.genhosppsych.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Priya Gopalan
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA, United States of America.
| | - Neeta Shenai
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA, United States of America
| | - Stefanie Dunn
- Wolff Center at the University of Pittsburgh Medical Center, United States of America
| | - Andrew Bilderback
- Wolff Center at the University of Pittsburgh Medical Center, United States of America
| |
Collapse
|
34
|
Lee YJ, Keum MS, Kim HG, Cheon EJ, Cho YC, Koo BH. Defense Mechanisms and Psychological Characteristics According to Suicide Attempts in Patients with Borderline Personality Disorder. Psychiatry Investig 2020; 17:840-849. [PMID: 32791818 PMCID: PMC7449843 DOI: 10.30773/pi.2020.0102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE There have been many biological studies on suicide behaviors of borderline personality disorder (BPD), however few studies have sought to psychoanalytic characteristics including defense mechanisms. Therefore, we investigated psychological, symptomatic, and personality characteristics including defense mechanisms in suicide attempters and non-suicide attempters among patients with BPD. METHODS We enrolled 125 patients with BPD. Forty-two patients with a history of one or more suicide attempts formed the suicide attempters group and 83 patients with no such history formed the non-suicide attempters group. We collated the differences in clinical and psychological characteristics between the two groups by using the Symptom Checklist-90-Revised (SCL-90-R), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Personality Disorder Questionnaire-4+ (PDQ-4+), and the Defense Style Questionnaire (DSQ). RESULTS The suicide attempters group scored higher on the hostility subscale of SCL-90-R. The suicide attempters group also scored higher on the Infrequency, Back Infrequency, Lie, Masculinity-femininity, Paranoia, Psychasthenia, and Schizophrenia scales of the MMPI-2. The incidence of paranoid and antisocial personality disorders, as assessed by the PDQ-4+, was significantly different in both groups. Maladaptive, self-sacrificing defense style, splitting and affiliation on the DSQ were also higher for the suicide attempters group. In the results of the logistic regression analysis, gender, the F(B) and L scales on the MMPI-2, and 'splitting of other's image' defense mechanism on the DSQ were the factors that significantly influenced to suicide attempts. CONCLUSION These findings suggest that impulsive psychiatric features and maladaptive defense style may be related to suicidal risk in patients with BPD. Therefore, our findings may help clinicians in estimating the risk of suicide in patients with BPD.
Collapse
Affiliation(s)
- Young-Ji Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Mu-Sung Keum
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hye-Geum Kim
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | | | - Bon-Hoon Koo
- Department of Psychiatry, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| |
Collapse
|
35
|
Roncero C, Remon D, Casado-Espada NM, Aguilar L, Gamonal-Limcaoco S, Gallego MT, Bote B, Montejo AL, Buch B. Perception and satisfaction in telemedicine on Mental Health among professionals during the COVID outbreak. A real-world experience in telepsychiatry. (Preprint). JMIR Form Res 2020. [DOI: 10.2196/22224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Lee YJ, Kim HG, Cheon EJ, Kim K, Choi JH, Kim JY, Kim JM, Koo BH. The Analysis of Electroencephalography Changes Before and After a Single Neurofeedback Alpha/Theta Training Session in University Students. Appl Psychophysiol Biofeedback 2020; 44:173-184. [PMID: 30903394 DOI: 10.1007/s10484-019-09432-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The underlying mechanisms of alpha/theta neurofeedback training have not been fully determined. Therefore, this study aimed to test the changes in the brain state feedback during the alpha/theta training. Twenty-seven healthy participants were trained during a single session of the alpha/theta protocol, and the resting quantitative electroencephalography (QEEG) was assessed before and after training. QEEG was recorded at eight scalp locations (F3, F4, C3, C4, T3, T4, O1, and O2), and the absolute power, relative power, ratio of sensory-motor rhythm beta (SMR) to theta (RST), ratio of SMR-mid beta to theta (RSMT), ratio of mid beta to theta (RMT), ratio of alpha to high beta (RAHB), and scaling exponent of detrended fluctuation analysis by each band were measured. The results indicated a significant increase of absolute alpha power, especially the slow alpha band, at all electrodes except T3 and T4. Moreover, the relative alpha power, especially the slow alpha band, showed a significant increase at all electrodes. The relative theta power showed a significant decrease at all electrodes, except T3. A significant decrease in relative beta power, relative lower beta power and relative mid beta power was observed at O1. RST (at C4, O1, and O2), RSMT and RMT (at F4, C4, O1 and O2), and RAHB (at all electrodes) showed significant increase. Scaling exponents at all electrodes except T3 showed a significant decrease. These findings indicate that a one-time session of alpha/theta training might have the possibility to enhance both vigilance and concentration, thus stabilizing the overall brain function.
Collapse
Affiliation(s)
- Young-Ji Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Hye-Geum Kim
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, 317-1, Daemyeong 5-dong, Nam-gu, Daegu, Republic of Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, 317-1, Daemyeong 5-dong, Nam-gu, Daegu, Republic of Korea
| | - Kiseong Kim
- Department of Bio and Brain Engineering, KAIST, Daejeon, 34141, Republic of Korea
| | - Joong-Hyeon Choi
- Department of Neurology, Haeundae Paik Hospital, Inje University, 875, Haeun-daero, Haeundae-gu, Busan, Republic of Korea
| | - Ji-Yean Kim
- Department of Psychology, Yeungnam University College of Medicine, Yeungnam University Medical Center, 317-1, Daemyeong 5-dong, Nam-gu, Daegu, Republic of Korea
| | - Jin-Mi Kim
- The Graduate School of Public Health and Social Welfare, Kyungil University, 50, Gamasil-gil, Hayang-eup, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, 317-1, Daemyeong 5-dong, Nam-gu, Daegu, Republic of Korea.
| |
Collapse
|
37
|
Matsumoto K, Hamatani S, Nagai K, Sutoh C, Nakagawa A, Shimizu E. Long-Term Effectiveness and Cost-Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder in Japan: One-Year Follow-Up of a Single-Arm Trial. JMIR Ment Health 2020; 7:e17157. [PMID: 32324150 PMCID: PMC7206520 DOI: 10.2196/17157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 03/25/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. OBJECTIVE The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. METHODS Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. RESULTS Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was -4.1 (F1=4.45, P=.04), the change in PDSS was -4.4 (F1=6.83, P=.001), and the change in LSAS was -30.9 (F1=6.73, P=.01). The change in the PHQ-9 at 12 months was -2.7 (F1=7.72, P=.007), and the change in the GAD-7 was -3.0 (F1=7.09, P=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (P=.01). Total costs to provide the VCBT were ¥60,800 to ¥81,960 per patient. The set threshold was ¥189,500 ($1723, €1579, and £1354) calculated based on willingness to pay in Japan. CONCLUSIONS VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030495.
Collapse
Affiliation(s)
- Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kazue Nagai
- Research and Education Center of Health Sciences, Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chia, Japan
| | - Akiko Nakagawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chia, Japan
| |
Collapse
|
38
|
Videoconferencing in psychiatry, a meta-analysis of assessment and treatment. Eur Psychiatry 2020; 36:29-37. [DOI: 10.1016/j.eurpsy.2016.03.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/16/2016] [Accepted: 03/30/2016] [Indexed: 12/16/2022] Open
Abstract
AbstractContextVideoconferencing in psychiatry allows psychiatric counseling to be dealt remotely. A number of human randomised clinical trials (RCTs) on this topic were conducted but not systematically analysed since 2005.ObjectsA meta-analysis was undertaken to test the hypothesis of non-inferiority of remote psychiatric counseling, including both assessment and treatment, compared to face-to-face setting. Focus of research was the general psychiatric approach, which includes pharmacotherapy, counseling and some not specific psychotherapeutic techniques such as listening, reformulation and clarification among others. Specific forms of psychotherapies were not included in this analysis.DesignRCTs including ≥ 10 subjects per arm were identified in Medline, the Cochrane Library, Embase and the reference list of single papers. A random-effect and a mixed-effect model served for test the hypothesis under analysis.ResultsTwenty-six RCTs were included in the analysis, involving 765 (assessment) and 1585 patients (efficacy). The non-inferiority of remote psychiatric counseling was reported both for assessment and treatment. Heterogeneity could not be excluded for assessment, but was excluded for treatment while taking into account clinical and study related variables (P-values = 0.003 and 0.06, respectively).ConclusionHigh levels of consistency between remote and in vivo psychiatric assessment is reported. Efficacy of remote psychiatric counseling was shown to be not inferior compared to in vivo settings. Heterogeneity could not be excluded for assessment, and further analyses are mandatory. The presence of multiple diagnoses included in the analysis was a limit of the present investigation.
Collapse
|
39
|
Gardner JS, Plaven BE, Yellowlees P, Shore JH. Remote Telepsychiatry Workforce: a Solution to Psychiatry's Workforce Issues. Curr Psychiatry Rep 2020; 22:8. [PMID: 31989417 DOI: 10.1007/s11920-020-1128-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to demonstrate how a remote workforce may increase access to care while reducing physician burnout. We review workforce issues and organizational and individual obstacles for implementing a telepsychiatry workforce including administrative, logistical, and clinical considerations and offer resources for how to overcome barriers that may arise in implementing a remote workforce. RECENT FINDINGS There is an increasingly unmet demand for mental health services and a shortage in psychiatrists. Burnout may be a key factor contributing to psychiatrists working less, pursuing less acute cases, and leading to worsened outcomes for patients and the psychiatrists themselves. Telepsychiatry provides comparable patient and provider satisfaction and equal outcomes when compared with face-to-face encounters. We provided 3 case examples to demonstrate psychiatrists demonstrating successful delivery of care in a range of clinic settings and workplace configurations while optimizing their quality of life and reducing their risk of burnout.
Collapse
Affiliation(s)
| | - Brittany E Plaven
- Walden University, Minneapolis, USA.,Department of Health Professions, Metropolitan State University of Denver, Denver, USA
| | | | - Jay H Shore
- AccessCare, 11100 E. Bethany Dr., Aurora, CO, 80014, USA.,Department of Psychiatry and Family Medicine, School of Medicine, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, USA
| |
Collapse
|
40
|
Rehder K, Lusk J, Chen JI. Deaths of Despair: Conceptual and Clinical Implications. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 28:40-52. [PMID: 34168422 DOI: 10.1016/j.cbpra.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since the late 1990s, mortality rates for middle-aged (45-55), White non-Hispanic (WNH) Americans began to rise while rates declined for all other demographic and age groups. Coinciding with the rise in mortality, rates of death due to suicide, drug- and alcohol-related overdoses, and alcohol-related liver diseases increased as well for this demographic. Research suggests these causes of death (i.e., suicide, poisoning, alcohol-related liver disease) are driving the overall mortality rate for middle-aged WNHs and have been described as "deaths of despair" in the literature. In the current paper, we describe the social and clinical features of "deaths of despair," explore theoretical models of psychopathology (e.g., depression, posttraumatic stress disorder) that may inform our understanding of mechanisms of risk for negative mental health outcomes, and propose an initial conceptual model of "deaths of despair" to identify intervention targets. We then review an applied case example demonstrating how this model could be used for clinical application. We conclude our paper by describing how current cognitive-behavioral interventions may address these mechanisms of "despair."
Collapse
Affiliation(s)
- Kristoffer Rehder
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jaimie Lusk
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jason I Chen
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| |
Collapse
|
41
|
Apostolaros M, Babaian D, Corneli A, Forrest A, Hamre G, Hewett J, Podolsky L, Popat V, Randall P. Legal, Regulatory, and Practical Issues to Consider When Adopting Decentralized Clinical Trials: Recommendations From the Clinical Trials Transformation Initiative. Ther Innov Regul Sci 2019; 54:779-787. [PMID: 32557302 PMCID: PMC7362888 DOI: 10.1007/s43441-019-00006-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/17/2019] [Indexed: 01/18/2023]
Abstract
Background Traditional clinical trials are often expensive, inefficient, include selected populations, and can create significant participant burden via travel and other logistical demands. Using new technologies and methodologies to promote a decentralized approach has the potential to improve the efficiency of clinical trials. The Clinical Trials Transformation Initiative (CTTI)—a public–private partnership to improve clinical trials—launched a multi-stakeholder Decentralized Clinical Trials (DCTs) Project to provide recommendations on addressing the actual and perceived legal, regulatory, and practical challenges with DCT design and conduct in the United States. Methods Informed by qualitative group interviews and an expert meeting, CTTI engaged stakeholders to identify key challenges to implementing DCTs and possible solutions. Results The CTTI DCT project team used the interview findings and expert feedback to develop recommendations that will drive broader use of DCTs. Conclusions CTTI’s recommendations cover protocol design, use of telemedicine and mobile healthcare providers, medical product supply chain, investigator delegation and oversight, and safety monitoring considerations. By implementing these recommendations, sponsors, contract research organizations, and others can help advance successful medical product development using mobile technologies and methodologies in DCTs.
Collapse
Affiliation(s)
- Maria Apostolaros
- Pharmaceutical Research and Manufacturers of America (PhRMA), 950 F Street NW, Suite 300, Washington, DC, 20004, USA
| | - David Babaian
- Advarra Consulting, 1501 Fourth Ave, Suite 800, Seattle, WA, 98101, USA
| | - Amy Corneli
- Clinical Trials Transformation Initiative, 200 Morris St, Durham, NC, 27701, USA
- Department of Population Health Sciences, Duke Clinical Research Institute, 215 Morris St, Suite 210, Durham, NC, 27701, USA
| | - Annemarie Forrest
- Clinical Trials Transformation Initiative, 200 Morris St, Durham, NC, 27701, USA.
| | - Gerrit Hamre
- Hamre Strategies LLC, 507 N Elizabeth St, Durham, NC, 27701, USA
| | - Jan Hewett
- Office of Compliance, Center for Drug Evaluation and Research, Food and Drug Administration, New Hampshire Ave, Building 51, Silver Spring, MD, 20903, USA
| | - Laura Podolsky
- Science 37, Inc., 12121 Bluff Creek Dr, Suite 100, Los Angeles, CA, 90094, USA
| | - Vaishali Popat
- Center for Drug Evaluation and Research, Office of New Drugs, Food and Drug Administration, New Hampshire Ave, Building 22, Silver Spring, MD, 20903, USA
| | - Penny Randall
- IQVIA, 10188 Telesis Court, Suite 400, San Diego, CA, 92121, USA
| |
Collapse
|
42
|
Best P, McConnell T, Davidson G, Badham J, Neill RD. Group based video-conferencing for adults with depression: findings from a user-led qualitative data analysis using participatory theme elicitation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:40. [PMID: 31844555 PMCID: PMC6896757 DOI: 10.1186/s40900-019-0173-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Accessing support services for depression has been historically difficult given the societal stigma that exists regarding the condition. Recent advances in digital technologies continue to be postulated as a potential panacea yet the results from research trials have been mixed with a range of effect sizes. METHODS This article offers a different perspective by presenting a panel of end users (co-researchers) with qualitative interview data (n = 8) taken from a feasibility RCT of a group based video-conferencing service for depressed adults. The co-researcher panel were introduced to a new method of participatory data analysis known as Participatory Theme Elicitation (PTE). This method involves using network analysis techniques to create groupings and visual diagrams in order to support the generation of themes and minimise scientific researcher input/influence. RESULTS Co-researchers reported that while VC based interventions appeared convenient, accessible and relatively low cost - additional training and support should be offered to improve uptake and retention. In addition, co-researchers suggested that further exploration is needed regarding the level of self-awareness one feels in a group based VC environment and whether this facilitates disclosure (through disinhibition) or increases anxiety. CONCLUSION The findings presented here appear to support existing (researcher and academic-led) literature in the field as well as suggest new areas for investigation. By presenting data generated solely by co-researchers, this article also adds to the evidence surrounding participatory analysis methods - particularly the growing need for robust approaches that are accessible and less time-consuming than those currently available. TRIAL REGISTRATION NUMBER NCT03288506 (Clinicaltrials.gov) 20th Sept 2017 https://clinicaltrials.gov/ct2/show/NCT03288506.
Collapse
Affiliation(s)
- Paul Best
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Tracey McConnell
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Gavin Davidson
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| | - Jennifer Badham
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Royal Victoria Hospital, Queen’s University Belfast, Belfast, UK
| | - Ruth D. Neill
- School of Social Sciences Education and Social Work. 6 College Park, Queen’s University Belfast, Belfast, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, UK
| |
Collapse
|
43
|
Petersen D, Salazar B, Kertz SJ. Therapist and Treatment-Seeking Students’ Perceptions of Telemental Health. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
44
|
Kaonga NN, Morgan J. Common themes and emerging trends for the use of technology to support mental health and psychosocial well-being in limited resource settings: A review of the literature. Psychiatry Res 2019; 281:112594. [PMID: 31605874 DOI: 10.1016/j.psychres.2019.112594] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/29/2019] [Accepted: 09/29/2019] [Indexed: 12/19/2022]
Abstract
There are significant disparities in access to mental health care. With the burgeoning of technologies for health, digital tools have been leveraged within mental health and psychosocial support programming (eMental health). A review of the literature was conducted to understand and identify how eMental health has been used in resource-limited settings in general. PubMed, Ovid Medline and Web of Science were searched. Six-hundred and thirty full-text articles were identified and assessed for eligibility; of those, 67 articles met the inclusion criteria and were analyzed. The most common mental health use cases were for depression (n = 25) and general mental health and well-being (n = 21). Roughly one-third used a website or Internet-enabled intervention (n = 23) and nearly one-third used an SMS intervention (n = 22). Technology was applied to enhance service delivery (n = 32), behavior change communication (n = 26) and data collection (n = 8), and specifically dealt with adherence (n = 7), ecological momentary assessments (n = 7), well-being promotion (n = 5), education (n = 8), telemedicine (n = 28), machine learning (n = 5) and games (n = 2). Emerging trends identified wearables, predictive analytics, robots and virtual reality as promising areas. eMental health interventions that leverage low-tech tools can introduce, strengthen and expand mental health and psychosocial support services and can be a starting point for future, advanced tools.
Collapse
Affiliation(s)
- Nadi Nina Kaonga
- HealthEnabled, Cape Town, South Africa; Tufts University School of Medicine, Boston, MA, United States; Maine Medical Center, Portland, ME, United States.
| | - Jonathan Morgan
- Regional Psychosocial Support Initiative (REPSSI), Cape Town, South Africa.
| |
Collapse
|
45
|
Saberi P, Dawson Rose C, Wootton AR, Ming K, Legnitto D, Jeske M, Pollack LM, Johnson MO, Gruber VA, Neilands TB. Use of technology for delivery of mental health and substance use services to youth living with HIV: a mixed-methods perspective. AIDS Care 2019; 32:931-939. [PMID: 31132864 DOI: 10.1080/09540121.2019.1622637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Technology use has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18-29 year-old YLWH, and explored technology use as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with mental health measures such as depression, trauma, and adverse childhood experiences and marijuana and stimulants use. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with 29 participants, barriers to and facilitators of accessing and maintaining mental health services were identified. Most participants favored technology use for mental health and substance use service delivery, including videoconferencing with a counselor. Provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing accessibility of these services.
Collapse
Affiliation(s)
- Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Carol Dawson Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Angie R Wootton
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kristin Ming
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Dominique Legnitto
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Melanie Jeske
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Lance M Pollack
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA.,Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Valerie A Gruber
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| |
Collapse
|
46
|
Mahmoud H, Vogt EL, Sers M, Fattal O, Ballout S. Overcoming Barriers to Larger-Scale Adoption of Telepsychiatry. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181228-02] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
47
|
Hassan A, Sharif K. Efficacy of Telepsychiatry in Refugee Populations: A Systematic Review of the Evidence. Cureus 2019; 11:e3984. [PMID: 30972263 PMCID: PMC6443105 DOI: 10.7759/cureus.3984] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction Telepsychiatry is becoming an increasingly appealing option for mental health treatment due to its ability to overcome barriers which prevent certain demographics from having access to mental health services. There is a surprising lack of research being done on this promising mode of health care delivery. The aim of this study is to evaluate the existing literature in order to determine the clinical effectiveness and cost-effectiveness of telepsychiatry in resource-constrained environments. Methods Literature searches were performed in PsychINFO, PubMed, Medline, EMBASE, Centre for Reviews and Dissemination, and the Cochrane Library Controlled Trial Registry databases (2000 - May 2017). A search of the following terms was used: telemedicine; telemedical; telepsychiatry; telepsychiatric; teleconsultation; e-health; video conference; and telecare. Type of mental disorder and intervention, along with the clinical outcome or patient satisfaction, were all identified. Exclusion criteria included studies with a sample size of fewer than 10 cases, as well as studies which failed to analyze intervention outcomes. Results Of the 1,477 identified articles, 14 randomized controlled trials were included for review. Despite the methodological limitations and the small number of existing studies, there appears to be limited evidence pointing towards the efficacy of telepsychiatry in resource-constrained environments, although patients and providers tend to prefer face-to-face treatment over video conferencing. Two of the studies included in this paper found video conferencing to be more effective than face-to-face treatment, while none reported the opposite. At the very least, we hypothesize that psychotherapeutic treatment delivered via video conferencing is just as effective as a traditional treatment, albeit less desirable. Conclusion More research is required in order to further evaluate the efficacy of telepsychiatry in the management of mental illness, as there is a current lack of scientific evidence to draw any conclusions. However, there exists a strong hypothesis that telepsychiatric treatment yields the same results as the traditional, in-person therapy and that telepsychiatry is a useful alternative when traditional therapy is not possible. Countries with substantial numbers of refugees living in resource-constrained areas, such as camps, should be encouraged to develop telepsychiatry programs.
Collapse
Affiliation(s)
- Ahmad Hassan
- Psychiatry, Yale University School of Medicine, New Haven, USA
| | - Kareem Sharif
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA
| |
Collapse
|
48
|
Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
Collapse
Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
| |
Collapse
|
49
|
Tuerk PW, Keller SM, Acierno R. Treatment for Anxiety and Depression via Clinical Videoconferencing: Evidence Base and Barriers to Expanded Access in Practice. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:363-369. [PMID: 31975928 DOI: 10.1176/appi.focus.20180027] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review summarizes six decades of clinical outcome research relevant to evidence-based practices for depression and anxiety delivered via clinical videoconferencing. The authors conducted a literature search of previous systematic reviews and an updated search of publications specific to anxiety and depression. Overall, strong evidence supports the safety and clinical effectiveness of administering evidence-based psychotherapy for anxiety and depression via clinical videoconferencing among heterogeneous populations and age ranges, and in multiple care settings, with similar outcomes to in-person care. Despite the overall clinical effectiveness of the modality, the authors discuss common logistical and institutional barriers to long-term effective implementation. Future systems-level research is required to investigate replicable and sustainable models for implementing and expanding access to evidence-based psychotherapies via clinical videoconferencing.
Collapse
Affiliation(s)
- Peter W Tuerk
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Stephanie M Keller
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Ron Acierno
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| |
Collapse
|
50
|
Roumelioti ME, Steel JL, Yabes J, Vowles KE, Vodovotz Y, Beach S, Rollman B, Weisbord SD, Unruh ML, Jhamb M. Rationale and design of technology assisted stepped collaborative care intervention to improve patient-centered outcomes in hemodialysis patients (TĀCcare trial). Contemp Clin Trials 2018; 73:81-91. [PMID: 30208343 PMCID: PMC6168366 DOI: 10.1016/j.cct.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/17/2018] [Accepted: 09/07/2018] [Indexed: 01/08/2023]
Abstract
Most hemodialysis (HD) patients experience symptoms of depression, pain and fatigue that impair their health-related quality of life (HRQOL) significantly. These symptoms are associated with increased hospitalization and mortality, mediated by behavioral factors (e.g. non-adherence to medication and dialysis) and biological factors (e.g. inflammatory cytokines). Prior interventions to alleviate symptoms and improve HRQOL showed limited effectiveness in HD patients and their effect on bio-behavioral mediators is lacking evidence. It is imperative to improve patient-centered dialysis care and to address call from Kidney Disease Improving Global Outcomes (KDIGO) guidelines for integration of symptom assessment and management in routine HD-care. Technology-Assisted stepped Collaborative Care (TĀCcare) is a multi-center randomized controlled trial (RCT) of 150 diverse HD patients from Pennsylvania and New Mexico, designed to compare the effectiveness of a 12-week stepped collaborative care intervention (cognitive behavioral therapy, CBT) with an attention control arm of technology-delivered health education. Collaborative care provides an integrated multi-disciplinary structured management plan. Furthermore, a stepped approach to pharmacotherapy and/or CBT allows for individualization of treatment according to patients' clinical status, preferences and treatment response. To simplify the delivery of CBT and to minimize patient and provider burden, we will use live video-conferencing with patients in dialysis units. We will examine the effect of these interventions on patient symptoms, HRQOL, treatment adherence and inflammatory biomarkers. This RCT tests a readily implementable intervention that can be integrated in routine HD-care and will generate novel and meaningful insights on strategies to alleviate common symptoms and improve HRQOL in HD.
Collapse
Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM, United States
| | - Jennifer L Steel
- Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonathan Yabes
- Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico & Division of Physical Medicine and Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Yoram Vodovotz
- Department of Immunology and Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Scott Beach
- Department of Psychology, University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bruce Rollman
- Department of Medicine, Psychiatry, Biomedical Informatics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven D Weisbord
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Mark L Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM, United States
| | - Manisha Jhamb
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| |
Collapse
|