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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.
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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
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Kister K, Laskowski J, Dybała E, Makarewicz A. Are we ready for Telepsychiatry? Benefits and challenges of digital
psychotherapy. CURRENT PROBLEMS OF PSYCHIATRY 2023. [DOI: 10.12923/2353-8627/2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Telemedicine is one of the most modern and fastest-growing branches of medicine. The most common form is video consultation. We distinguish between synchronous and asynchronous telepsychiatry. This study aims to show the benefits of using telepsychiatry services, the challenges it poses to users, and to evaluate its use against traditional therapy.
Materials and methods: A review of literature from 1956-2023 in EMBASE, OpenKnowledge and PubMed databases was conducted. Keywords used were: telepsychiatry, teletherapy, and digital psychiatry. Ninety-eight articles were included.
Discussion: Telepsychiatry is an opportunity for regions affected by medical staff shortages. It bypasses cultural barriers, the problem of traveling and reduces the cost of medical point-of-service. Telepsychiatry is an opportunity for patients who do not use psychiatrists due to discrimination in a conservative society. Groups that may find it challenging include the elderly, the blind, and the deaf. Creating a healthy therapeutic alliance through a screen can be impossible, making it difficult to achieve successful therapy. A barrier to developing telepsychiatry is the need for more guidelines for dealing with medical errors.
Conclusions: Telemedicine can help in accessing specialized care regardless of location. Telepsychiatry provides a safe and anonymous environment for patients reluctant to receive inpatient therapy. The effectiveness of online therapy is primarily debated. Telepsychiatry should be limited to follow-up consultations and well-known patients - it is a form of complementing the diagnosis and treatment process. The authors point to the need for developing specific guidelines for conducting teletherapy with particular attention to the problem of suicide.
Keywords: telepsychiatry, teletherapy, digital psychiatry.
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Affiliation(s)
- Klaudia Kister
- I Departmentof Psychiatry, Psychoterapy and Early Intervention of Medical University in Lublin, Poland - Students Research Group
| | - Jakub Laskowski
- Department of Paediatrician Oncology, Transplantology and Haematology Medical University of Lublin, Poland - Students Research Group
| | | | - Agata Makarewicz
- I Department of Psychiatry, Psychoterapy and Early Intervention, Medical University of Lublin, Poland
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Negev M, Magal T, Kaphzan H. Attitudes of psychiatrists toward telepsychiatry: A policy Delphi study. Digit Health 2023; 9:20552076231177132. [PMID: 37312951 PMCID: PMC10259121 DOI: 10.1177/20552076231177132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives To delineate areas of consensus and disagreements among practicing psychiatrists from various levels of clinical experience, hierarchy and organizations, and to test their ability to converge toward agreement, which will enable better integration of telepsychiatry into mental health services. Methods To study attitudes of Israeli public health psychiatrists, we utilized a policy Delphi method, during the early stages of the COVID pandemic. In-depth interviews were conducted and analyzed, and a questionnaire was generated. The questionnaire was disseminated amongst 49 psychiatrists, in two succeeding rounds, and areas of consensus and controversies were identified. Results Psychiatrists showed an overall consensus regarding issues of economic and temporal advantages of telepsychiatry. However, the quality of diagnosis and treatment and the prospect of expanding the usage of telepsychiatry to normal circumstances-beyond situations of pandemic or emergency were disputed. Nonetheless, efficiency and willingness scales slightly improved during the 2nd round of the Delphi process. Prior experience with telepsychiatry had a strong impact on the attitude of psychiatrists, and those who were familiar with this practice were more favorable toward its usage in their clinic. Conclusions We have delineated experience as a major impact on the attitudes toward telepsychiatry and the willingness for its assimilation in clinical practice as a legitimate and trustworthy method. We have also observed that the organizational affiliation significantly affected psychiatrists' attitude, when those working at local clinics were more positive toward telepsychiatry compared with employees of governmental institutions. This might be related to experience and differences in organizational environment. Taken together, we recommend to include hands-on training of telepsychiatry in medical education curriculum during residency, as well as refresher exercises for attending practitioners.
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Affiliation(s)
- Maya Negev
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamir Magal
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
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Shaker AA, Austin SF, Sørensen JA, Storebø OJ, Simonsen E. Psychiatric treatment conducted via telemedicine versus in-person consultations in mood, anxiety and personality disorders: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e060690. [PMID: 36171023 PMCID: PMC9528631 DOI: 10.1136/bmjopen-2021-060690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Major advancements in technology have led to considerations how telemedicine (TM) and other technology platforms can be meaningfully integrated in treatment for psychiatric disorders. The COVID-19 pandemic has placed a further focus on use of TM in psychiatry. Despite the widespread use of TM, little is known about its effect compared with traditional in-person (IP) consultation. The objective of this systematic review is to examine if individual psychiatric outpatient interventions for adults using TM are comparable to IP in terms of (1) psychopathology outcomes, (2) levels of patient satisfaction, (3) working alliance and (4) dropout from treatment. METHODS AND ANALYSIS This review will only include randomised controlled trials for adult participants with mood disorders, anxiety or personality disorders. The primary outcome is psychopathology, and secondary outcomes include patient satisfaction, treatment alliance and dropout rate. Systematic searches were conducted in MEDLINE, APA PsycINFO, Embase, Web of Science and CINAHL. The inverse-variance method will be used to conduct the meta-analysis. Effect sizes will be calculated as standardised mean difference (Hedges' g) for the primary outcome, mean difference for patient satisfaction and working alliance, and risk ratio for the dropout rate. Effect sizes will be supplemented with 95% CI. We will calculate the I² statistic to quantify heterogeneity and Chi-square statistic (χ²) to test for heterogeneity for the primary outcome. Potential clinical and methodological heterogeneity moderators will be assessed in subgroup and sensitivity analysis. The risk of bias will be assessed by Cochrane Risk of Bias Tool V.2, and confidence in cumulative evidence will be assessed by Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review protocol. Data sets will be deposited in the Zenodo repository. The findings of this study will be published in a peer-review scientific journal. PROSPERO REGISTRATION NUMBER CRD42021256357.
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Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | | | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Sánchez-Guarnido AJ, Hidalgo N, Arenas de la Cruz J, Esteban I, Mondón S, Herruzo C. Analysis of the Consequences of the COVID-19 Pandemic on People with Severe Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8549. [PMID: 34444298 PMCID: PMC8393683 DOI: 10.3390/ijerph18168549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 01/01/2023]
Abstract
For people with severe mental disorders (SMDs) the COVID-19 pandemic may pose a number of risks. These include the loss of needed care, a higher probability of infection, and the worsening of their mental health. To analyze the pandemic's impact on care received, relapses, loss of employment, and adherence to preventive guidelines in SMD sufferers, a multicenter retrospective cohort study was carried out comparing 185 patients diagnosed with SMD and 85 with common disorders. The results showed that during lockdown, there was a significant reduction in face-to-face psychotherapeutic, nursing, and occupational therapy interventions. In the same period, telematic interventions were introduced which, although subsequently reduced, now continue to be used to a greater extent than before the pandemic. Employment decreased significantly (13% vs. 9.2%; χ2 = 126.228 p < 0.001). The percentage of people with SMD following preventive guidelines was significantly lower for both hand washing (56.2% vs. 75.3%; χ2 = 9.360, p = 0.002) and social distancing (47% vs. 63.5; χ2 = 6.423 p = 0.011). In conclusion, the COVID-19 pandemic has led to a reduction in the interventions that are needed for the recovery of people with SMDs, together with a significant loss of employment and an increased risk of contagion due to less adherence to preventive guidelines. In the future, appropriate attention to these people's needs must be guaranteed.
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Affiliation(s)
| | - Nuria Hidalgo
- Hospital Santa Ana, 18600 Motril, Spain; (A.J.S.-G.); (N.H.); (I.E.)
| | | | | | - Silvia Mondón
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Carlos Herruzo
- Department of Psychology, Universidad de Córdoba, 14071 Córdoba, Spain
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Kulkarni KR, Shyam RPS, Bagewadi VI, Gowda GS, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study of collaborative telepsychiatric consultations for a rehabilitation centre managed by a primary healthcare centre. Indian J Med Res 2021; 152:417-422. [PMID: 33380707 PMCID: PMC8061593 DOI: 10.4103/ijmr.ijmr_676_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background & objectives: Telepsychiatric methods can be used for the purpose of providing clinical care comparable to in-person treatment in various settings including rehabilitation. Previous evidence has shown that clinical outcomes for both are comparable. In view of challenges posed in the implementation of traditional psychiatric care in India, telepsychiatry offers an avenue to provide feasible, affordable and clinically useful psychiatric services. This study was conducted to examine the utility, feasibility and clinical effectiveness of providing collaborative telepsychiatric services with a primary care doctor for inpatients in a rehabilitation centre through a telepsychiatrist of estabilished psychiatry department in a tertiary care centre in south India in a collaborative care model with a primary care doctor. Methods: Patients at the rehabilitation centre attached to an urban primary healthcare centre received collaborative care using telepsychiatry for a period from January 2013 to December 2016. A retrospective review of their charts was performed and sociodemographic, clinical and treatment details were collected and analyzed. Results: The sample population (n=132) consisted of 75 per cent males, with a mean age of 43.8 ± 12.1 yr. Each patient received an average of 7.8 ± 4.9 live video-consultations. Initially, an antipsychotic was prescribed for 84.1 per cent (n=111) of patients. Fifty four patients (40.9%) had a partial response and 26 (19.7%) patients showed a good response. Interpretation & conclusions: The study sample represented the population of homeless persons with mental illness who are often brought to the rehabilitation centre. This study results demonstrated the successful implementation of inpatients collaborative telepsychiatry care model for assessment, follow up, investigation and treatment of patients through teleconsultation.
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Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R P S Shyam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harihara N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Korecka N, Rabenstein R, Pieh C, Stippl P, Barke A, Doering B, Gossmann K, Humer E, Probst T. Psychotherapy by Telephone or Internet in Austria and Germany Which CBT Psychotherapists Rate It more Comparable to Face-to-Face Psychotherapy in Personal Contact and Have more Positive Actual Experiences Compared to Previous Expectations? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7756. [PMID: 33114136 PMCID: PMC7660328 DOI: 10.3390/ijerph17217756] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
Objectives: COVID-19 has led to changes in the provision in mental health services. The current study investigated influencing factors on: (i) the comparability of psychotherapy via internet/telephone with psychotherapy in face-to-face contact as well as (ii) the actual experience with psychotherapy via internet/telephone compared to respective prior expectations in CBT therapists. Methods: A quantitative cross-sectional study was conducted in the form of an online survey. The research samples, registered cognitive-behavioral therapy (CBT) psychotherapists in Austria and Germany, were contacted by e-mail. Results: One hundred and ninety CBT therapists were analyzed in this study. The total number of patients treated via telephone/internet is a decisive factor for the subjective evaluation of the comparability of psychotherapy via telephone/internet and psychotherapy in personal contact. This factor also influences the extent (positive/negative) of the assessment of the actual experience with psychotherapy via internet/telephone compared to previous expectations. Neither age nor gender were associated with comparability of psychotherapy via internet/telephone with psychotherapy in face-to-face contact or the actual experience with psychotherapy via internet/telephone compared to respective prior expectations. Conclusions: Implications of the results are that attitudes towards remote psychotherapy might be increased in CBT therapists when they treat more patients remotely and experiences with remote psychotherapies should be included in psychotherapy training.
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Affiliation(s)
- Nicole Korecka
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Rafael Rabenstein
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, Löwengasse 3, 1030 Vienna, Austria;
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, 85072 Eichstätt, Germany; (A.B.); (B.D.); (K.G.)
| | - Bettina Doering
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, 85072 Eichstätt, Germany; (A.B.); (B.D.); (K.G.)
| | - Katharina Gossmann
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 26, 85072 Eichstätt, Germany; (A.B.); (B.D.); (K.G.)
| | - Elke Humer
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (N.K.); (R.R.); (C.P.); (E.H.)
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Serhal E, Crawford A, Cheng J, Kurdyak P. Implementation and Utilisation of Telepsychiatry in Ontario: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:716-725. [PMID: 28541753 PMCID: PMC5638186 DOI: 10.1177/0706743717711171] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Rural areas in Ontario have fewer psychiatrists, making access to specialist mental health care challenging. Our objective was to characterise psychiatrists delivering and patients receiving telepsychiatry in Ontario and to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalisation. METHOD We conducted a serial panel study to evaluate the characteristics of psychiatrists providing telepsychiatry from April 2007 to March 2013. In addition, we conducted a cross-sectional study for fiscal year 2012-2013 to examine telepsychiatry patient characteristics and create an in-need patient cohort of individuals with a recent psychiatric hospitalisation that assessed if they had follow-up with a psychiatrist in person or through telepsychiatry within 1 year of discharge. RESULTS In fiscal year 2012-2013, a total of 3801 people had 5635 telepsychiatry visits, and 7% ( n = 138) of Ontario psychiatrists provided telepsychiatry. Of the 48,381 people identified as in need of psychiatric care, 60% saw a local psychiatrist, 39% saw no psychiatrist, and less than 1% saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry within a year. Three northern regions had more than 50% of in-need patients fail to access psychiatry within 1 year. CONCLUSIONS Currently, relatively few patients and psychiatrists use telepsychiatry. In addition, patients scarcely access telepsychiatry for posthospitalisation follow-up. This study, which serves as a preliminary baseline for telepsychiatry in Ontario, demonstrates that telepsychiatry has not evolved systematically to address need and highlights the importance of system-level planning when implementing telepsychiatry to optimise access to care.
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Affiliation(s)
- Eva Serhal
- Centre for Addiction and Mental Health, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Eva Serhal, MBA, Centre for Addiction and Mental Health, 821-250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joyce Cheng
- Centre for Addiction and Mental Health, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario
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Caxaj CS. A Review of Mental Health Approaches for Rural Communities: Complexities and Opportunities in the Canadian Context. ACTA ACUST UNITED AC 2016. [DOI: 10.7870/cjcmh-2015-023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three mental health approaches with potential relevance to rural Canada were reviewed: telepsychiatry, integrated mental health models, and community-based approaches. These approaches have been evaluated in relation to their cost-effectiveness, comprehensiveness, client-centredness, cultural appropriateness, acceptability, feasibility and fidelity; criteria that may vary amidst rural contexts. Collaborative approaches to care, technologies fully integrated into local health systems, multi-sectoral capacity-building, and further engagement with informal social support networks may be particularly promising strategies in rural communities. More research is required to determine rural mental health pathways among diverse social groups, and further, to establish the acceptability of novel approaches in mental health.
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Affiliation(s)
- C. Susana Caxaj
- University of British Columbia
- University of British Columbia
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Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry 2015; 5:286-304. [PMID: 26425443 PMCID: PMC4582305 DOI: 10.5498/wjp.v5.i3.286] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 02/05/2023] Open
Abstract
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
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Kasckow J, Felmet K, Appelt C, Thompson R, Rotondi A, Haas G. Telepsychiatry in the assessment and treatment of schizophrenia. ACTA ACUST UNITED AC 2015; 8:21-27A. [PMID: 23428781 DOI: 10.3371/csrp.kafe.021513] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Telehealth technology has become more available to providers as a means of treating chronic diseases. Consideration of the applicability of telehealth technology in the treatment of schizophrenia calls for a review of the evidence base in light of the special needs and challenges in the treatment of this population. Our aims are to assess the types and nature of distant interventions for patients with schizophrenia, either telephone-based, internet-based or video-based telehealth systems. METHODS The following databases--MEDLINE, PsycINFO, CINAHL, the Cochrane Library, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and EMBASE--were searched for the following terms alone or in combination with schizophrenia: telepsychiatry or telemedicine or telepsychology or satellite communication or remote communication. Inclusion criteria were: 1) articles dealing with telephone-, internet- or video-based interventions and 2) studies emphasizing development of an intervention, feasibility or clinical trials. Exclusions included were: 1) single case reports and 2) papers not written in English. With our search terms, we retrieved a total of 390 articles, of which 18 unique articles were relevant. RESULTS Based on the limited data available, the use of modalities involving the telephone, internet and videoconferencing appears to be feasible in patients with schizophrenia. In addition, preliminary evidence suggests these modalities appear to improve patient outcomes. DISCUSSION More research is needed. Investigators need to improve existing telehealth systems. In addition, researchers need to focus on developing newer interventions and determining whether these approaches can improve patient outcomes.
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Affiliation(s)
- John Kasckow
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kandi Felmet
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, Pittsburgh, PA
| | - Cathleen Appelt
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, Pittsburgh, PA
| | - Robert Thompson
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, Pittsburgh, PA
| | - Armando Rotondi
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gretchen Haas
- VA Pittsburgh Health Care System MIRECC and Behavioral Health Service, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, PA
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Wade VA, Eliott JA, Hiller JE. Clinician acceptance is the key factor for sustainable telehealth services. QUALITATIVE HEALTH RESEARCH 2014; 24:682-94. [PMID: 24685708 DOI: 10.1177/1049732314528809] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Telehealth, the delivery of health care services at a distance using information and communications technology, has been slow to be adopted and difficult to sustain. Researchers developing theories concerning the introduction of complex change into health care usually take a multifactorial approach; we intentionally sought a single point of intervention that would have maximum impact on implementation. We conducted a qualitative interview study of 36 Australian telehealth services, sampled for maximum variation, and used grounded theory methods to develop a model from which we chose the most important factor affecting the success of telehealth. We propose that clinician acceptance explains much of the variation in the uptake, expansion, and sustainability of Australian telehealth services, and that clinician acceptance could, in most circumstances, overcome low demand, technology problems, workforce pressure, and lack of resourcing. We conclude that our model offers practical advice to those seeking to implement change with limited resources.
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Affiliation(s)
- Victoria A Wade
- 1The University of Adelaide, Adelaide, South Australia, Australia
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13
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DE Weger E, Macinnes D, Enser J, Francis SJ, Jones FW. Implementing video conferencing in mental health practice. J Psychiatr Ment Health Nurs 2013; 20:448-54. [PMID: 22762416 DOI: 10.1111/j.1365-2850.2012.01947.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this paper is to provide an overview of the evidence base regarding the use of video conferencing (VC), implementation issues, policies, procedures, technical requirements and VC etiquette. The paper is based on a literature review of VC within the mental health sector and the authors' experience in implementing VC. Six themes emerged from the literature review: applications of VC, VC assessments, treatment, training and supervision, practitioner anxiety, and VC administrative processes. The results of the review support the use of VC in mental health services. Guidelines for the implementation of VC are discussed, including the importance of staff and service user consultations, training in the use of VC, clear guidance for staff with regards to usage, confidentiality and data protection policies, and VC etiquette. Challenges that can arise when implementing VC in a mental health context are also discussed. Arguably, it is not the technology, but the cultural change it represents to staff which seems to be the most important factor regarding successful implementation.
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Affiliation(s)
- E DE Weger
- Canterbury Christ Church University, Kent, UK
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14
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Smith AC, Armfield NR, Croll J, Gray LC. A review of Medicare expenditure in Australia for psychiatric consultations delivered in person and via videoconference. J Telemed Telecare 2012; 18:169-71. [PMID: 22362827 DOI: 10.1258/jtt.2012.sft111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We examined the activity (services recorded) and cost (benefits paid) of reimbursement associated with telepsychiatry services in the Australian public health-care sector. We reviewed the activity and costs administered through the government's Medicare Benefits Schedule (MBS) from July 2002 to June 2011. During this nine-year-period, almost 14 million psychiatric consultations were funded through Medicare at a cost of $1.6 billion. Of these, 8003 were telepsychiatry consultations which cost $934,000, i.e. the video consultations subgroup represented 0.06% of all psychiatric consultations provided and 0.06% of the total cost to the government for these services. Despite telepsychiatry being a widely reported and successful example of telehealth internationally, the uptake of telepsychiatry in Australia has been slow.
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Affiliation(s)
- Anthony C Smith
- Centre for Online Health, Level 3 Foundation Building, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia.
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16
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Bahaadinbeigy K, Yogesan K, Wootton R. Gaps in the systematic reviews of the telemedicine field. J Telemed Telecare 2010; 16:414-6. [DOI: 10.1258/jtt.2010.100505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kambiz Bahaadinbeigy
- Australian e-Health Research Centre, ICT Centre, CSIRO, Perth
- University of Western Australia, Australia
| | | | - Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, Tromsø, Norway
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