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Sablone S, Bellino M, Lagona V, Franco TP, Groicher M, Risola R, Violante MG, Grattagliano I. Telepsychology revolution in the mental health care delivery: a global overview of emerging clinical and legal issues. Forensic Sci Res 2024; 9:owae008. [PMID: 39229280 PMCID: PMC11369075 DOI: 10.1093/fsr/owae008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/16/2023] [Indexed: 09/05/2024] Open
Abstract
Since the outbreak of the COVID-19 pandemic, remote healthcare delivery by technological devices has become a growing practice. It represented an unprecedented change in personal and professional activities, allowing health specialists to continue working online by assisting their patients from home. Psychological practice greatly benefited from this innovation, guaranteeing diagnostic and therapeutic effectiveness through cyber counseling. However, in many countries there have been no enactments of specific laws nor adaptations of the professional deontological code aimed at regulating this new psychological practice dimension, generally defined as telepsychology. This article aims to briefly review the scientific literature on this tool's effectiveness and especially analyze the legal and operational framework in which telepsychology has been to date practiced in Italy and other national realities, thus providing a global overview that may be useful to understand how to improve this valuable but still immature practice. Key points The coronavirus pandemic exposed to short- and long-term increase in psychological and psychiatric imbalances.Cyber counseling has been proven to be effective to treat a wide range of psychological disorders.Many of the current national and international legislations concerning the telepsychology practice are still immature. Ad hoc legal frameworks are required for each national context to guarantee a safe and effective cyber counseling delivery.
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Affiliation(s)
- Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Mara Bellino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Valeria Lagona
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Tamara Patrizia Franco
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Matthew Groicher
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Roberta Risola
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Maria Grazia Violante
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Ignazio Grattagliano
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
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Fisker Christensen L, Sørensen L, Johansen KK. Staff experiences with videoconferences during the COVID-19 pandemic in forensic psychiatry outpatients. Nord J Psychiatry 2024; 78:370-375. [PMID: 38546409 DOI: 10.1080/08039488.2024.2331209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/14/2024]
Abstract
AIM To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. METHOD Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. RESULTS Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact-pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? CONCLUSION Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences.
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Affiliation(s)
- Lone Fisker Christensen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
| | - Line Sørensen
- Department of Psychiatry Odense, Region of Southern Denmark, Odense, Denmark
| | - Kirsten Kjær Johansen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
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Chavarria V, Rubio-Valera M, Doménech Abella J, Baladón LH, Mateu I, Arias de la Torre J, Alvarós JC, Peña-Salazar C, Dima AL, Serrano-Blanco A. Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey. Telemed J E Health 2024; 30:e1935-e1943. [PMID: 38597958 DOI: 10.1089/tmj.2023.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.
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Affiliation(s)
- Victor Chavarria
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Joan Doménech Abella
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Luisa Higuera Baladón
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Isabel Mateu
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Jorge Arias de la Torre
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Institute of Biomedicina, University of Leon, Leon, Spain
| | | | - Carlos Peña-Salazar
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Alexandra L Dima
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Karachaliou E, Douzenis P, Chatzinikolaou F, Pantazis N, Martinaki S, Bali P, Tasios K, Douzenis A. Prisoners' Perceptions and Satisfaction with Telepsychiatry Services in Greece and the Effects of Its Use on the Coercion of Mental Healthcare. Healthcare (Basel) 2024; 12:1044. [PMID: 38786454 PMCID: PMC11121354 DOI: 10.3390/healthcare12101044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/04/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Prisoners are often associated with mental health and substance use disorders. Coercive measures are widely used in prison settings. The objective of this study was to compare inmates' perceptions and satisfaction with telepsychiatry versus face-to-face consultation and the effects of telepsychiatry on the use of coercive measures. The sample consisted of 100 male inmates from various backgrounds who had experienced both approaches of services (face to face and telepsychiatry). METHOD The data were obtained through an interview where the individuals completed a Demographic Data Questionnaire, a Participant Satisfaction Questionnaire to assess satisfaction with face-to-face psychiatric services, and a Participant Satisfaction Questionnaire to assess their satisfaction with services offered via telepsychiatry. Additionally, calculations of time spent waiting for a face-to-face psychiatric evaluation and time spent in handcuffs and in confined spaces were made before and after the introduction of telepsychiatry. RESULTS Statistically significant improvements (all p-values < 0.001) were noted in waiting times, support for relapse prevention, follow up, quality of mental health care, quality of care in the management of psychiatric problems and related medication, behavior of psychiatrists, duration of the assessment, sense of comfort, and confidentiality. Telepsychiatry led to the elimination of time spent in handcuffs and in confined spaces (transport vehicles). CONCLUSION According to the results of this study, telepsychiatry is an acceptable method of service delivery in correctional facilities and was associated with a reduction of coercive practices.
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Affiliation(s)
| | - Phoebe Douzenis
- University Hospitals of Derby and Burton, Derby DE22 3NE, UK;
| | - Fotios Chatzinikolaou
- Department of Laboratory of Forensic Medicine and Toxicology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Sophia Martinaki
- Department of Social Work, University of West Attica, 12241 Athens, Greece;
| | - Panagiota Bali
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece;
| | | | - Athanasios Douzenis
- Department of Psychiatry, School of Medicine, National & Kapodistrian University of Athens, 15772 Athens, Greece;
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Skala J, Chavez JX, Anderson K, Gulrajani C. Examiners' perceptions of forensic mental health assessments conducted via videoconferencing. BEHAVIORAL SCIENCES & THE LAW 2023; 41:292-309. [PMID: 36965143 DOI: 10.1002/bsl.2621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic led to an acceleration in the adoption of videoconferencing (VC) for conducting forensic mental health evaluations (forensic mental health assessments [FMHA]). Two years into the COVID-19 pandemic, we administered a survey to 71 Minnesota-licensed forensic evaluators. Approximately two-thirds (65.7%) had started using VC for FMHA only after the pandemic, though a combined 84.5% reported performing FMHA via VC frequently at present. A striking 43.7% of respondents preferred VC for FMHA over in-person evaluation, and another 22.5% expressed no preference between modalities. Further, nearly 70% of respondents denied there were any populations for which they would never use VC to complete an FMHA. We conclude that the widespread adoption of VC for FMHA with the advent of the COVID-19 pandemic has induced a lasting change in the practice of FMHA. We postulate that with further advancements in technology and the development of testing instruments that can be administered online, the use of VC for FMHA will become standard practice.
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Affiliation(s)
- Josie Skala
- Department of Psychiatry and Behavioral Sciences, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Jacob X Chavez
- Minnesota Direct Care and Treatment - Forensic Services, Forensic Mental Health Program, St. Peter, Minnesota, USA
| | - Katelin Anderson
- Office of Information Technology, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Chinmoy Gulrajani
- Department of Psychiatry and Behavioral Sciences, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
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Lewis DE, Ash P, Roberts VC, Schwenke TJ, Pagán-González M, Egan GJ. Jail-Based Competency Restoration Services in the United States: The Need, the Controversy, the Impact of COVID-19, and Implications for Future Treatment Delivery. CRIMINAL JUSTICE AND BEHAVIOR 2023; 50:216-234. [PMID: 36741811 PMCID: PMC9843285 DOI: 10.1177/00938548221120280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Jail-based competency restoration largely emerged as a method to address the backlog at forensic hospitals around the United States, as the number of justice-involved persons in need of restoration outgrew available beds. Jail-based competency restoration units (JBCRUs) appear to be highly effective and cost-saving. However, after the COVID-19 outbreak, services at some JBCRUs were stalled, as providers were forced to either quickly initiate or ramp up technology use to maintain services. The present study describes the course of programming for a JBCRU in Fulton County, Georgia, prior to and after the onset of COVID-19, during which time all treatment shifted to telehealth. A matched comparison group of prepandemic defendants was used to compare in-person versus telehealth services and findings indicated that while defendants' length of stay remained effectively the same, the restoration rate for telehealth increased remarkably over prepandemic levels (χ2 = 10.1, p = .001). Such findings suggest that telehealth services are an effective mode of delivery for competency restoration.
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Affiliation(s)
- Douglas E. Lewis
- Douglas E. Lewis Jr., Psychology
Department, Georgia Diagnostic and Classification Prison, P.O. Box 3877, 2978
Hwy 36, West Jackson, GA 30233; e-mail:
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Bosse JD, Hoffman K, Wiest K, Todd Korthuis P, Petluri R, Pertl K, Martin SA. Patient evaluation of a smartphone application for telehealth care of opioid use disorder. Addict Sci Clin Pract 2022; 17:50. [PMID: 36085078 PMCID: PMC9462609 DOI: 10.1186/s13722-022-00331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background People with opioid use disorder (OUD) face barriers to entering and remaining in life-saving treatment (e.g., stigma, detrimental interactions with health care, and privacy concerns). Telehealth and related technology can reduce barriers to entering and staying in care. Patient feedback is critical to the development of these newer treatment approaches to ensure they are usable and do not inadvertently recreate treatment barriers. Purpose Evaluate the perceived usability of existing and planned features of a mobile application (app) that facilitates delivery of OUD treatment via telehealth. Methods People with current or prior experience with OUD treatment were eligible for the study. Participants (n = 31; 55% women) provided feedback on an interactive prototype demonstration via individual qualitative interviews and completed a quantitative survey on the app’s perceived usability. Descriptive statistics summarized the usability survey. We analyzed qualitative interview transcripts to elicit common themes. Results Participants were primarily white (77%) with a mean age of 42.2 years (range 22–69). Participants rated the six major features of the current app as helpful (median response 5 out of 5) and appreciated the flexibility of conducting a visit from a place of their choosing. Participants regarded the five proposed components of the app, such as daily affirmations and medication treatment-related reminders (e.g., pick up medication at pharmacy, medication schedule), as useful features with medians 5 out of 5, and reported they would recommend the app to others for OUD care. Participant qualitative interviews provided additional information on perceived usability of existing and proposed app features. Conclusion Our study suggests that an appealing, easy-to-use app—with tools and features that effectively support care—could circumvent existing barriers and foster sustained recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00331-4.
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Hartzell SYT. Telemedicine in a primary care clinic in Fairbanks, Alaska: Not a magic bullet for providing treatment during COVID-19. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221085878. [PMID: 36204522 PMCID: PMC9413496 DOI: 10.1177/27550834221085878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022]
Abstract
Stay-at-home orders due to the COVID-19 pandemic have increased patients’ reliance on
virtual physician visits, via telemedicine. Telemedicine has benefits of use during the
pandemic and has benefits outside of the pandemic. It is underutilized in certain types of
medical organizations, providers, and among specific populations in the United States. It
is important to understand the barriers to incorporating telemedicine effectively in the
areas that it is underutilized, especially in rural locations. The researcher discussed
the telemedicine expansion for two family practice doctors in Fairbanks, Alaska (AK). The
family practice doctors experienced barriers that partially echo what has been stated in
research. Research suggests that changes to Medicare and Medicaid telemedicine policies
may not be enough to address these barriers. Other supports to expand telemedicine where
it is needed includes providing more incentives to providers, waivers from insurance
companies for patients to purchase equipment, and more education to patients about when,
how, and where to receive telemedicine. More supports need to be provided to those
underserved by telemedicine, especially for clients who are on Medicaid, living in
low-income areas, and/or living in rural locations.
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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Springer PR, Bischoff RJ, Taylor NC, Neuhaus V, Leow C. Competency-based training in the supervision of relational telemental supervision. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:375-391. [PMID: 33780568 DOI: 10.1111/jmft.12513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Supervision has long been considered essential to developing effective mental health practice, especially among COAMFTE accredited training programs. But with telemental health rapidly being accepted as a standard treatment medium for couple and family therapy, there is little guidance about how to supervise clinicians who are engaged in telemental health practice. This paper presents an important step toward increasing the effectiveness of the supervision of therapists who are delivering relational therapies online through the identification of relational competencies unique to this delivery medium. These competencies have been adopted and integrated into a COAMFTE accredited master's degree program that has been providing training in telemental health since 2008. The competencies are described, and supervision strategies that can be utilized and developmentally assessed throughout the program will be detailed.
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Affiliation(s)
- Paul R Springer
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Richard J Bischoff
- Institute of Agriculture and Natural Resources, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Nathan C Taylor
- School of Applied Human Sciences, University of Northern Iowa, Cedar Falls, IA, USA
| | - Vanessa Neuhaus
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Cassandra Leow
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
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Colombo MG, Koch R, Joos S. [Acceptance of Video Consultations in Correctional Facilities from the Patients' Perspective - Results from the Mixed-Methods Evaluation of a Pilot Project in Baden-Württemberg]. PSYCHIATRISCHE PRAXIS 2021; 49:80-88. [PMID: 33773499 DOI: 10.1055/a-1400-2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Video consultations have proven themselves in international penal systems. Amidst a lack of medical staff, video consultations were offered in five correctional facilities in Baden-Württemberg in 2018 as part of a pilot project. This evaluation study aimed at assessing the acceptance of video consultations among patients. METHODS The mixed-methods evaluation consisted of site visits, interviews, questionnaires and an analysis of medical treatment data. RESULTS A total of 305 video consultations were conducted between June and December 2018. Among the most frequent reasons for encounter were feeling anxious/nervous/tense, sleep disturbance, headache and drug abuse. Including familiar medical staff and offering training for the involved physicians were important factors that enabled a trusting communication. CONCLUSION Video consultations were seen as a useful addition to existing health care. However, they were considered less suitable for both emergencies and physical examinations.
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Affiliation(s)
- Miriam Giovanna Colombo
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Roland Koch
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen
| | - Stefanie Joos
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen
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Serhal E, Iwajomo T, de Oliveira C, Crawford A, Kurdyak P. Characterizing Family Physicians Who Refer to Telepsychiatry in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:25-33. [PMID: 32911964 PMCID: PMC7890579 DOI: 10.1177/0706743720954061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Telepsychiatry can improve access to psychiatric services for those who otherwise cannot easily access care. Family physicians are gatekeepers to specialized care in Ontario, so it is essential to understand predictors relating to referrals to telepsychiatry to better plan services and increase telepsychiatry adoption. METHODS This study used an annual retrospective cross-sectional study design to compare physicians who referred their patients to telepsychiatry each year from fiscal year (FY) 2008 to FY 2016. A 1-year (FY 2016) comparison of family physicians who referred to telepsychiatry (FPTs) compared to family physicians who did not refer to telepsychiatry (FPNTs) matched (1:2) by region was also conducted. Finally, we used statistical modeling to understand the predictors of referring to telepsychiatry among physicians. RESULTS Between FY 2008 and FY 2016, the number of patients receiving telepsychiatry increased from 925 visits to 13,825 visits. Thirty-two percent of Ontario primary care physicians referred to telepsychiatry in 2016. Several characteristics were notably different between FPTs and FPNTs: FPTs were more likely to be from a residence with less than 10,000 people, to have more nurse practitioners in the practice, and to be from a family health team than FPNTs. Rostered patients of FPTs were more likely to reside in rural areas, have more clinical complexity, and to utilize more mental health services compared to FPNTs. CONCLUSIONS There has been an increase in the use of telepsychiatry by patients and family physicians over the study period, although there remains opportunity for significant growth. Family physicians who live in rural areas, are part of an FHT, have more NPs, with more rural and complex patients were more likely to refer to telepsychiatry. As recent pro-telemedicine policies support the growth of telepsychiatry, this study will serve as an important baseline.
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Affiliation(s)
- Eva Serhal
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Claire de Oliveira
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Allison Crawford
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Batastini AB, Paprzycki P, Jones ACT, MacLean N. Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice. Clin Psychol Rev 2020; 83:101944. [PMID: 33227560 DOI: 10.1016/j.cpr.2020.101944] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.
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Affiliation(s)
- Ashley B Batastini
- University of Southern Mississippi, USA; University of Mississippi Medical Center Department of Psychiatry, USA.
| | - Peter Paprzycki
- University of Southern Mississippi, USA; Mississippi Center for Clinical and Translational Research, USA; University of Toledo, USA
| | | | - Nina MacLean
- Michigan Department of Health & Human Services - Center for Forensic Psychiatry, USA
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Sivakumar PT, Mukku SSR, Kar N, Manjunatha N, Phutane VH, Sinha P, Kumar CN, Math SB. Geriatric Telepsychiatry: Promoting Access to Geriatric Mental Health Care Beyond the Physical Barriers. Indian J Psychol Med 2020; 42:41S-46S. [PMID: 33354062 PMCID: PMC7736734 DOI: 10.1177/0253717620958380] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Psychiatric illnesses are an important contributor of morbidity and mortality in older adults. There is increase in older adults with psychiatric disorders paralleling their growth in absolute numbers. This leads to challenges in mental health care and service delivery. Several barriers that exists in our community hinder older adults from receiving mental health care. Additionally, lack of adequate human resources in geriatric mental health care compounds the problem. Telemedicine, though not new in other fields of medicine, is relatively new in the practice of psychiatry in India. This is probably due to lack of clear guidelines and regulations regarding the same in India. There is a recent increase in teleconsultations in India similar to other developed countries due to ongoing COVID-19 pandemic. The recent telepsychiatry operational guidelines have made telepsychiatry a legitimate and official practice in India. Challenges specific to older adults in the form of low digital literacy, sensory issues, and cognitive impairment can be overcome by adopting telepsychiatry services in coming years. Concerns related to security and safety of telepsychiatry require further evaluation.
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Affiliation(s)
- Palanimuthu Thangaraju Sivakumar
- Dept. of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shiva Shanker Reddy Mukku
- Dept. of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nilamadhab Kar
- Black Country Healthcare NHS Foundation Trust, Wolverhampton, England, United Kingdom
| | | | - Vivek Haridas Phutane
- Goulburn Valley Area Mental Health Services (GVAMHS), Goulburn Valley Health, Shepparton and Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Preeti Sinha
- Dept. of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Tele Medicine Centre, Dept. of Psychiatry, NIMHANS, Bengaluru, India
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15
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Springer P, Bischoff RJ, Kohel K, Taylor NC, Farero A. Collaborative Care at a Distance: Student Therapists' Experiences of Learning and Delivering Relationally Focused Telemental Health. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:201-217. [PMID: 32277719 PMCID: PMC7262045 DOI: 10.1111/jmft.12431] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
There is mounting evidence that telemental health is an effective delivery method for treating a variety of mental, emotional, behavioral, and relational health problems. While many of the therapeutic skills leading to the effectiveness of face-to-face treatments are transferable, the effectiveness of telemental health requires unique skills. The purpose of this phenomenological study was to determine the experience of learning how to use videoconferencing to deliver relationally focused mental health care. Participants included 10 graduates of a COAMFTE-accredited master's degree program emphasizing training in telemental health. Each student had practicum placements that required videoconferencing to deliver relationally based psychotherapy. Analysis of interview data revealed (a) personal reservations about distance delivery; (b) the importance of scaffolding student learning through curriculum, supervision, and mental health-care delivery protocols; (c) the technological barriers associated with this delivery method; and (d) overcoming technological barriers through intentionality.
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Edge C, Black G, King E, George J, Patel S, Hayward A. Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use. J Telemed Telecare 2019; 27:325-342. [PMID: 31640460 DOI: 10.1177/1357633x19869131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prison telemedicine can improve the access, cost and quality of healthcare for prisoners, however adoption in prison systems worldwide has been variable despite these demonstrable benefits. This study examines anticipated and realised benefits, barriers and enablers for prison telemedicine, thereby providing evidence to improve the chances of successful implementation. METHODS A systematic search was conducted using a combination of medical subject headings and text word searches for prisons and telemedicine. Databases searched included: PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, Scopus and International Bibliography of the Social Sciences. Articles were included if they reported information regarding the use of/advocacy for telemedicine, for people residing within a secure correctional facility. A scoping summary and subsequent thematic qualitative analysis was undertaken on articles selected for inclusion in the review, to identify issues associated with successful implementation and use. RESULTS One thousand, eight hundred and eighty-two non-duplicate articles were returned, 225 were identified for full text review. A total of 163 articles were included in the final literature set. Important considerations for prison telemedicine implementation include: differences between anticipated and realised benefits and barriers, differing wants and needs of prison and community healthcare providers, the importance of top-down and bottom-up support and consideration of logistical and clinical compatibility. CONCLUSIONS When implemented well, patients, prison and hospital staff are generally satisfied with telemedicine. Successful implementation requires careful consideration at outset of the partners to be engaged, the local context for implementation and the potential benefits that should be communicated to encourage participation.
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Affiliation(s)
- Chantal Edge
- UCL Collaborative Centre for Inclusion Health, London, UK
| | - Georgia Black
- UCL Department of Applied Health Research, London, UK
| | - Emma King
- UCL Collaborative Centre for Inclusion Health, London, UK
| | | | - Shamir Patel
- Central North West London NHS Foundation Trust, London, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology and Health Care, London, UK
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Weaver A, Himle J, Elliott M, Hahn J, Bybee D. Rural Residents' Depressive Symptoms and Help-Seeking Preferences: Opportunities for Church-Based Intervention Development. JOURNAL OF RELIGION AND HEALTH 2019; 58:1661-1671. [PMID: 30953285 DOI: 10.1007/s10943-019-00807-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examines rural residents' depressive symptoms, helps seeking preferences and perceptions of a church-based group depression intervention, informing feasibility of adapting evidence-based treatment for delivery in rural churches. A cross-sectional survey was administered to 100 members of 2 churches in a rural Midwestern community; 63 congregants responded. Depression was assessed via the Patient Health Questionnaire-9. Descriptive analyses were performed, and 12.9% of respondents screened positive for depression. Another 25% reported mild symptomatology. Respondents preferred informal help seeking, although reported more openness to formal providers to address others' depression. Results suggest receptivity to church-based treatment. Almost two-third of respondents reported they would consider attending a church-based group depression intervention, 80% would recommend it to a friend in need, and 60% indicated it would benefit their community. Delivering evidence-based depression treatment within church settings may provide a viable option for increasing access to care in this rural community.
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Affiliation(s)
- Addie Weaver
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, USA.
| | - Joseph Himle
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark Elliott
- Hillsdale Church of the Nazarene, Hillsdale, MI, USA
| | | | - Deborah Bybee
- Department of Community Psychology, Michigan State University, East Lansing, MI, USA
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Abstract
Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted. RESULTS: Four USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.
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Serhal E, Lazor T, Kurdyak P, Crawford A, de Oliveira C, Hancock-Howard R, Coyte PC. A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities. J Telemed Telecare 2019; 26:607-618. [DOI: 10.1177/1357633x19853139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Residents of Northern Ontario have limited access to local psychiatric care. To address this, three program models exist: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist. Evidence shows that telepsychiatry has comparable outcomes to in-person consultations. The objective of this study was to determine the cost difference between programs. Methods A cost-minimization analysis estimating cost per visit from a public healthcare payer economic costing perspective was conducted. Data on fixed and variable costs were obtained. Evidence-based assumptions were made where relevant. Base-case scenarios and a break-even analysis were completed, as well as deterministic and probabilistic sensitivity analyses, to explore the effects of parameter variability on program costs. Results Costs per visit were lowest in telepsychiatry (CAD$360) followed by traveling physicians (CAD$558) and patient reimbursement (CAD$620). Among the 100,000 Monte Carlo simulations, results showed telepsychiatry was the least costly program in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively. The break-even analysis found telepsychiatry was the least costly program after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients). Discussion Our analyses support telepsychiatry as the least costly program. These results have important implications for program planning, including the prioritization of telepsychiatry, increased integration of telepsychiatry with other modalities of outreach psychiatry, and limiting use of the patient remuneration program to where medically necessary, to reduce overall cost.
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Affiliation(s)
- Eva Serhal
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tanya Lazor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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20
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Phillips JG, Diesfeld K, Mann L. Instances of online suicide, the law and potential solutions. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2019; 26:423-440. [PMID: 31984087 PMCID: PMC6762158 DOI: 10.1080/13218719.2018.1506719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 07/27/2018] [Indexed: 06/10/2023]
Abstract
To understand the social and legal issues posed by suicide-related communications over the Internet (messages of threatened suicide and advocated suicide), this article examines a selection of cases involving different types of online baiting and harassment that illustrate different legal and technological issues. The anonymity afforded by computer-mediated communication allows bullies to harass vulnerable individuals and leak (disclose) their personal information. Computer mediation of communication potentially diffuses responsibility; imposes a temporal asynchrony between signified intent and audience response; and reduces the empathy that might motivate observers or witnesses to intervene and render assistance, factors that make online baiting a serious social, legal and technological problem. Potential actions (both legal and technological) for addressing this problem are outlined.
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Affiliation(s)
- James G. Phillips
- Psychology Department, Auckland University of Technology, Auckland, New Zealand
| | - Kate Diesfeld
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | - Leon Mann
- Melbourne Melbourne School of Psychological Science, University of Melbourne, Parkville, Australia
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21
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Ihorn SM, Arora P. Teleconsultation to Support the Education of Students with Visual Impairments: A Program Evaluation. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2018. [DOI: 10.1080/10474412.2018.1425878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kip H, Bouman YHA, Kelders SM, van Gemert-Pijnen LJEWC. eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State. Front Psychiatry 2018; 9:42. [PMID: 29515468 PMCID: PMC5826338 DOI: 10.3389/fpsyt.2018.00042] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients. OBJECTIVE To examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness. METHODS A systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients. RESULTS The search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of. DISCUSSION To overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth's potential, further research on development, implementation, and evaluation should be conducted.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | | | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Lisette J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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23
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Bice-Urbach B, Kratochwill T, Fischer AJ. Teleconsultation: Application to Provision of Consultation Services for School Consultants. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2017. [DOI: 10.1080/10474412.2017.1389651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Siddiqui J, Herchline T, Kahlon S, Moyer KJ, Scott JD, Wood BR, Young J. Infectious Diseases Society of America Position Statement on Telehealth and Telemedicine as Applied to the Practice of Infectious Diseases. Clin Infect Dis 2017; 64:237-242. [PMID: 28096274 DOI: 10.1093/cid/ciw773] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 11/12/2022] Open
Abstract
The use of telehealth and telemedicine offers powerful tools for delivering clinical care, conducting medical research, and enhancing access to infectious diseases physicians. The Infectious Diseases Society of America (IDSA) has prepared a position statement to educate members on the use of telehealth and telemedicine technologies. The development of telehealth and telemedicine programs requires the consideration of several issues such as HIPAA, state and local licensure requirements, credentialing and privileging, scope of care, quality, and responsibility and liability. IDSA supports appropriate use of telehealth and telemedicine to provide timely, cost-effective specialty care to resource-limited populations.
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Affiliation(s)
| | - Thomas Herchline
- Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | | | - Kay J Moyer
- Clinical Affairs, Infectious Diseases Society of America, Arlington, Virginia;
| | | | - Brian R Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Jeremy Young
- Division of Infectious Diseases, Immunology, and International Medicine, Department of Medicine, University of Illinois, Chicago
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25
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Fischer AJ, Collier-Meek MA, Bloomfield B, Erchul WP, Gresham FM. A comparison of problem identification interviews conducted face-to-face and via videoconferencing using the consultation analysis record. J Sch Psychol 2017. [PMID: 28633939 DOI: 10.1016/j.jsp.2017.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
School psychologists who experience challenges delivering face-to-face consultation may utilize videoconferencing to facilitate their consultation activities. Videoconferencing has been found to be an effective method of service delivery in related fields and emerging research suggests that it may be effective for providing teacher training and support in school settings. In this exploratory investigation, we used the Consultation Analysis Record (Bergan & Tombari, 1975) and its four indices to assess the effectiveness of conducting problem identification interviews via videoconferencing versus face-to-face. Overall, findings indicated significant differences across these two conditions, with videoconference interviews coded as having higher indices of content relevance, process effectiveness, and message control, but lower content focus, compared to face-to-face interviews. As these indices have been positively associated with favorable consultation outcomes, the results provide initial support for the effectiveness of consultation delivered via videoconferencing.
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Saeed SA, Johnson TL, Bagga M, Glass O. Training Residents in the Use of Telepsychiatry: Review of the Literature and a Proposed Elective. Psychiatr Q 2017; 88:271-283. [PMID: 27796920 DOI: 10.1007/s11126-016-9470-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Many regions in the United States are deficient in mental health services, especially those in rural areas. As a result of these deficiencies, many patients in need of psychiatric services are often left untreated. Although it is clear that telepsychiatry has great potential in improving patient access to mental health care in areas where psychiatric services are deficient, the lack of familiarity with the technology and inadequate training are current barriers to expanding the use of telepsychiatry. A review of telepsychiatry, its clinical applications, and evidence-based literature regarding competencies in graduate medical education related to telepsychiatry are provided. An approach to implementing telepsychiatry into a curriculum is suggested. We also propose an elective clinical experience with resources for didactics or independent study that will enable residents to develop a knowledge base and competence in the practice of telepsychiatry.
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Affiliation(s)
- Sy Atezaz Saeed
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 600 Moye Blvd., Suite 4E-102, Greenville, NC, 27834, USA.
| | - Toni L Johnson
- Department of Psychiatry and Behavioral Medicine, Psychiatric Outpatient Clinic, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
| | - Mandeep Bagga
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
| | - Oliver Glass
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
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Naskar S, Victor R, Das H, Nath K. Telepsychiatry in India - Where Do We Stand? A Comparative Review between Global and Indian Telepsychiatry Programs. Indian J Psychol Med 2017; 39:223-242. [PMID: 28615754 PMCID: PMC5461830 DOI: 10.4103/0253-7176.207329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.
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Affiliation(s)
- Subrata Naskar
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Robin Victor
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Himabrata Das
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kamal Nath
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
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Telehealth: Increasing Access to High Quality Care by Expanding the Role of Technology in Correctional Medicine. J Clin Med 2017; 6:jcm6020020. [PMID: 28208807 PMCID: PMC5332924 DOI: 10.3390/jcm6020020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022] Open
Abstract
The United States (US) has a large correctional population. However, many incarcerated persons lack access to evidence-based, up-to-date medical care, particularly by subspecialty providers, due to limitations of geography, travel, cost and other resources. The use of telehealth technologies can remove these barriers, increasing access to high quality, multidisciplinary care. Studies have shown that, with telemedicine, timely triage and medical management can be provided across many disciplines, which may lead to improved clinical outcomes and significant cost savings.
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Abstract
The delivery of psychiatric care via video-teleconferencing (VTC) technology is thought to have reached a tipping point. As a medical speciality with relatively few material or technical requirements for service delivery, psychiatry has been one of the earliest to embrace the possibility of providing evaluations and treatment at a distance. Such technical infrastructure as is necessary can often be found in the institutions already in existence. It was natural therefore that institutionally based telepsychiatry would lay the foundation for the development of the field. In this article we review the history and development of institutional VTC in a wide variety of clinically supervised settings such as hospitals, outpatient clinics, and forensic settings. We cite evidence supporting institutionally sponsored use and expand on key takeaways for the development and expansion of videoconferencing in these settings. We also speculate on the future direction and development of psychiatric care provided by these arrangements.
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Affiliation(s)
- Robert Lee Caudill
- a Department of Psychiatry and Behavioral Sciences , University of Louisville, School of Medicine, University of Louisville Healthcare Outpatient Center , Louisville , Kentucky , USA
| | - Zachary Sager
- a Department of Psychiatry and Behavioral Sciences , University of Louisville, School of Medicine, University of Louisville Healthcare Outpatient Center , Louisville , Kentucky , USA
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30
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Barrera-Valencia C, Benito-Devia AV, Vélez-Álvarez C, Figueroa-Barrera M, Franco-Idárraga SM. [Cost-effectiveness of Synchronous vs. Asynchronous Telepsychiatry in Prison Inmates With Depression]. ACTA ACUST UNITED AC 2016; 46:65-73. [PMID: 28483175 DOI: 10.1016/j.rcp.2016.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/10/2015] [Accepted: 04/15/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Telepsychiatry is defined as the use of information and communication technology (ICT) in providing remote psychiatric services. Telepsychiatry is applied using two types of communication: synchronous (real time) and asynchronous (store and forward). OBJECTIVE To determine the cost-effectiveness of a synchronous and an asynchronous telepsychiatric model in prison inmate patients with symptoms of depression. METHODS A cost-effectiveness study was performed on a population consisting of 157 patients from the Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. The sample was determined by applying Zung self-administered surveys for depression (1965) and the Hamilton Depression Rating Scale (HDRS), the latter being the tool used for the comparison. RESULTS Initial Hamilton score, arrival time, duration of system downtime, and clinical effectiveness variables had normal distributions (P>.05). There were significant differences (P<.001) between care costs for the different models, showing that the mean cost of the asynchronous model is less than synchronous model, and making the asynchronous model more cost-effective. CONCLUSIONS The asynchronous model is the most cost-effective model of telepsychiatry care for patients with depression admitted to a detention centre, according to the results of clinical effectiveness, cost measurement, and patient satisfaction.
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Affiliation(s)
- Camilo Barrera-Valencia
- Grupo Telesalud, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia.
| | | | - Consuelo Vélez-Álvarez
- Departamento de Salud Pública, Grupo de Investigación, Promoción de Salud y Prevención de la Enfermedad, Universidad de Caldas, Manizales, Colombia
| | - Mario Figueroa-Barrera
- Departamento de Salud Mental, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia
| | - Sandra Milena Franco-Idárraga
- Departamento de Salud Pública, Grupo de Investigación, Promoción de Salud y Prevención de la Enfermedad, Universidad de Caldas, Manizales, Colombia
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Batastini AB. Improving Rehabilitative Efforts for Juvenile Offenders Through the Use of Telemental Healthcare. J Child Adolesc Psychopharmacol 2016; 26:273-7. [PMID: 26288198 DOI: 10.1089/cap.2015.0011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The use of videoconferencing technology in the provision of mental health services is expected to increase rapidly over the next several years. Given the high rates of juvenile offenders in need of such services and the new norms of communication among young people in general, technology-based service modalities are a promising approach for increasing the availability and intensity of services, as well as engagement and compliance with treatment recommendations. This article will discuss the current state of the juvenile justice system, the literature on the use of telemental healthcare (TMH) with delinquent youth, how TMH fits within the generally accepted model of correctional rehabilitation, and special considerations for applying TMH to this population and setting. Although there is no evidence to suggest negative outcomes associated with TMH, future research is greatly needed to justify its use.
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Affiliation(s)
- Ashley B Batastini
- Department of Psychological Sciences, Texas Tech University , Lubbock, Texas
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Young JD, Patel M. HIV Subspecialty Care in Correctional Facilities Using Telemedicine. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 21:177-85. [PMID: 25788612 DOI: 10.1177/1078345815572863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the United States, prisons and jails contain a population at high risk for HIV infection with a relatively large proportion known to be HIV positive. However, many incarcerated persons lack access to subspecialty HIV care due to barriers of geography and travel. Telemedicine clinics can remove these barriers, increasing access to expert, multidisciplinary care. With telemedicine, correctional facilities can provide up-to-date, evidence-based HIV management, which may lead to improved compliance, greater virologic suppression, improved CD4 T-cell counts, fewer adverse drug interactions, and decreased transmission in the community. While HIV care in prisons is an example of harnessing this technology, telemedicine can be used for the diagnosis and management of multiple acute and chronic diseases for underserved populations.
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Affiliation(s)
- Jeremy D Young
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahesh Patel
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Saeed S. North Carolina Statewide Telepsychiatry Program (NC-STeP): Using telepsychiatry to improve access to evidence-based care. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Mental disorders are common [1] and they are associated with high levels of distress, morbidity, disability, and mortality. We know today that psychiatric treatments work and there is extensive evidence and agreement on effective mental health practices for persons with these disorders. Unfortunately, at a time when treatment for psychiatric illness has never been more effective, many people with these disorders do not have access to psychiatric services due to the shortage, and maldistribution of providers, especially psychiatrists. This has resulted in patients going to hospital emergency departments to seek services resulting in long lengths of stay and boarding of psychiatric patients in hospital emergency departments. A growing body of literature now suggests that the use of telepsychiatry to provide mental health care has the potential to mitigate the workforce shortage that directly affects access to care, especially in remote and underserved areas [2,3].The North Carolina Statewide Telepsychiatry Program (NC-STeP) was developed in response to NC Session Law 2013-360. The vision of NC-STeP is to assure that if an individual experiencing an acute behavioral health crisis enters an emergency department of a hospital anywhere in the state of North Carolina, s/he receives timely, evidence-based psychiatric treatment through this program. Aside from helping address the problems associated with access to mental health care, NC-STeP is helping North Carolina face a pressing and difficult challenge in the healthcare delivery system today: the integration of science-based treatment practices into routine clinical care. East Carolina University's Center for Telepsychiatry is the home for this statewide program, which is connecting 80-85 hospital emergency departments across the state of North Carolina. The plan for NC-STeP was developed in collaboration with a workgroup of key stakeholders including representatives from Universities in NC, hospitals/healthcare systems, NC Hospital Association, NC Psychiatric Association, LME-MCOs, NC-Department of HHS, and many others. The NC General Assembly has appropriated $4 million over two years to fund the program. The program is also partially funded by the Duke Endowment.The program has already connected 56 of the projected 85 hospitals in the first 18 months since its inception and over 12,000 encounters have been successfully completed during this time. A web portal has been designed and implemented that combines scheduling, EMR, HIE functions, and data management systems. This presentation will provide current program data on the length of stay, dispositions, IVC status, and other parameters for all ED patients who received telepsychiatry services. NC-STeP is now positioned well to create collaborative linkages and develop innovative models for the mental health care delivery by connecting psychiatric providers with EDs and Hospitals, Community-based mental health providers, Primary Care Providers, FQHCs and Public Health Clinics, and others. NC-STeP is positioned well to build capacity by taking care of patients in community-based settings and by creating collaborative linkages across continuums of care. By doing so, the program implements evidence-based practice to make recovery possible for patients that it serves.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Fischer AJ, Dart EH, Leblanc H, Hartman KL, Steeves RO, Gresham FM. AN INVESTIGATION OF THE ACCEPTABILITY OF VIDEOCONFERENCING WITHIN A SCHOOL-BASED BEHAVIORAL CONSULTATION FRAMEWORK. PSYCHOLOGY IN THE SCHOOLS 2016. [DOI: 10.1002/pits.21900] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
This article reviews the organization, infrastructure basics, applications, effectiveness, outreach, and implementation barriers related to telepsychiatry. We highlight the tremendous potential and promise that this technology holds and also discuss the importance that telepsychiatry may play in the field of psychodynamic psychiatry. Given the growing effectiveness evidence base for therapy delivered over the Internet, telepsychiatry holds a large unexplored territory to help psychodynamically minded patients connect with psychodynamically oriented psychiatrists. This economically advantageous medium can be utilized to deliver psychodynamically guided approaches to the patient, alone or in combination with pharmacological and other psychosocial interventions. We hope, this article will help psychodynamically trained psychiatrists to consider bridging the gap with the remotely located, chronically mentally ill population which oftentimes has scarcity of resources.
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Affiliation(s)
- Sy Atezaz Saeed
- Professor and Chairman, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
| | - Vivek Anand
- Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
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Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry 2015; 5:286-304. [PMID: 26425443 PMCID: PMC4582305 DOI: 10.5498/wjp.v5.i3.286] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 02/05/2023] Open
Abstract
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
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Adjorlolo S, Chan HC(O. Forensic Assessment via Videoconferencing: Issues and Practice Considerations. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2015. [DOI: 10.1080/15228932.2015.1015363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Crisis Management and Conflict Resolution: Using Technology to Support Couples Throughout Deployment. CONTEMPORARY FAMILY THERAPY 2015. [DOI: 10.1007/s10591-015-9343-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Achey MA, Beck CA, Beran DB, Boyd CM, Schmidt PN, Willis AW, Riggare SS, Simone RB, Biglan KM, Dorsey ER. Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial. Trials 2014; 15:465. [PMID: 25431346 PMCID: PMC4289172 DOI: 10.1186/1745-6215-15-465] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/06/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Interest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden. METHODS/DESIGN We are conducting a randomized comparative effectiveness study (Connect.Parkinson) comparing usual care in the community to usual care augmented by virtual house calls with a Parkinson disease specialist. Recruitment is completed centrally using online advertisements and emails and by contacting physicians, support groups, and allied health professionals. Efforts target areas with a high proportion of individuals not receiving care from neurologists. Approximately 200 individuals with Parkinson disease and their care partners will be enrolled at 20 centers throughout the United States and followed for one year. Participants receive educational materials, then are randomized in a 1:1 ratio to continue their usual care (control arm) or usual care and specialty care delivered virtually (intervention arm). Care partners are surveyed about their time and travel burden and their perceived caregiver burden. Participants are evaluated via electronic survey forms and videoconferencing with a blinded independent rater at baseline and at 12 months. All study activities are completed remotely.The primary outcomes are: (1) feasibility, as measured by the proportion of visits completed, and (2) quality of life, as measured by the 39-item Parkinson's Disease Questionnaire. Secondary outcomes include measures of clinical benefit, quality of care, time and travel burden, and caregiver burden. DISCUSSION Connect.Parkinson will evaluate the feasibility and effectiveness of using technology to deliver care into the homes of individuals with Parkinson disease. The trial may serve as a model for increasing access and delivering patient-centered care at home for individuals with chronic conditions. TRIAL REGISTRATION This trial was registered on clinicaltrials.gov on January 8, 2014 [NCT02038959].
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Affiliation(s)
- Meredith A Achey
- />Center for Human Experimental Therapeutics, University of Rochester Medical Center, 265 Crittenden Boulevard, CU420694, Rochester, NY 14642 USA
| | - Christopher A Beck
- />Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 265 Crittenden Boulevard, Box 630, Rochester, NY 14642 USA
| | - Denise B Beran
- />National Parkinson Foundation, 200 SE 1st Street, Suite 800, Miami, FL 33131 USA
| | - Cynthia M Boyd
- />Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL 7th Floor, Center Tower, Baltimore, MD 21224 USA
| | - Peter N Schmidt
- />National Parkinson Foundation, 200 SE 1st Street, Suite 800, Miami, FL 33131 USA
| | - Allison W Willis
- />Departments of Neurology and of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Office 723, Philadelphia, PA 19104 USA
| | - Sara S Riggare
- />Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institute, Tomtebodavägen 18a, Plan 4, S-17177 Stockholm, Sweden
| | - Richard B Simone
- />Simone Consulting, 456 Palmetto Drive, Sunnyvale, CA 94086 USA
| | - Kevin M Biglan
- />Department of Neurology, Movement and Inherited Neurological Disorders Unit, University of Rochester Medical Center, 265 Crittenden Boulevard, Box MIND, Rochester, NY 14642 USA
| | - E Ray Dorsey
- />Center for Human Experimental Therapeutics, University of Rochester Medical Center, 265 Crittenden Boulevard, CU420694, Rochester, NY 14642 USA
- />Department of Neurology, Movement and Inherited Neurological Disorders Unit, University of Rochester Medical Center, 265 Crittenden Boulevard, Box MIND, Rochester, NY 14642 USA
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Deslich SA, Thistlethwaite T, Coustasse A. Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations. Perm J 2014; 17:80-6. [PMID: 24355894 DOI: 10.7812/tpp/12-123] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. METHODS A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. RESULTS Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. CONCLUSIONS Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.
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Affiliation(s)
- Stacie Anne Deslich
- Master of Science in Healthcare Administration, Graduate School of Business at Marshall University in South Charleston, West Virginia. E-mail:
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Synchronization of Nonverbal Behaviors in Detecting Mediated and Non-mediated Deception. JOURNAL OF NONVERBAL BEHAVIOR 2014. [DOI: 10.1007/s10919-014-0179-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rowe M, Rosenheck R, Stern E, Bellamy C. Video conferencing technology in research on schizophrenia: a qualitative study of site research staff. Psychiatry 2014; 77:98-102. [PMID: 24575916 DOI: 10.1521/psyc.2014.77.1.98] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study was to advance knowledge of the experience of multisite research staff with video conferencing mental health data collection among study participants with schizophrenia. An end-of-study focus group was conducted with all (N = 19) study coordinators of a multisite randomized trial of pharmacotherapy for schizophrenia to characterize the experiences of coordinators overseeing semistructured assessments via video conferencing technology (VCT). Researchers conducted an audiotaped voluntary focus group. Investigators independently coded a transcript of the focus group, followed by discussions to reach consensus on key themes. Three key themes emerged, involving issues associated with (a) the technology itself, (b) the technology in the context of clinical care and research, and (c) the feasibility of using VCT for study assessments, including coordinators' perceptions of participants' experience of VCT. Additional themes were that (a) interviewer skills appeared to moderate the impact of VCT, (b) research participants with serious psychiatric disorders who participated in VCT assessments appeared, overall, to be more amenable to the technology than research coordinators anticipated, and (c) because VCT will be adapted in a wide range of settings, staffing and resource needs should be considered in planning for and adopting VCT for psychiatric research or clinical assessment. This study adds contextual detail and emphasis to the existing literature on the use of VCT in research and factors regarding the effective deployment of the technology in research.
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Glover JA, Williams E, Hazlett LJ, Campbell N. Connecting to the Future: Telepsychiatry in Postgraduate Medical Education. Telemed J E Health 2013; 19:474-9. [DOI: 10.1089/tmj.2012.0182] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juliet A. Glover
- University of South Carolina/Palmetto Health—Neuropsychiatry, Columbia, South Carolina
| | - Emily Williams
- University of South Carolina/Palmetto Health—Neuropsychiatry, Columbia, South Carolina
| | - Linda J. Hazlett
- Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Nioka Campbell
- University of South Carolina/Palmetto Health—Neuropsychiatry, Columbia, South Carolina
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45
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Metacognitive Therapy for Obsessive Compulsive Disorder By Videoconference: A Preliminary Study. BEHAVIOUR CHANGE 2013. [DOI: 10.1017/bec.2012.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Evidence-supported therapy for obsessive-compulsive disorder (OCD) is often difficult to access, especially in rural and remote areas. Videoconferencing is gaining momentum as a means of improving access. Metacognitive therapy (MCT) has already been found to be effective for OCD when delivered face-to-face. This preliminary study explored whether videoconference-based MCT can be effective for OCD. Three participants completed a brief course of MCT using videoconferencing. Participants experienced clinically significant reductions in OCD symptoms, depression, anxiety, and stress, some of which were maintained after a 6- to 8-week follow-up period. Results suggest that videoconferencing MCT can be effective for OCD. Implications for clinicians are discussed.
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Parmanto B, Pulantara IW, Schutte JL, Saptono A, McCue MP. An integrated telehealth system for remote administration of an adult autism assessment. Telemed J E Health 2012; 19:88-94. [PMID: 23230821 DOI: 10.1089/tmj.2012.0104] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We developed a telehealth system to administer an autism assessment remotely. The remote assessment system integrates videoconferencing, stimuli presentation, recording, image and video presentation, and electronic assessment scoring into an intuitive software platform. This is an advancement over existing technologies used in telemental health, which currently require several devices. The number of children, adolescents, and adults with autism spectrum disorders (ASDs) has increased dramatically over the past 20 years and is expected to continue to increase in coming years. In general, there are not many clinicians trained in either the diagnosis or treatment of adults with ASD. Given the number of adults with autism in need, a remote assessment system can potentially provide a solution to the lack of trained clinicians. The goal is to make the remote assessment system as close to face-to-face assessment as possible, yet versatile enough to support deployment in underserved areas. The primary challenge to achieving this goal is that the assessment requires social interaction that appears natural and fluid, so the remote system needs to be able to support fluid natural interaction. For this study we developed components to support this type of interaction and integrated these components into a system capable of supporting the entire autistic assessment protocol. We then implemented the system and evaluated the system on real patients. The results suggest that we have achieved our goal in developing a system with high-quality interaction that is easy to use.
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Affiliation(s)
- Bambang Parmanto
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA.
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Absalom-Hornby V, Hare DJ, Gooding P, Tarrier N. Attitudes of relatives and staff towards family intervention in forensic services using Q methodology. J Psychiatr Ment Health Nurs 2012; 19:162-73. [PMID: 22070759 DOI: 10.1111/j.1365-2850.2011.01770.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Attitudes about family interventions have been identified as a possible reason for the poor implementation of such treatments. The current study used Q methodology to investigate the attitudes of relatives of forensic service users and clinical staff towards family interventions in medium secure forensic units, particularly when facilitated by a web camera. Eighteen relatives and twenty-nine staff completed a sixty-one item Q sort to obtain their idiosyncratic views about family intervention. The results indicated that relatives and staff mostly held positive attitudes towards family intervention. Relatives showed some uncertainty towards family intervention that may reflect the lack of involvement they receive from the forensic service. Staff highlighted key barriers to successful implementation such as lack of dedicated staff time for family work and few staff adequately trained in family intervention. Despite agreement with the web-based forensic family intervention technique and its benefits, both staff and relatives predicted problems in the technique.
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Affiliation(s)
- V Absalom-Hornby
- Division of Clinical Psychology, University of Manchester, Manchester, UK.
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Absalom‐Hornby V, Gooding P, Tarrier N. Family intervention using a web camera (e‐FFI) within forensic services: a case study and feasibility study. ACTA ACUST UNITED AC 2012. [DOI: 10.1108/14636641211204478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
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Steel K, Cox D, Garry H. Therapeutic videoconferencing interventions for the treatment of long-term conditions. J Telemed Telecare 2011; 17:109-17. [PMID: 21339304 DOI: 10.1258/jtt.2010.100318] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a systematic review of literature relating to videoconferencing in therapeutic interventions for chronic conditions. Two hundred articles were reviewed in detail, 35 of which were relevant to the study. Of these, eight were randomized controlled trials (RCTs) and the remainder were service evaluations, pilot studies and case studies. Two major themes emerged, relating specifically to videoconferencing: clinical outcomes and patient satisfaction. There were 14 studies which measured clinical outcomes of interventions for chronic conditions delivered by videoconferencing. A range of evidence, including four RCTs of high quality, indicates that interventions for a variety of conditions, including psychological and physical, delivered by videoconferencing produce similar outcomes to treatment delivered in-person. Evidence suggests that levels of patient satisfaction with telerehabilitation are high and that the formation of a good therapeutic alliance is possible. Several papers reported that clinical staff showed lower levels of satisfaction in using telerehabilitation than patients. It is feasible to use videoconferencing as a means of delivering therapeutic interventions for people with chronic conditions in rural communities.
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Affiliation(s)
- Katie Steel
- Isis Education Centre, Warneford Lane, Headington, Oxford OX3 7JX, UK.
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