Procedural and Methodological Issues in Telepsychiatry Research and Program Development (original) (raw)
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Telepsychiatry: An Electronic Alternative
Iris publishers LLC, 2019
One of the major issues facing the patient population in the United States is the problem of effective and timely mental health care. The core of this issue is that patients are unable to see a mental health provider in a timely manner to be screened for psychiatric illness, be competently diagnosed and subsequently treated in an evidence-based manner. In a bid to mitigate this issue, the field of telepsychiatry has slowly evolved in the last couple of decades into a system which allows face-to-face quality psychiatric assessment, diagnosis and treatment modalities delivered through electronic mediums, primarily video-teleconferencing. This electronic, cost effective mechanism allows access to a mental health provider in a timely manner, enhancing psychiatric care due to early intervention and follow-up, leading to positive outcomes. There is a dire need for mental health providers to be taught the skills required to evaluate patients who are not geographically present in their vicinity due to various circumstances and the optimal ways to assess their mental health conditions. There is a need for clinicians to learn this new and evolving technology and gain expertise to identify underlying emotional issues via technological means and help patients in achieving positive mental health outcomes.
Telepsychiatry: promise, potential and challenges
Indian Journal Psychiatry 2013; 55: 3-11
Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called 'Mental Health Gap'. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store-forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.
Telepsychiatry: Technology Progress, Challenges, and Language and Transcultural Issues
Patients with psychiatric disorders or problems need specialists to correctly diagnose and treat their psychiatric issues. However, a lot of psychiatric patients, especially the patients living rural and remote communities, cannot get timely effective treatment or they lack appropriate care because they cannot access to quality mental health treatment. Telepsychiatry is an effective means of delivering quality psychiatric care and services. Telepsychiatry patients benefit from reduced travel, less lost work time, shorter waiting time for specialist referrals, and reduced costs. Telepsychiatry has gained high levels of satisfaction in all age groups, including the elderly. It is especially useful in rural areas where access to quality psychiatric care is limited or non-existent. Telepsychiatry often uses two-way, real time, interactive and video based services on the network to deliver psychiatric care. This paper introduces several telepsychiatry service delivery models, advantages and applications of telepsychiatry, and the technology such as videoconferencing and variables such as bandwidth used in telepsychiatry treatment sessions. Some technology progress such as mobile telepsychiatry, telepsychiatry based on cloud computing, and telepsychiatry information security based on cryptographic technology or biometrics is presented in this paper. Issues about cultures and languages in telepsychiatry, and limitations and challenges of telepsychiatry in technology and services, ethical and legal considerations of the telepsychiatry, syndromes and patients groups at significantly increased risk in telepsychiatry, patient-psychiatrist relationship in telepsychiatry, and future or further research in telepsychiatry are also discussed.
Telepsychiatry in the Assessment and Treatment of Schizophrenia
Clinical Schizophrenia & Related Psychoses, 2014
Background: Telehealth technology has become more available to providers as a means of treating chronic diseases. Consideration of the applicability of telehealth technology in the treatment of schizophrenia calls for a review of the evidence base in light of the special needs and challenges in the treatment of this population. Our aims are to assess the types and nature of distant interventions for patients with schizophrenia, either telephone-based, internet-based or video-based telehealth systems. Methods: The following databases-MEDLINE, PsycINFO, CINAHL, the Cochrane Library, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and EMBASEwere searched for the following terms alone or in combination with schizophrenia: telepsychiatry or telemedicine or telepsychology or satellite communication or remote communication. Inclusion criteria were: 1) articles dealing with telephone-, internet-or video-based interventions and 2) studies emphasizing development of an intervention, feasibility or clinical trials. Exclusions included were: 1) single case reports and 2) papers not written in English. With our search terms, we retrieved a total of 390 articles, of which 18 unique articles were relevant. Results: Based on the limited data available, the use of modalities involving the telephone, internet and videoconferencing appears to be feasible in patients with schizophrenia. In addition, preliminary evidence suggests these modalities appear to improve patient outcomes. Discussion: More research is needed. Investigators need to improve existing telehealth systems. In addition, researchers need to focus on developing newer interventions and determining whether these approaches can improve patient outcomes.
A review of the first five years of the University of Arizona telepsychiatry programme
Journal of Telemedicine and Telecare, 2005
We performed a retrospective review of the first five years of activity in the University of Arizona Telepsychiatry Programme. The programme began in 1998 as part of a telemedicine service for underserved rural areas. Over the first five years, 1086 teleconsultations were carried out for a total of 206 patients. There were 159 adult (77%) and 47 paediatric patients (23%). During the study period, the racial/ethnic diversity of the paediatric patients increased, as did the number of follow-up visits for adult patients (average 5.3/patient). These trends suggested that telepsychiatry became an integral part of the mental health service system at the six referring sites. Adult patients completed 81 satisfaction surveys (51%) and psychiatrists completed 47 (23%). The responses showed that providers and patients found telepsychiatry services satisfactory, although in a minority of teleconsultations (18% for providers and 17% for patients) equipment problems were distracting. The continued use of the services suggests that the telepsychiatry programme fills a service gap in rural areas of the state.
Telemedicine and e-Health, 2006
Although telepsychiatry in the form of videoconferencing has been well received in terms of increasing access to care and user satisfaction, few data on treatment outcomes and efficacy from telepsychiatry applications are available at the present time. This paper evaluates the efficacy of telepsychiatry through videoconference in the treatment of mental disorders by comparing to face-to-face conventional (F2FC) treatment. We carried out a randomized clinical trial where 140 psychiatric outpatients were randomized to either F2FC treatment or videoconference telepsychiatry (VCTP) treatment. Patients were diagnosed according to International Classification of Diseases, 10th edition (ICD-10) criteria using the Composite International Diagnostic Interview. Treatment involves eight consultations lasting 30 minutes over the 24-week study period. Patients received pertinent psychotropic medication plus cognitive-behavioral therapy during sessions. The same psychiatrist diagnosed and treated all the patients that were recruited from the Community Mental Health Centre of San Sebastian de la Gomera, in the Canary Islands. Change in psychiatric test scores served as the primary efficacy criterion. Efficacy was determined by comparing baseline (visit 1) Clinical Global Impressions-Severity of Illness (CGI-S) and-Improvement (CGI-I) scales as well as Global Indexes (GSI, PSDI, and PST) from SCL-90R with scores obtained at the end of the study period (week 24). Response was defined as a CGI-I score of 1 or 2. Reliable Change Indexes were computed in SCL-90R Global Indexes scores. Of 140 patients randomized, 130 completed 24 weeks of treatment. Only 4 patients dropped out prematurely from the study in VCTP and 6 in F2FC. The study involves 534 teleconsultations, 522 F2FC consultations, and more than 500 hours of clinical practice. Significant improvements were found on the CGI and SCL-90-R Global Indexes scores of both treatment groups, showing clear clinical state improvement. No statistically significant differences were observed when the efficacy of VCTP treatment was compared to F2FC psychiatric treatment efficacy. This study demonstrated that telepsychiatry treatment through videoconference has equivalent efficacy to F2FC psychiatric treatment. Telepsychiatry showed to be an effective mean of delivering mental health services to psychiatric outpatients living in remote areas with limited resources.
Planning and Implementing Telepsychiatry in a Community Mental Health Setting: A Case Study Report
Community Mental Health Journal
Healthcare institutions in the United States are increasingly adopting telehealth services given their numerous benefits in enhancing access to care. Despite that, few accounts of such organizational experiences in the literature exist, especially those pertaining to telepsychiatry. In this case study, we report the planning and implementation of a telepsychiatry program adopted by a community mental health organization in suburban Chicago, Illinois from 2017 until 2019. We analyze findings gathered from the organization's secondary archival data, highlighting process and outcome evaluations of the program. Results show high levels of patient engagement compared to in-person service modality. Also, our results show an increase in the number of patients served, efficiency in service delivery, decreases in patient wait time to accessing services, and overall positive feedback from patients, families, and staff members. We discuss the successes and challenges encountered by the organization and synthesize them into practical applications recommended for similar initiatives.