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Appleton R, Barnett P, Vera San Juan N, Tuudah E, Lyons N, Parker J, Roxburgh E, Spyridonidis S, Tamworth M, Worden M, Yilmaz M, Sevdalis N, Lloyd-Evans B, Needle JJ, Johnson S. Implementation strategies for telemental health: a systematic review. BMC Health Serv Res 2023; 23:78. [PMID: 36694164 PMCID: PMC9873395 DOI: 10.1186/s12913-022-08993-1] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in a rapid shift from traditional face-to-face care provision towards delivering mental health care remotely through telecommunications, often referred to as telemental health care. However, the manner and extent of telemental health implementation have varied considerably across settings and areas, and substantial barriers are encountered. There is, therefore, a need to identify what works best for service users and staff and establish the key mechanisms for efficient integration into routine care. OBJECTIVE We aimed to identify investigations of pre-planned strategies reported in the literature intended to achieve or improve effective and sustained implementation of telemental health approaches (including video calls, telephone calls, text messaging platforms or a combination of any of these approaches with face-to-face care), and to evaluate how different strategies influence implementation outcomes. METHODS A systematic review was conducted, with five databases searched for any relevant literature published between January 2010 and July 2021. Studies were eligible if they took place in specialist mental health services and focused on pre-planned strategies to achieve or improve the delivery of mental health care through remote communication between mental health professionals or between mental health professionals and service users, family members, unpaid carers, or peer supporters. All included studies were quality-assessed. Data were synthesised using the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies and the taxonomy of implementation outcomes. RESULTS A total of 14 studies were identified as meeting the inclusion criteria from a total of 14,294 records of which 338 were assessed at full text. All ERIC implementation strategies were used by at least one study, the most commonly reported being 'Train and educate stakeholders'. All studies reported using a combination of several implementation strategies, with the mean number of strategies used per study of 3.5 (range 2-6), many of which were reported to result in an improvement in implementation over time. Few studies specifically investigated a single implementation strategy and its associated outcomes, making conclusions regarding the most beneficial strategy difficult to draw. CONCLUSIONS Using a combination of implementation strategies appears to be a helpful method of supporting the implementation of telemental health. Further research is needed to test the impact of specific implementation strategies on implementation outcomes.
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Affiliation(s)
- Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.,Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Elizabeth Tuudah
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Natasha Lyons
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | - Jennie Parker
- Lived Experience Researcher, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | - Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Trust, London, UK
| | | | | | | | | | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | - Justin J Needle
- Centre for Health Services Research, City, University of London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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Appleton R, Williams J, Vera San Juan N, Needle JJ, Schlief M, Jordan H, Sheridan Rains L, Goulding L, Badhan M, Roxburgh E, Barnett P, Spyridonidis S, Tomaskova M, Mo J, Harju-Seppänen J, Haime Z, Casetta C, Papamichail A, Lloyd-Evans B, Simpson A, Sevdalis N, Gaughran F, Johnson S. Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review. J Med Internet Res 2021; 23:e31746. [PMID: 34709179 PMCID: PMC8664153 DOI: 10.2196/31746] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. OBJECTIVE To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. METHODS Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. RESULTS A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. CONCLUSIONS Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025.
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Affiliation(s)
- Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, King's College London, London, United Kingdom
| | - Norha Vera San Juan
- NIHR Mental Health Policy Research Unit, King's College London, London, United Kingdom
| | - Justin J Needle
- Centre for Health Services Research, City, University of London, London, United Kingdom
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Harriet Jordan
- Centre for Implementation Science, King's College London, London, United Kingdom
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, King's College London, London, United Kingdom
| | - Monika Badhan
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Trust, London, United Kingdom
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Spyros Spyridonidis
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Magdalena Tomaskova
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Jiping Mo
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | | | - Zoë Haime
- Division of Psychiatry, University College London, London, United Kingdom
| | - Cecilia Casetta
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alexandra Papamichail
- NIHR Mental Health Policy Research Unit, King's College London, London, United Kingdom
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, King's College London, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, United Kingdom
- NIHR Mental Health Policy Research Unit, King's College London, London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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