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Yellowlees PM, Burke MM, Gonzalez AD, Fisher A, Chan SR, Hilty DM, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Fine J, Bannister J, Iosif AM. Patient and Provider Satisfaction with Asynchronous Versus Synchronous Telepsychiatry in Primary Care: A Secondary Mixed-Methods Analysis of a Randomized Controlled Trial. Telemed J E Health 2024; 30:e1049-e1063. [PMID: 38011623 PMCID: PMC11035926 DOI: 10.1089/tmj.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Asynchronous telepsychiatry (ATP) consultations are a novel form of psychiatric consultation. Studies comparing patient and provider satisfaction for ATP with that for synchronous telepsychiatry (STP) do not exist. Methods: This mixed-methods study is a secondary analysis of patients' and primary care providers' (PCPs) satisfaction from a randomized clinical trial of ATP compared with STP. Patients and their PCPs completed satisfaction surveys, and provided unstructured feedback about their experiences with either ATP or STP. Differences in patient satisfaction were assessed using mixed-effects logistic regression models, and the qualitative data were analyzed using thematic analysis with an inductive coding framework. Results: Patient satisfaction overall was high with 84% and 97% of respondents at 6 months reported being somewhat or completely satisfied with ATP and STP, respectively. Patients in the STP group were more likely to report being completely satisfied, to recommend the program to a friend, and to report being comfortable with their care compared with ATP (all p < 0.05). However, there was no difference between the patients in ATP and STP in perceived change in clinical outcomes (p = 0.51). The PCP quantitative data were small, and thus only summarized descriptively. Conclusions: Patients expressed their overall satisfaction with both STP and ATP. Patients in ATP reported more concerns about the process, likely because feedback after ATP was slower than that after STP consultations. PCPs had no apparent preference for STP or ATP, and reported implementing the psychiatrists' recommendations for both groups when such recommendations were made, which supports our previous findings. Trial Registration: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M. Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Michelle M. Burke
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Alvaro D. Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Alice Fisher
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Steven R. Chan
- Stanford University School of Medicine, Stanford, California, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Robert M. McCarron
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Lorin M. Scher
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Andres F. Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, California, USA
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Hilty DM, Stubbe D, McKean AJ, Hoffman PE, Zalpuri I, Myint MT, Joshi SV, Pakyurek M, Li STT. A scoping review of social media in child, adolescents and young adults: research findings in depression, anxiety and other clinical challenges. BJPsych Open 2023; 9:e152. [PMID: 37563766 PMCID: PMC10594088 DOI: 10.1192/bjo.2023.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Social media and other technologies are reshaping communication and health. AIMS This review addresses the relationship between social media use, behavioural health conditions and psychological well-being for youth aged <25 years. METHOD A scoping review of 11 literature databases from 2000 to 2020 explored research studies in youth in five areas: clinical depression and anxiety, quantitative use, social media mode, engagement and qualitative dimensions and health and well-being. RESULTS Out of 2820 potential literature references, 140 met the inclusion criteria. The foci were clinical depression and anxiety disorders (n = 78), clinical challenges (e.g. suicidal ideation, cyberbullying) (n = 34) and psychological well-being (n = 28). Most studies focused on Facebook, Twitter, Instagram and YouTube. Few studies are longitudinal in design (n = 26), had comparison groups (n = 27), were randomised controlled trials (n = 3) or used structured assessments (n = 4). Few focused on different youth and sociodemographic populations, particularly for low-income, equity-seeking and deserving populations. Studies examined association (n = 120; 85.7%), mediating (n = 16; 11.4%) and causal (n = 4; 2.9%) relationships. Prospective, longitudinal studies of depression and anxiety appear to indicate that shorter use (≤3 h/day) and purposeful engagement is associated with better mood and psychological well-being. Depression may predict social media use and reduce perception of support. Findings provide families, teachers and providers ways to engage youth. CONCLUSIONS Research opportunities include clinical outcomes from functional perspective on a health continuum, diverse youth and sociodemographic populations, methodology, intervention and privacy issues. More longitudinal studies, comparison designs and effectiveness approaches are also needed. Health systems face clinical, training and professional development challenges.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA; and Mental Health, Veterans Affairs Northern California Health Care System, California, USA
| | - Dorothy Stubbe
- Child Study Center, Yale School of Medicine, Connecticut, USA
| | | | - Pamela E. Hoffman
- Department of Psychiatry & Behavioral Science, Yale School of Medicine, Connecticut, USA
| | - Isheeta Zalpuri
- Department of Psychiatry & Behavioral Science, Stanford University Medical Center, California, USA
| | - Myo T. Myint
- Department of Psychiatry & Behavioral Science, Tulane University School of Medicine, Louisiana, USA
| | - Shashank V. Joshi
- Department of Psychiatry & Behavioral Science, Stanford University Medical Center, California, USA
| | - Murat Pakyurek
- Division of Child and Adolescent Psychiatry, University of California, Davis School of Medicine, California, USA
| | - Su-Ting T. Li
- Department of Pediatrics, University of California, Davis School of Medicine, California, USA
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Hilty DM, Groshong LW, Coleman M, Maheu MM, Armstrong CM, Smout SA, Crawford A, Drude KP, Krupinski EA. Best Practices for Technology in Clinical Social Work and Mental Health Professions to Promote Well-being and Prevent Fatigue. Clin Soc Work J 2023; 51:1-35. [PMID: 37360756 PMCID: PMC10233199 DOI: 10.1007/s10615-023-00865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested.
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Affiliation(s)
- Donald M. Hilty
- Department of Psychiatry & Behavioral Sciences, UC Davis, 2230 Stockton Boulevard, Sacramento, CA 95817 USA
| | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Marlene M. Maheu
- Coalition for Technology in Behavioral Sciences, Telebehavioral Health Institute, Inc, 5173 Waring Road #124, San Diego, CA 92120 USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, U.S., 810 Vermont Avenue NW, Washington, DC 20420 USA
| | - Shelby A. Smout
- Virginia Commonwealth University, 3110 Kensington Ave Apt 3, Richmond, VA 23221 USA
| | - Allison Crawford
- Ontario Mental Health at CAMH, Toronto, Canada
- University of Toronto, Toronto, Canada
- Suicide Prevention Service, 1001 Queen St West, Toronto, ON M6J 1H4 Canada
| | - Kenneth P. Drude
- Coalition Technology in Behavioral Science, 680 E. Dayton Yellow Springs Rd, Fairborn, OH 45324 USA
| | - Elizabeth A. Krupinski
- Department of Radiology & Imaging Sciences, Emory University, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
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Gentry MT, Murray AP, Altchuler SI, McKean AJ, Joyce JB, Hilty DM. Development and Implementation of a Virtual Clinical Skills Examination in General Psychiatry. Acad Psychiatry 2023; 47:48-52. [PMID: 35918600 PMCID: PMC9345010 DOI: 10.1007/s40596-022-01691-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, psychiatry programs have administered the Clinical Skills Evaluation (CSE) through videoconferencing. The authors evaluated the feasibility and appropriateness of administering virtual CSEs. METHODS Virtual CSEs were administered to 11 general psychiatry residents on March 16, 2021. Teleconference software was used to connect faculty at work sites, residents at a simulation center, and volunteer patients at home. Before and after the CSE, residents and faculty were surveyed with Likert scale questions to evaluate their perceptions and experience. RESULTS All virtual CSEs were completed successfully. Nine residents (82%) and 12 faculty (92%) responded to both surveys. Most participants (range, 67-83%) indicated that the virtual CSE was appropriate for assessing patient health and resident skills. Most participants (range, 56-100%) reported that the opening and closing of the interview, informational and affective cues, and rapport were adequately assessed. All participants agreed that suicidal and homicidal risks could be adequately assessed. Most faculty and residents (76%) believed that unique skills were required for telehealth interviews. Before the CSE, more faculty than residents believed that they received adequate training for the virtual CSE (P=.02); afterward, most participants thought that training was adequate (P=.46). More faculty than residents reported increased convenience with virtual assessments (both surveys, P<.01). CONCLUSION Virtual CSEs were deemed feasible and appropriate. Further research is needed to identify the specific skills required to perform a virtual CSE and to clarify the potential limitations and benefits of this format.
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Affiliation(s)
| | - Andrew P Murray
- Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, WI, USA
| | | | | | - Jeremiah B Joyce
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Donald M Hilty
- VA Northern California Health Care System, and University of California, Davis, Sacramento, CA, USA
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Abstract
Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost-benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost-benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis-such as effectiveness and implementation science approaches-contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Eva Serhal
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Allison Crawford
- ECHO Ontario Mental Health and ECHO Ontario Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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Chochol MD, Gentry M, Hilty DM, McKean AJ. Psychiatry Residents as Medical Student Educators: a Review of the Literature. Acad Psychiatry 2022; 46:475-485. [PMID: 34008132 DOI: 10.1007/s40596-021-01478-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Professional organizations and medical schools need trainees as medical student educators. There are limited data describing the training of residents and fellows as educators. There are also limited data describing the impact of trainee educators on medical student performance and clerkship experience. METHODS A narrative literature search was done in PubMed, Embase, and PsychINFO from inception to January 1, 2021, to explore the approaches, methods, and outcomes (e.g., potential benefits) of psychiatric trainees as medical student educators. A total of 630 papers were screened using title and abstract, of which 20 met inclusion criteria. Studies were categorized into four quality tiers based on methodology. RESULTS Studies described how training programs utilized trainees as student educators, and various methods of teaching instruction. Residents and fellows valued being educators and reported these experiences increased teaching abilities. Medical students rated trainee educators well. Resident-led teaching initiatives were associated with increased exam scores in one study. Data were limited by low survey response rates, qualitative (i.e., subjective) inquiry, and heterogeneity in teaching and training modalities. CONCLUSIONS Due to a lack of high-quality studies, definitive conclusions cannot be drawn about the effectiveness of psychiatry trainees as medical educators nor about how to best train them as educators. Nevertheless, literature suggests that incorporating trainees as educators both augments resident and fellow training and enhances medical student experience and performance. Future research should assess needs and standardize methods, curricula, and outcome measures more systematically.
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Affiliation(s)
| | | | - Donald M Hilty
- University of California Davis School of Medicine, Sacramento, CA, USA
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7
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Merrill CA, Maheu MM, Drude KP, Groshong LW, Coleman M, Hilty DM. CTiBS and Clinical Social Work: Telebehavioral Health Competencies for LCSWs in the Age of COVID-19. Clin Soc Work J 2022; 50:115-123. [PMID: 35039696 PMCID: PMC8754554 DOI: 10.1007/s10615-021-00827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Licensed Clinical Social Workers (LCSWs) have been integrating technology into psychotherapy practice for at least two decades, but the COVID-19 pandemic dramatically shifted the primary method of service delivery for diagnostic assessment and therapy to telebehavioral health. By developing telebehavioral health competencies, the 250,000 + LCSWs in the US can ensure and enhance the quality of care both during and after the COVID public health emergency (PHE). This article applies an evidence- and consensus-based, interprofessional telebehavioral health (TBH) competency framework to the field of social work. This framework was developed by the Coalition for Technology in Behavioral Science (CTiBS), initially published in 2017. It has seven competency domains: (1) clinical evaluation and care; (2) virtual environment and telepresence; (3) technology; (4) legal and regulatory issues; (5) evidence-based and ethical practice (comprised of Standards and Guidelines and Social Media); (6) mobile health and apps; and (7) telepractice development. The framework outlines three competency levels (novice, proficient, and authority) covering 49 specific objectives and 146 measurable competencies or practices. The TBH competencies support existing in-person clinical practices and are intended for trainees and practitioners who are implementing TBH in practice. This competency framework can also be used to integrate clinical social work professional development, research, and training. Additionally, considerations for other behavioral health professions regarding licensure, certification, and policy may apply to clinical social work. Future research is needed on implementation and evaluation of the competencies.
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Affiliation(s)
- Crystal A. Merrill
- School of Public Service & Education, Capella University, Minneapolis, MN 55402 USA
| | | | | | | | - Mirean Coleman
- National Association of Social Workers, Washington, DC USA
| | - Donald M. Hilty
- Northern California Veterans Affairs Health Care System, Mather, CA USA
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Gentry MT, Puspitasari AJ, McKean AJ, Williams MD, Breitinger S, Geske JR, Clark MM, Moore KM, Frye MA, Hilty DM. Clinician Satisfaction with Rapid Adoption and Implementation of Telehealth Services During the COVID-19 Pandemic. Telemed J E Health 2021. [DOI: 10.1089/tmj.2020.0575 10.1089/tmj.2020.0575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alastair J. McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D. Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer R. Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M. Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine M. Moore
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald M. Hilty
- VA Northern California Health Care System, Mather, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, Sacramento, California, USA
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Mucic D, Shore JH, Hilty DM, Krysta K, Krzystanek M. Lessons Learned or Forgotten? Impacts of COVID-19 on the Future Direction of Global (e-)Mental Health Care. Curr Psychiatry Rep 2021; 23:86. [PMID: 34842979 PMCID: PMC8628486 DOI: 10.1007/s11920-021-01300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has impacted lives globally, posing unique challenges to mental health services exposing vulnerability and limitations within these systems. During the course of the pandemic, telecommunications technologies (e-mental health care) have served a critical role in psychiatric care. It is important to understand current lessons learned in e-mental health care and implications for global mental health systems for both emerging from the pandemic and after the pandemic has ended. RECENT FINDINGS There are significant regulatory, policy, and evaluation challenges for global e-mental health impacting patients, clinicians, health systems, and decision-makers. These include complex regulatory issues, difficulties of providing care across boundaries, and keeping pace with the implementation of new technologies in behavioral health. The collaborative development of global standards along with policies, appropriate regulations, and developing new models of research and development opens the possibility of improved access to care across national boundaries.
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Affiliation(s)
- D Mucic
- Little Prince Treatment Centre, Havneholmen 82, 5th, 1561, Copenhagen V, Denmark.
| | - J H Shore
- Office of Telehealth and Technology Implementation for Behavioral Health Practice and Science (TIPS), Department of Psychiatry, Aurora, USA
- Department of Psychiatry and Family Medicine, School of Medicine And Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D M Hilty
- VA Northern California Health Care, System & UC Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, CA, 95817, USA
| | - K Krysta
- Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Clinic of Psychiatric Rehabilitation, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland
| | - M Krzystanek
- Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Clinic of Psychiatric Rehabilitation, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland
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Hilty DM, Armstrong CM, Smout SA, Crawford A, Maheu MM, Drude KP, Chan S, Yellowlees PM, Krupinski EA. PROVIDER TECHNOLOGY, FATIGUE AND WELL-BEING: A SCOPING REVIEW (Preprint). J Med Internet Res 2021; 24:e34451. [PMID: 35612880 PMCID: PMC9178447 DOI: 10.2196/34451] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
- Northern California Veterans Affairs Health Care System, Mather, CA, United States
| | - Christina M Armstrong
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
| | - Shelby A Smout
- Virginia Commonwealth University, Richmond, VA, United States
| | - Allison Crawford
- Extension for Community Healthcare Outcomes, Ontario Mental Health at Centre for Addiction and Mental Health, University of Toronto Virtual Mental Health, and Canada Suicide Prevention Service, Toronto, ON, Canada
| | - Marlene M Maheu
- Telebehavioral Health Institute, LLC and Coalition for Technology in Behavioral Science, San Diego, CA, United States
| | - Kenneth P Drude
- Coalition for Technology in Behavioral Science & Ohio Board of Psychology, Dayton, OH, United States
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine & Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Peter M Yellowlees
- Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Elizabeth A Krupinski
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
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11
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Shoemaker EZ, Johnson C, Hilty DM, Fung CC. Flipping a Single Lecture in a Survey Course to Active Learning: Do the Benefits Justify the Costs? ACTA ACUST UNITED AC 2021; 7:151-159. [PMID: 34729392 PMCID: PMC8552619 DOI: 10.1007/s41347-021-00230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/15/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022]
Abstract
Health education has seen a surge of interest in active learning strategies like the flipped classroom. In response to the need for physical distancing in the age of COVID-19, schools are rapidly shifting to web-based and video technology, sometimes without being able to predict the outcomes of this change. The objectives of this pilot experiment were to (1) compare active learning (AL) methods versus traditional lecture for transmitting and retaining knowledge in the introductory pre-clinical medical school curriculum and (2) weigh whether the costs required to flip instruction were justified by learning gains. The authors took a 2 h lecture for first-year medical students and converted half of it into an AL format. In-person lecture and active learning groups were compared in terms of student knowledge at pre-intervention, immediately post-intervention, and 6 months post-intervention. Costs for first-time delivery and anticipated costs for repeat delivery of each format were calculated. Students’ gains in knowledge increased in both groups, though more by lecture (control) than via AL. Delivering a single hour of new AL costs 3.4 times that of a new lecture. Repeat offerings of the AL intervention were estimated to cost 5.4 times that of the repeat lecture. The 1 h AL session was less effective than the 1 h lecture for knowledge acquisition and retention at 6-month follow-up. The AL was more expensive to produce and to repeat. Future research needs to evaluate the impact of AL with a larger N, control group, structured faculty/resident procedures, and assessment of gaining and applying attitudes and skills in addition to knowledge.
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Affiliation(s)
- Erica Z Shoemaker
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | | | - Donald M Hilty
- Department of Psychiatry & Behavioral Sciences, Northern California Veterans Administration Health Care System, UC Davis, 10535 Hospital Way, Mather, CA 95655 USA
| | - Cha-Chi Fung
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
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12
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Maheu MM, Wright SD, Neufeld J, Drude KP, Hilty DM, Baker DC, Callan JE. Interprofessional telebehavioral health competencies framework: Implications for telepsychology. Professional Psychology: Research and Practice 2021. [DOI: 10.1037/pro0000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Yellowlees PM, Parish MB, Gonzalez AD, Chan SR, Hilty DM, Yoo BK, Leigh JP, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Soltero KM, Fisher A, Fine JR, Bannister J, Iosif AM. Clinical Outcomes of Asynchronous Versus Synchronous Telepsychiatry in Primary Care: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24047. [PMID: 33993104 PMCID: PMC8335606 DOI: 10.2196/24047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/26/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. OBJECTIVE This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. METHODS Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients' self-reported physical and mental health and depression) outcomes were assessed every 6 months. RESULTS For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI -0.2 to 0.6; P=.28; and GAF: -0.6, 95% CI -3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI -0.04 to 0.8; P=.07; and GAF: -0.5, 95% CI -3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. CONCLUSIONS This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. TRIAL REGISTRATION ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Alvaro D Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Steven R Chan
- Stanford University School of Medicine, Stanford, CA, United States
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Donald M Hilty
- Northern California Veterans Administration, Mather, CA, United States
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - J Paul Leigh
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | | | - Lorin M Scher
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Andres F Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Jay Shore
- University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | | | - Alice Fisher
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jeffrey R Fine
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
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14
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Hertlein KM, Drude KP, Hilty DM, Maheu MM. Toward proficiency in telebehavioral health: applying interprofessional competencies in couple and family therapy. J Marital Fam Ther 2021; 47:359-374. [PMID: 33600613 DOI: 10.1111/jmft.12496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
During the coronavirus pandemic, many behavioral health professionals providing psychotherapeutic services, including couple/marriage and family therapists (C/MFTs), quickly changed from providing in-person services to telebehavioral health (TBH) services, with specific reliance on teleconferencing. Many therapists were thrust into telehealth with minimal or no prior telebehavioral health experience, education, or training. Although TBH services have been shown to be effective and efficient with mental health and substance abuse problems, the teaching and learning of telebehavioral competencies have generally not been included in the formal education and training received by C/MFTs. This article presents an existing interprofessional telebehavioral health competencies framework not before published in C/MFT journals. This article will also demonstrate how those competencies are applicable to the education, training, and practice of telebehavioral health by C/MFTs. Implications for educational, service, and regulatory organizations are presented.
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Affiliation(s)
- Katherine M Hertlein
- Department of Psychiatry and Behavioral Health, University of Nevada, Las Vegas, NV, USA
| | | | - Donald M Hilty
- University of California Davis School of Medicine, Sacramento, CA, USA
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15
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Russo RA, Griffeth BT, Combs H, Dinsell V, Palka JM, Morreale MK, Borghesani PR, Harper BL, Hilty DM, Fore-Arcand L. Elements of an Excellent Psychiatry Clerkship Experience: A Survey Study of Graduating Medical Students. Acad Psychiatry 2021; 45:174-179. [PMID: 33409938 DOI: 10.1007/s40596-020-01373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE One possible factor associated with choosing psychiatry as a career is students rating their psychiatry clerkship as excellent. Although this suggests that an excellent clerkship may improve recruitment into psychiatry, to our knowledge there has never been a multi-site survey study of graduating medical students that identify what factors lead to an excellent clerkship rating. The purpose of this study was to determine factors that medical student find important for an excellent psychiatry clerkship experience. METHODS A total of 1457 graduating medical students at eight institutions were sent a 22-item Likert-type survey about what clinical and administrative factors they considered when rating their psychiatry clerkship via email in the fall of their last year. 357 (24.5%) responded and Z-test, t-tests, and multiple regression analyses were carried out. RESULTS The factors which students rated higher than the mean included planned application to psychiatry residency, clear expectations, a transparent grading process, feeling part of a team, timely feedback by faculty, and a competent clerkship coordinator and director. Lectures, active learning, and self-study were rated as less pertinent, and the overall clerkship rating did differ between students going into psychiatry versus other specialties. CONCLUSIONS Although the low response undermines the validity of findings, by improving the administration of the clerkship with clear expectations, grading, feedback, and by encouraging clinical teams to fully integrate students clerkship ratings might improve which could potentially improve recruitment. Future research could further quantify and qualify these parameters and compare psychiatric clerkships to other clerkships.
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Affiliation(s)
- Rachel A Russo
- VA North Texas Health Care System and University of Texas - Southwestern Medical Center, Dallas, TX, USA.
| | - Benjamin T Griffeth
- University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Heidi Combs
- University of Washington School of Medicine, Seattle, WA, USA
| | - Victoria Dinsell
- New York University Grossman School of Medicine, New York, NY, USA
| | - Jayme M Palka
- VA North Texas Health Care System and University of Texas - Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Donald M Hilty
- VA Northern California Health Care System and University of California Davis School of Medicine, Davis, CA, USA
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16
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Hilty DM, Zalpuri I, Torous J, Nelson EL. Child and adolescent asynchronous technology competencies for clinical care and training: Scoping review. Fam Syst Health 2021; 39:121-152. [PMID: 33151726 DOI: 10.1037/fsh0000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective: Asynchronous technologies such as mobile health, e-mail, e-consult, and social media are being added to in-person and synchronous service delivery. To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. This study sought out competencies for asynchronous technologies and/or an approach to define them. Methods: This 6-stage scoping review of Pubmed/Medline, APA PsycNET, PsycINFO and other databases was based on a broad research question, "What skills are needed for clinicians and trainees to provide quality care using asynchronous technologies for children and adolescents, and how can they be made measurable to implement, teach and evaluate?" The search focused on key words in 4 concept areas: (a) competencies; (b) asynchronous technology; (c) synchronous telepsychiatry, telebehavioral or telemental health; and (d) clinical. The screeners reviewed the full-text articles based on inclusion (mesh of the key words) and exclusion criteria. Results: From a total of 5,877 potential references, 2 authors found 509 eligible for full text review and found 110 articles directly relevant to the concepts. Clinical studies discuss clinical, technical and administrative workflow rather than competencies, though behavioral health professions' position statements advise on adapting care and training. Existing technology competencies for video, social media, mobile health, and other asynchronous technologies were used to build a framework. Training, faculty development, and organizational suggestions are suggested. Conclusions: Research is needed on how to implement and evaluate asynchronous competencies to ensure quality clinical care and training, which is a paradigm shift for participants. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System
| | - Isheeta Zalpuri
- Department of Psychiatry, Pediatric Mood Disorders Clinic, Stanford University Medical Center
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Eve-Lynn Nelson
- Department of Pediatrics, Kansas City Medical Center, University of Kansas School of Medicine, University of Kansas
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17
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Gentry MT, Puspitasari AJ, McKean AJ, Williams MD, Breitinger S, Geske JR, Clark MM, Moore KM, Frye MA, Hilty DM. Clinician Satisfaction with Rapid Adoption and Implementation of Telehealth Services During the COVID-19 Pandemic. Telemed J E Health 2021; 27:1385-1392. [PMID: 33606560 DOI: 10.1089/tmj.2020.0575] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Materials and Methods: Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Results: A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Discussion: Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Conclusion: This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.
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Affiliation(s)
- Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ajeng J Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alastair J McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine M Moore
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald M Hilty
- VA Northern California Health Care System, Mather, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, Sacramento, California, USA
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18
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Cruz C, Orchard K, Shoemaker EZ, Hilty DM. A Survey of Residents/Fellows, Program Directors, and Faculty About Telepsychiatry: Clinical Experience, Interest, and Views/Concerns. ACTA ACUST UNITED AC 2021; 6:327-337. [PMID: 33585672 PMCID: PMC7870779 DOI: 10.1007/s41347-020-00164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
The effectiveness of telepsychiatry video for clinical care is well established, and clinician and psychiatry resident interest in it is growing—particularly in light of the COVID-19 impact. Still, few residency programs in the United States have core curricula, rotations/electives available, and competencies, and many faculty have no experience. A survey was sent via national organization listserves for residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience and interest, and views/concerns, using Likert-like and yes/no questions. Descriptive statistics and other analyses compared the groups to assess impact of clinical experience on interest and views/concerns. Respondents (N = 270) have limited clinical experience with telepsychiatry (46% none), with trainees having less than others, and yet, most were very interested or interested in it (68%). Trainees (N = 123) have concerns about being prepared for future practice. Clinical experience with video in the range of 6–20 h appears to dramatically increase interest and reduce concerns, though less time has a positive effect. Respondents have concerns about connectivity, medico-legal issues, and clinical effectiveness (e.g., diverse populations, psychosis, and emergencies) with telepsychiatry. More research is needed to assess current clinical and curricular experience, interest, and concerns. Additional curricular interventions during residency and fellowship training could build skills and confidence, if this is feasible, and the benefits outweigh the costs.
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Affiliation(s)
- Cesar Cruz
- Child and Adolescent Psychiatry, USC Institute of Psychiatry & Law, Los Angeles, CA USA
| | - Kali Orchard
- Yellowknife Adult and Child Psychiatry, Yellowknife, Canada
| | - Erica Z Shoemaker
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, USC and LAC+USC Medical Center, Los Angeles, CA USA
| | - Donald M Hilty
- Northern California Veterans Administration Health Care System, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Davis, CA USA
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19
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Hilty DM, Armstrong CM, Edwards-Stewart A, Gentry MT, Luxton DD, Krupinski EA. Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review. J Technol Behav Sci 2021; 6:252-277. [PMID: 33501372 PMCID: PMC7819828 DOI: 10.1007/s41347-020-00190-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023]
Abstract
Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.
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Affiliation(s)
- Donald M. Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, Washington, DC USA
| | | | - Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN US
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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20
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Breitinger S, Gentry MT, Hilty DM. Key Opportunities for the COVID-19 Response to Create a Path to Sustainable Telemedicine Services. Mayo Clin Proc 2020; 95:2602-2605. [PMID: 33276833 PMCID: PMC7528871 DOI: 10.1016/j.mayocp.2020.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Scott Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Department of Psychiatry, Weill Cornell Medicine, New York, NY.
| | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- VA Northern California Health Care and Department of Psychiatry, UC Davis School of Medicine, Sacramento, CA
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21
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Hilty DM, Torous J, Parish MB, Chan SR, Xiong G, Scher L, Yellowlees PM. A Literature Review Comparing Clinicians' Approaches and Skills to In-Person, Synchronous, and Asynchronous Care: Moving Toward Competencies to Ensure Quality Care. Telemed J E Health 2020; 27:356-373. [PMID: 32412882 DOI: 10.1089/tmj.2020.0054] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Research is increasing on asynchronous technologies used by specialist clinicians and primary care, including e-mail, text, e-consultation, and store-and-forward (asynchronous) options. Studies typically describe interventions and care outcomes rather than development of clinical skills for using technology. Methods: This article attempts to compare clinicians' approaches to, and skills for, asynchronous technologies versus in-person and synchronous (i.e., video) care. Literature from technology, health care, pedagogy, and business were searched from 2000 to 2019 for title words, including synchronous (e.g., video, telemental or behavioral health, telepsychiatry), asynchronous (e.g., app, e-consultation, e-mail, text, sensor in a wearable device), education, clinical, and consultation. Results: From a total of 4,812 potential references, two authors (D.M.H., J.T.) found 4,622 eligible for full text review and found 381 articles directly relevant to the concept areas in combination for full text review. However, exclusion criteria subtracted 305, leaving a total of 76 articles. While in-person and synchronous care are similar in many ways, the clinical approach to asynchronous care has many differences. As asynchronous technologies and models of care are feasible and effective, often for consultation, an outline of patient, primary care provider, and specialist clinician goals and skills are presented. Few studies specifically discuss skills or competencies for asynchronous care, but components from published clinical informatics, video, social media, and mobile health competencies were organized into Accreditation Council of Graduate Medical Education domains. Conclusions: Further implementation of science research is needed for asynchronous technology interventions, as well as clinician competencies using asynchronous technologies, to ensure optimal outcomes for patients in health care.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Burke Parish
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Steven R Chan
- Stanford University School of Medicine, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, UC Davis School of Medicine, Sacramento, California, USA
| | - Glen Xiong
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA.,Department of Internal Medicine, UC Davis School of Medicine, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Peter M Yellowlees
- Department of Psychiatry, UC Davis School of Medicine, Sacramento, California, USA
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22
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Hilty DM, Gentry MT, McKean AJ, Cowan KE, Lim RF, Lu FG. Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches. Mhealth 2020; 6:20. [PMID: 32270012 PMCID: PMC7136658 DOI: 10.21037/mhealth.2019.10.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 - July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and other databases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.
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Affiliation(s)
- Donald M. Hilty
- Northern California Veterans Administration Health Care System, Mather, CA 95655, USA
- Department of Psychiatry & Behavioral Sciences, UC Davis, Mather, CA 95655, USA
| | - Melanie T. Gentry
- Geriatric Psychiatry Fellowship, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Alastair J. McKean
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Kirsten E. Cowan
- Essentia Health and Child Psychiatrist Affiliated with Mayo Clinic Department of Psychiatry and Psychology, Hinckley, MN 55037, USA
| | - Russell F. Lim
- Emeritus Clinical Professor of Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Francis G. Lu
- Clinical Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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Aboujaoude E, Gega L, Parish MB, Hilty DM. Editorial: Digital Interventions in Mental Health: Current Status and Future Directions. Front Psychiatry 2020; 11:111. [PMID: 32174858 PMCID: PMC7056878 DOI: 10.3389/fpsyt.2020.00111] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Lina Gega
- Department of Health Sciences & Hull York Medicine School, University of York, York, United Kingdom
| | - Michelle B. Parish
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
| | - Donald M. Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
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Cowan KE, McKean AJ, Gentry MT, Hilty DM. Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clin Proc 2019; 94:2510-2523. [PMID: 31806104 DOI: 10.1016/j.mayocp.2019.04.018] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
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Affiliation(s)
- Kirsten E Cowan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Essentia Health, Duluth, MN
| | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
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Hilty DM, Unützer J, Ko DG, Luo J, Worley LLM, Yager J. Approaches for Departments, Schools, and Health Systems to Better Implement Technologies Used for Clinical Care and Education. Acad Psychiatry 2019; 43:611-616. [PMID: 31172384 DOI: 10.1007/s40596-019-01074-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Donald M Hilty
- University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Jürgen Unützer
- University of Washington School of Medicine, Seattle, WA, USA
| | - Dong-Gil Ko
- University of Cincinnati, Carl H. Lindner College of Business, Cincinnati, OH, USA
| | - John Luo
- University of California, Riverside Health, Riverside, CA, USA
| | - Linda L M Worley
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joel Yager
- University of Colorado at Denver School of Medicine, Denver, CO, USA
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26
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Maheu MM, Drude KP, Hertlein KM, Lipschutz R, Wall K, Hilty DM. Correction to: An Interprofessional Framework for Telebehavioral Health Competencies. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Hilty DM, Yager J, Seritan AL, Levine R, DeJong SM, Borus J. A Historical Review of Key Events and Components of Faculty and Professional Development in Psychiatry. Psychiatr Clin North Am 2019; 42:357-373. [PMID: 31358117 DOI: 10.1016/j.psc.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Psychiatry's evolution has entailed clinical, educational, research, and administrative missions. Faculty development efforts concern ways in which professional identity, attitudes and skills are transmitted and enhanced from generation to generation. Top-down efforts by national and international organizations and bottom-up movements by individuals in numerous local settings have helped faculty and guided the profession forward. Organizations have provided new faculty with access to mentors and peers across the country, training opportunities, and up-to-date information on emerging scientific, pedagogical, and regulatory trends. Additional innovations and evaluation regarding best practices for faculty development initiatives in psychiatry are needed.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, MC A011-04, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Andreea L Seritan
- Department of Psychiatry, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 401 Parnassus Avenue, Box 0984-APC, San Francisco, CA 94143, USA
| | - Ruth Levine
- Department of Psychiatry and Behavioral Sciences, Student Affairs and Admissions, School of Medicine, University of Texas Medical Branch, Ashbel Smith Building, Suite 1.210. 301 University Boulevard, Galveston, TX 77555-1307, USA
| | - Sandra M DeJong
- Department of Psychiatry, Cambridge Health Alliance, Harvard University School of Medicine, Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA 02139, USA
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Hilty DM, Chan S, Torous J, Luo J, Boland RJ. Mobile Health, Smartphone/Device, and Apps for Psychiatry and Medicine: Competencies, Training, and Faculty Development Issues. Psychiatr Clin North Am 2019; 42:513-534. [PMID: 31358129 DOI: 10.1016/j.psc.2019.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Faculty and trainees need clinical skills, knowledge, and attitudes to ensure quality care using technology. Clinical faculty teach, supervise, and role model skills for trainees and interprofessional team members. Mobile health, smartphone/device, and app competencies may be situated within the graduate medical education milestone domains. This article outlines these competencies and aligns them with clinical care, teaching methods, and evaluation. These competencies have similarities and differences from in-person and telepsychiatric care and additional dimensions like clinical decision support, technology selection, and information flow management across an e-platform. Health systems must integrate in-person and technology-based care, while maintaining the therapeutic relationship.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Steven Chan
- Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System, University of California, San Francisco, 3801 Miranda Avenue, Building 520F, Mail Code 116A, Palo Alto, CA 94304, USA
| | - John Torous
- Digital Psychiatry Division, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - John Luo
- UC Riverside Department of Psychiatry, UCR Health at Citrus Tower, 3390 University Avenue, Suite 115, Riverside, CA 92501, USA
| | - Robert J Boland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
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29
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Liu HY, Hilty DM. The Central Role of Professional Development and Psychiatry. Psychiatr Clin North Am 2019; 42:xiii-xv. [PMID: 31358131 DOI: 10.1016/j.psc.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Howard Y Liu
- Department of Psychiatry, University of Nebraska Medical Center, 985575 Nebraska Medical Center, Omaha, NE, 68198-5575, USA.
| | - Donald M Hilty
- Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, 10535 Hospital Way, Mather, CA 95655, USA; University of California Davis, Sacramento, CA 95817, USA.
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Abstract
Clinicians, interprofessional teams, organizational systems, and patients increasingly use technology for health and health care, communication, networking, and business. In this era of ubiquitous connectivity, the digital age has solidified the role of technology in continuing medical education, faculty development, and integrating professional and personal roles and identities. Clinicians are shifting from treating technology as a supplemental modality to using it as a central organizing and facilitating tool, particularly important for clinical care. This is known as an information technology-business-medicine understanding or conceptual framework.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Jessica Uno
- Psychiatry, Kaweah Delta Health Care District, 400 West Mineral King Avenue, Visalia, CA 93291, USA
| | - Steven Chan
- Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System, University of California, San Francisco, 3801 Miranda Avenue, Building 520F, Mail Code 116A, Palo Alto, CA 94304, USA
| | - John Torous
- Digital Psychiatry Division, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Robert J Boland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
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Abstract
In the ever-changing fields of health care, continuing professional development (CPD) and lifelong learning are essential for patient care, regulatory requirements, personal growth, and job satisfaction. However, no specific systems in approaching CPD have been delineated, and most health professionals are left to their own devices to manage it, on top of all their other professional responsibilities. This article (1) outlines the importance of CPD, (2) describes potential systematic approaches to CPD and potential ways to assess their effectiveness, and (3) reviews resources available to incorporate into a systematic approach.
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Affiliation(s)
- Kenneth P Drude
- Private Practice, Wright State University, 642 East Dayton Yellow Springs Road, Fairborn, OH, USA.
| | - Marlene Maheu
- Telebehavioral Health Institute, Inc., 5173 Waring Road, #124, San Diego, CA 92120, USA
| | - Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, 10535 Hospital Way, Mather, CA 95655, USA; Department of Psychiatry & Behavioral Sciences, University of California Davis, Davis, CA, USA
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Abstract
Projects done in interprofessional groups can foster faculty development with minimal resources beyond what is already available at the university or medical center. Each project can yield multiple "wins" in individual faculty growth while meeting the needs of academic medical centers. These projects can build collaborative skills and a sense of community among faculty, trainees, and staff. The combination of low costs, high yields, and improvements in team skills make these approaches appealing and sustainable in resource-constrained medical centers. The authors describe 4 sample projects and their teams, needed resources, and outcomes.
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Affiliation(s)
- Erica Z Shoemaker
- Child and Adolescent Psychiatry, Keck School of Medicine, University of Southern California, LAC+ USC Medical Center, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA.
| | - Myo Thwin Myint
- Triple Board & Child and Adolescent Psychiatry Programs, Tulane University School of Medicine, 1430 Tulane Avenue, #8055, New Orleans, LA 70112, USA
| | - Shashank V Joshi
- Lucile Packard Children's Hospital @ Stanford, 401 Quarry Road, Stanford, CA 94305-5719, USA
| | - Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, 10535 Hospital Way, Mather, CA 95655 (116/SAC), USA; Department of Psychiatry and Behavioral Sciences, UC Davis, Davis, CA, USA
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Abstract
Professional development refers to training, formal education, and/or advanced professional learning intended to help clinicians, teachers, researchers, and administrators improve their professional knowledge and effectiveness. Institutions have been trying to adapt to a rapidly changing internal and external environment, with resource constraints and competitive health care. Professional development may be contextualized using adult development, educational, and organizational perspectives, and most best practices overlap. Key partners are faculty, departments, institutions, and national organizations. Interprofessional, team-based and project-based longitudinal initiatives may ignite educational innovations, and serve as a method to learn authentically in the workplace, promote socialization, and change attitudes.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, Sacramento, CA 95655, USA.
| | - Howard Y Liu
- Department of Psychiatry, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA; Behavioral Health Education Center of Nebraska, Omaha, NE, USA
| | - Dorothy Stubbe
- Child Study Center, Child and Adolescent Psychiatry, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - John Teshima
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG-62, Toronto, Ontario M4N 3M5, Canada
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Hilty DM, Randhawa K, Maheu MM, McKean AJS, Pantera R. Therapeutic Relationship of Telepsychiatry and Telebehavioral Health: Ideas from Research on Telepresence, Virtual Reality and Augmented Reality. ACTA ACUST UNITED AC 2019. [DOI: 10.17140/pcsoj-5-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Joshi SV, Stubbe D, Li STT, Hilty DM. Correction to: The Use of Technology by Youth: Implications for Psychiatric Educators. Acad Psychiatry 2019; 43:466. [PMID: 30706432 PMCID: PMC6828113 DOI: 10.1007/s40596-018-1013-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article was originally published electronically on the publisher's internet portal (currently SpringerLink) on November 16, 2018 with open access.
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Affiliation(s)
| | | | - Su-Ting T Li
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Donald M Hilty
- Northern California Veterans Administration Health Care System, Sacramento, CA, USA.
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Hilty DM, Chan S, Torous J, Luo J, Boland RJ. A Telehealth Framework for Mobile Health, Smartphones, and Apps: Competencies, Training, and Faculty Development. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00091-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Reus VI, Fochtmann LJ, Bukstein O, Eyler AE, Hilty DM, Horvitz-Lennon M, Mahoney J, Pasic J, Weaver M, Wills CD, McIntyre J, Kidd J, Yager J, Hong SH. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. Focus (Am Psychiatr Publ) 2019; 17:158-162. [PMID: 32021585 DOI: 10.1176/appi.focus.17205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from Am J Psychiatry 2018; 175:86-90).
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Joshi SV, Stubbe D, Li STT, Hilty DM. The Use of Technology by Youth: Implications for Psychiatric Educators. Acad Psychiatry 2019; 43:101-109. [PMID: 30446956 PMCID: PMC6394428 DOI: 10.1007/s40596-018-1007-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 11/07/2018] [Indexed: 05/31/2023]
Affiliation(s)
| | | | - Su-Ting T Li
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Donald M Hilty
- Northern California Veterans Administration Health Care System, Sacramento, CA, USA.
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Hilty DM, DeJong S. Putting Technologies Used for Clinical Care and Education in Context. Acad Psychiatry 2018; 42:753-758. [PMID: 30350270 DOI: 10.1007/s40596-018-0996-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Sacramento, CA, USA.
| | - Sandra DeJong
- Harvard University School of Medicine, Cambridge, MA, USA
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Maheu MM, Drude KP, Hertlein KM, Hilty DM. A Framework of Interprofessional Telebehavioral Health Competencies: Implementation and Challenges Moving Forward. Acad Psychiatry 2018; 42:825-833. [PMID: 30284147 DOI: 10.1007/s40596-018-0988-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
Interprofessional telebehavioral health (TBH) competencies have been developed to standardize training and improve the quality of TBH care. The seven identified interprofessional TBH competency domains and three levels of expertise (novice, proficient, and authority) are briefly described. More in depth descriptions and examples of several of the competency domains are presented to illustrate what the competencies look like in practice. Some of the challenges faced in using such a competency framework are discussed.
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Affiliation(s)
| | | | | | - Donald M Hilty
- VA, Northern California Health Care System, Sacramento, CA, USA
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42
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Hilty DM, Maheu MM, Drude KP, Hertlein KM. The Need to Implement and Evaluate Telehealth Competency Frameworks to Ensure Quality Care across Behavioral Health Professions. Acad Psychiatry 2018; 42:818-824. [PMID: 30426453 DOI: 10.1007/s40596-018-0992-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/16/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Donald M Hilty
- University of California Davis School of Medicine, Sacramento, CA, USA.
| | | | - Kenneth P Drude
- Coalition Technology in Behavioral Science, Fairborn, OH, USA
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Hilty DM, Chan S, Hwang T, Wong A, Bauer AM. Advances in Mobile Mental Health: Opportunities and Implications for the Spectrum of E-Mental Health Services. Focus (Am Psychiatr Publ) 2018; 16:314-327. [PMID: 32015712 DOI: 10.1176/appi.focus.16301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Reprinted with permission from mHealth (2017), 3:34.
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Hilty DM, Turvey C, Hwang T. Lifelong Learning for Clinical Practice: How to Leverage Technology for Telebehavioral Health Care and Digital Continuing Medical Education. Curr Psychiatry Rep 2018. [PMID: 29527637 DOI: 10.1007/s11920-018-0878-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Psychiatric practice continues to evolve and play an important role in patients' lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player-in delivery, lifelong learning, and education/training. RECENT FINDINGS The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e.g., social media/networking, text, apps). Clinicians are combining telepsychiatry and these technologies frequently and they need to reflect on, learn more about, and develop skills for these technologies. The digital age has solidified the role of technology in continuing medical education and day-to-day practice. Other fields of medicine are also adapting to the digital age, as are graduate and undergraduate medical education and many allied mental health organizations. In the future, there will be more online training, simulation, and/or interactive electronic examinations, perhaps on a monthly cycle rather than a quasi-annual or 10-year cycle of recertification.
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Affiliation(s)
- Donald M Hilty
- Mental Health and UC Davis Department of Psychiatry & Behavioral Sciences, Northern California VA Healthcare System, 10535 Hospital Way, Mather, Sacramento, CA, 95655, USA.
| | - Carolyn Turvey
- Department of Psychiatry, University of Iowa and Iowa City VA Health Care, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Tiffany Hwang
- UCSD Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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Maheu MM, Drude KP, Hertlein KM, Lipschutz R, Wall K, Hilty DM. Correction to: An Interprofessional Framework for Telebehavioral Health Competencies. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41347-018-0046-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Videoconferencing has increased patient access to psychiatric care by linking specialists at academic or regional health centres with primary health care professionals in shortage areas (Hilty et al, 1999, 2002). Preliminary studies have demonstrated positive outcomes and user satisfaction (Hilty et al, 2002). Information is still being sought regarding costs because of a paucity of clinical outcome studies, cost data and randomised trials.
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48
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Reus VI, Fochtmann LJ, Bukstein O, Eyler AE, Hilty DM, Horvitz-Lennon M, Mahoney J, Pasic J, Weaver M, Wills CD, McIntyre J, Kidd J, Yager J, Hong SH. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. Am J Psychiatry 2018; 175:86-90. [PMID: 29301420 DOI: 10.1176/appi.ajp.2017.1750101] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victor I Reus
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Laura J Fochtmann
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Oscar Bukstein
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - A Evan Eyler
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Donald M Hilty
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | | | - Jane Mahoney
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Jagoda Pasic
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Michael Weaver
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Cheryl D Wills
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Jack McIntyre
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Jeremy Kidd
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Joel Yager
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
| | - Seung-Hee Hong
- From the APA Practice Guideline Writing Group (Victor I. Reus, M.D., Chair)
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Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. Psychosomatics 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California, Veterans Administration Health Care System, Mather, CA; Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC).
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine, Burlington, Vermont; Division of Consultation Psychiatry and Psychosomatic Medicine, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Robert M McCarron
- Psychiatry & Behavioral Sciences and Department of Internal Medicine, University of California, Irvine Health System, Irvine, CA
| | - David J Katzelnick
- Department of Psychiatry and Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA; Behavioral Health Integration Program (BHIP) and Washington State's Mental Health Integration Program (MHIP), Seattle, WA
| | - John Fortney
- Division of Population Health, Seattle, WA; Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA
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50
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Hilty DM, Maheu MM, Drude KP, Hertlein KM, Wall K, Long RP, Luoma TL. Telebehavioral Health, Telemental Health, e-Therapy and e-Health Competencies: the Need for an Interprofessional Framework. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0036-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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