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Guinart D, Marcy P, Hauser M, Dwyer M, Kane JM. Mental Health Care Providers' Attitudes Toward Telepsychiatry: A Systemwide, Multisite Survey During the COVID-19 Pandemic. Psychiatr Serv 2021; 72:704-707. [PMID: 33593104 DOI: 10.1176/appi.ps.202000441] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has forced a rapid transition to telepsychiatry. This study examined the experience and attitudes of mental health care providers toward telehealth. METHODS At 18 centers across the United States, 819 mental health care providers completed an electronic survey about telepsychiatry use and satisfaction. RESULTS Overall, 73% of providers using videoconferencing and 66% using the telephone rated their experience as excellent or good. Flexible scheduling or rescheduling (77%) and timely start (69%) were frequently reported advantages for both modalities. Challenges were related to patients' inability to use conferencing devices (52%), lack of sense of closeness or connection (46%), and technical problems (39%). After the pandemic resolves, 64% of respondents would want to continue using telepsychiatry in at least 25% of their caseload. CONCLUSIONS Telepsychiatry was very well perceived among mental health care providers, and many would like to continue using it. Access to technology and training raises concerns.
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Affiliation(s)
- Daniel Guinart
- Department of Psychiatry Research (Guinart, Kane) and Ambulatory Care Division (Dwyer), Zucker Hillside Hospital, Queens, New York City; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York (Guinart, Kane); Vanguard Research Group, Glen Oaks, New York (Marcy, Hauser)
| | - Patricia Marcy
- Department of Psychiatry Research (Guinart, Kane) and Ambulatory Care Division (Dwyer), Zucker Hillside Hospital, Queens, New York City; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York (Guinart, Kane); Vanguard Research Group, Glen Oaks, New York (Marcy, Hauser)
| | - Marta Hauser
- Department of Psychiatry Research (Guinart, Kane) and Ambulatory Care Division (Dwyer), Zucker Hillside Hospital, Queens, New York City; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York (Guinart, Kane); Vanguard Research Group, Glen Oaks, New York (Marcy, Hauser)
| | - Michael Dwyer
- Department of Psychiatry Research (Guinart, Kane) and Ambulatory Care Division (Dwyer), Zucker Hillside Hospital, Queens, New York City; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York (Guinart, Kane); Vanguard Research Group, Glen Oaks, New York (Marcy, Hauser)
| | - John M Kane
- Department of Psychiatry Research (Guinart, Kane) and Ambulatory Care Division (Dwyer), Zucker Hillside Hospital, Queens, New York City; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York (Guinart, Kane); Vanguard Research Group, Glen Oaks, New York (Marcy, Hauser)
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52
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Schoebel V, Wayment C, Gaiser M, Page C, Buche J, Beck AJ. Telebehavioral Health During the COVID-19 Pandemic: A Qualitative Analysis of Provider Experiences and Perspectives. Telemed J E Health 2021; 27:947-954. [PMID: 34028302 DOI: 10.1089/tmj.2021.0121] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Due to the COVID-19 pandemic and prompted by recent federal and state policy shifts impacting behavioral health care delivery, the use of telebehavioral health has rapidly increased. This qualitative study describes behavioral health provider perspectives on the use of telebehavioral health before and during the pandemic and how policy changes impacted access to and utilization of behavioral health services in Michigan. Materials and Methods: A convenience sample of 31 licensed and nonlicensed behavioral health providers operating in Michigan participated in semi-structured interviews between July and August 2020. Interviews were audio-recorded, transcribed, and analyzed by using inductive methods. Results: The thematic analysis resulted in four overarching themes: (1) increased access to care; (2) maintenance of quality of care; (3) minimal privacy concerns; and (4) client and provider satisfaction. Discussion: During and post-pandemic, providers need flexibility to determine whether in-person or telebehavioral health services, including audio-only, best meet client needs. Providers identified several populations for which telebehavioral health was less accessible: clients with serious mental illness and substance use disorder, those with no broadband Internet access, children, and older adults. Additional training in telebehavioral health service provision can positively impact quality of care. Conclusion: Policies that support reimbursement parity and expand provider use of telebehavioral health services should be maintained after the COVID-19 pandemic ends to avoid imposing barriers to accessing behavioral health care barriers post-pandemic.
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Affiliation(s)
- Victoria Schoebel
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caitlyn Wayment
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.,Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Maria Gaiser
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Cory Page
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jessica Buche
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Angela J Beck
- Behavioral Health Workforce Research Center, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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53
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Haque SN, DeStefano S, Banger A, Rutledge R, Romaire M. Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study. JMIR Form Res 2021; 5:e24118. [PMID: 33949958 PMCID: PMC8135026 DOI: 10.2196/24118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/23/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. Objective The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Methods This work was conducted as part of a larger evaluation of a Centers for Medicare & Medicaid Services–funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Results Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Conclusions Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing.
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Affiliation(s)
| | | | - Alison Banger
- RTI International, Research Triangle Park, NC, United States
| | - Regina Rutledge
- RTI International, Research Triangle Park, NC, United States
| | - Melissa Romaire
- RTI International, Research Triangle Park, NC, United States
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54
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Telepsychiatry versus face to face consultation in COVID-19 Era from the patients' perspective. Asian J Psychiatr 2021; 59:102641. [PMID: 33838435 PMCID: PMC8015378 DOI: 10.1016/j.ajp.2021.102641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/26/2021] [Indexed: 11/24/2022]
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55
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Ferguson JM, Jacobs J, Yefimova M, Greene L, Heyworth L, Zulman DM. Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inform Assoc 2021; 28:453-462. [PMID: 33125032 PMCID: PMC7665538 DOI: 10.1093/jamia/ocaa284] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives To describe the shift from in-person to virtual care within Veterans Affairs (VA) during the early phase of the COVID-19 pandemic and to identify at-risk patient populations who require greater resources to overcome access barriers to virtual care. Materials and Methods Outpatient encounters (N = 42 916 349) were categorized by care type (eg, primary, mental health, etc) and delivery method (eg, in-person, video). For 5 400 878 Veterans, we used generalized linear models to identify patient sociodemographic and clinical characteristics associated with: 1) use of virtual (phone or video) care versus no virtual care and 2) use of video care versus no video care between March 11, 2020 and June 6, 2020. Results By June, 58% of VA care was provided virtually compared to only 14% prior. Patients with lower income, higher disability, and more chronic conditions were more likely to receive virtual care during the pandemic. Yet, Veterans aged 45–64 and 65+ were less likely to use video care compared to those aged 18–44 (aRR 0.80 [95% confidence interval (CI) 0.79, 0.82] and 0.50 [95% CI 0.48, 0.52], respectively). Rural and homeless Veterans were 12% and 11% less likely to use video care compared to urban (0.88 [95% CI 0.86, 0.90]) and nonhomeless Veterans (0.89 [95% CI 0.86, 0.92]). Discussion Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic; however, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers. Conclusions and Relevance While virtual care may expand access, access barriers must be addressed to avoid exacerbating disparities.
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Affiliation(s)
- Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Josephine Jacobs
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| | - Maria Yefimova
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Office of Research Patient Care Services, Stanford Health Care, Stanford, California, USA
| | - Liberty Greene
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA.,Department of Medicine, UC San Diego School of Medicine, San Diego, California, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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56
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Rosen JM, Adams LV, Geiling J, Curtis KM, Mosher RE, Ball PA, Grigg EB, Hebert KA, Grodan JR, Jurmain JC, Loucks C, Macedonia CR, Kun L. Telehealth's New Horizon: Providing Smart Hospital-Level Care in the Home. Telemed J E Health 2021; 27:1215-1224. [PMID: 33656918 DOI: 10.1089/tmj.2020.0448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During the COVID-19 pandemic, medical providers have expanded telehealth into daily practice, with many medical and behavioral health care visits provided remotely over video or through phone. The telehealth market was already facilitating home health care with increasing levels of sophistication before COVID-19. Among the emerging telehealth practices, telephysical therapy; teleneurology; telemental health; chronic care management of congestive heart failure, chronic obstructive pulmonary disease, diabetes; home hospice; home mechanical ventilation; and home dialysis are some of the most prominent. Home telehealth helps streamline hospital/clinic operations and ensure the safety of health care workers and patients. The authors recommend that we expand home telehealth to a comprehensive delivery of medical care across a distributed network of hospitals and homes, linking patients to health care workers through the Internet of Medical Things using in-home equipment, including smart medical monitoring devices to create a "medical smart home." This expanded telehealth capability will help doctors care for patients flexibly, remotely, and safely as a part of standard operations and during emergencies such as a pandemic. This model of "telehomecare" is already being implemented, as shown herein with examples. The authors envision a future in which providers and hospitals transition medical care delivery to the home just as, during the COVID-19 pandemic, students adapted to distance learning and adults transitioned to remote work from home. Many of our homes in the future may have a "smart medical suite" as well as a "smart home office."
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Affiliation(s)
- Joseph M Rosen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Thayer School of Engineering, Hanover, New Hampshire, USA
| | - Lisa V Adams
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - James Geiling
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kevin M Curtis
- Connected Care/Center for Telehealth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robyn E Mosher
- Department of Medicine and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Perry A Ball
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eliot B Grigg
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Kendra A Hebert
- Geisel School of Medicine at Dartmouth, Biomedical Research, Hanover, New Hampshire, USA
| | | | | | - Charles Loucks
- John Picard & Associates, Orem, Utah, USA.,Taurean Holdings, LLC, Orem, Utah, USA
| | - Christian R Macedonia
- Lancaster Maternal-Fetal Medicine, Lancaster General Hospital, Lancaster, Pennsylvania, USA
| | - Luis Kun
- William Perry Center for Hemispheric Defense Studies, National Defense University, Washington, District of Columbia, USA
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57
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Ganapathy A, Clough BA, Casey LM. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed J E Health 2021; 27:1332-1343. [PMID: 33646057 DOI: 10.1089/tmj.2020.0455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.
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Affiliation(s)
- Aarthi Ganapathy
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
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58
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Gentry MT, Puspitasari AJ, McKean AJ, Williams MD, Breitinger S, Geske JR, Clark MM, Moore KM, Frye MA, Hilty DM. Clinician Satisfaction with Rapid Adoption and Implementation of Telehealth Services During the COVID-19 Pandemic. Telemed J E Health 2021; 27:1385-1392. [PMID: 33606560 DOI: 10.1089/tmj.2020.0575] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Materials and Methods: Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Results: A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Discussion: Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Conclusion: This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.
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Affiliation(s)
- Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ajeng J Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alastair J McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine M Moore
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald M Hilty
- VA Northern California Health Care System, Mather, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, Sacramento, California, USA
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59
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Molfenter T, Roget N, Chaple M, Behlman S, Cody O, Hartzler B, Johnson E, Nichols M, Stilen P, Becker S. Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study. JMIR Ment Health 2021; 8:e25835. [PMID: 33481760 PMCID: PMC7895293 DOI: 10.2196/25835] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/01/2020] [Accepted: 01/19/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Social distancing guidelines for COVID-19 have caused a rapid transition to telephone and video technologies for delivering treatment for substance use disorders (SUDs). OBJECTIVE This study examined the adoption of these technologies across the SUD service continuum, acceptance of these technologies among service providers, and intent of providers to use these technologies after the pandemic. Additional analysis using the validated technology acceptance model (TAM) was performed to test the potential applications of these technologies after the pandemic. The study objectives were as follows: (1) to assess the use of telehealth (telephone and video technologies) for different SUD services during COVID-19 in May-June 2020, (2) to assess the intended applications of telehealth for SUD services beyond COVID-19, (3) to evaluate the perceived ease of use and value of telehealth for delivering SUD services, and (4) to assess organizational readiness for the sustained use of telehealth services. METHODS An online survey on the use of telephonic and video services was distributed between May and August 2020 to measure the current use of these services, perceived organizational readiness to use these services, and the intent to use these services after COVID-19. In total, 8 of 10 regional Addiction Technology Transfer Centers representing 43 states distributed the survey. Individual organizations were the unit of analysis. RESULTS In total, 457 organizations responded to the survey. Overall, the technology was widely used; >70% (n>335) of organizations reported using telephone or video platforms for most services. The odds of the intent of organizations to use these technologies to deliver services post COVID-19 were significantly greater for all but two services (ie, telephonic residential counseling and buprenorphine therapy; mean odds ratio 3.79, range 1.87-6.98). Clinical users preferred video technologies to telephone technologies for virtually all services. Readiness to use telephone and video technologies was high across numerous factors, though telephonic services were considered more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced the intent to use both telephone and video technologies. CONCLUSIONS The overall perceived ease of use and usefulness of telephonic and video services suggest promising post-COVID-19 applications of these services. Survey participants consistently preferred video services to telephonic services; however, the availability of telephonic services to those lacking easy access to video technology is an important characteristic of these services. Future studies should review the acceptance of telehealth services and their comparative impact on SUD care outcomes.
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Affiliation(s)
- Todd Molfenter
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Nancy Roget
- Center for the Application of Substance Abuse Technologies, University of Nevada-Reno, Reno, NV, United States
| | - Michael Chaple
- New York State Psychiatric Institute, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, United States
| | - Stephanie Behlman
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Olivia Cody
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA, United States
| | - Edward Johnson
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, United States
| | - Maureen Nichols
- Addiction Research Institute, Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, United States
| | - Sara Becker
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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60
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Disney L, Mowbray O, Evans D. Telemental Health Use and Refugee Mental Health Providers Following COVID-19 Pandemic. CLINICAL SOCIAL WORK JOURNAL 2021; 49:463-470. [PMID: 33967352 PMCID: PMC8090514 DOI: 10.1007/s10615-021-00808-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 05/07/2023]
Abstract
The outbreak of COVID-19 has increased stress, fear, and anxiety for many people. At the same time, social isolation restrictions have disrupted most in-person mental health services. Many mental health providers are adapting to the crisis by utilizing telemental health. However, the literature is scant about how to most effectively utilize telemental health practices with refugee clients, many of whom do not speak English and require an interpreter, may have limited technological proficiency or access, and/or have additional case management needs and coordination as part of their treatment plan. The purpose of this study is to understand how mental health clinicians and case workers at a refugee-serving mental health clinic are successfully shifting their face-to-face practice to telemental health, the obstacles they encounter, and what resources they have found to be helpful. Two main themes emerged from the data: (1) refugee mental health providers display initiative and flexibility in their adaptation to telemental health and (2) providers reported numerous obstacles to effective telemental health, including client barriers, tech barriers, communication issues, and the challenge of reading nonverbal cues virtually. By better understanding telemental health when working with refugees, clinical social workers will be more effective in meeting the needs of a population with significant mental health needs and limited mental healthcare access.
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Affiliation(s)
- Lindsey Disney
- School of Social Welfare, University at Albany, Albany, NY USA
| | - Orion Mowbray
- School of Social Work, University of Georgia, Athens, GA USA
| | - Dana Evans
- Positive Growth, Inc., Clarkston, GA USA
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61
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Hughto JMW, Peterson L, Perry NS, Donoyan A, Mimiaga MJ, Nelson KM, Pantalone DW. The provision of counseling to patients receiving medications for opioid use disorder: Telehealth innovations and challenges in the age of COVID-19. J Subst Abuse Treat 2021; 120:108163. [PMID: 33298301 PMCID: PMC7545305 DOI: 10.1016/j.jsat.2020.108163] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jaclyn M W Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | | | - Nicholas S Perry
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | | | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - David W Pantalone
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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62
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Naal H, Mahmoud H, Whaibeh E. The potential of telemental health in improving access to mental health services in Lebanon: Analysis of barriers, opportunities, and recommendations. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1863743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hossam Mahmoud
- Cambia Health Solutions, Tufts University School of Medicine, Boston, MA, USA
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63
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Muir SD, de Boer K, Nedeljkovic M, Meyer D. Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review. BMC Health Serv Res 2020; 20:999. [PMID: 33131495 PMCID: PMC7603749 DOI: 10.1186/s12913-020-05858-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations. METHODS A systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems. RESULTS The initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians). CONCLUSIONS This review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.
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Affiliation(s)
- Samuel D Muir
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia.
| | - Kathleen de Boer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Maja Nedeljkovic
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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White VM, Molfenter T, Gustafson DH, Horst J, Greller R, Gustafson DH, Kim JS, Preuss E, Cody O, Pisitthakarm P, Toy A. NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol. Implement Sci 2020; 15:94. [PMID: 33097097 PMCID: PMC7582427 DOI: 10.1186/s13012-020-01053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation. METHODS This cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizations DISCUSSION: This study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies. TRIAL REGISTRATION ClinicalTrials.gov , NCT03954184 . Posted 17 May 2019.
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Affiliation(s)
- Veronica M White
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA.
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Rachelle Greller
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Educational Sciences, 1025 West Johnson St, Madison, WI, 53706-1706, USA
| | - Eric Preuss
- Division of Behavioral Health, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, IA, 50319-0075, USA
| | - Olivia Cody
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Praan Pisitthakarm
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
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Nguyen M, Fujioka J, Wentlandt K, Onabajo N, Wong I, Bhatia RS, Bhattacharyya O, Stamenova V. Using the technology acceptance model to explore health provider and administrator perceptions of the usefulness and ease of using technology in palliative care. BMC Palliat Care 2020; 19:138. [PMID: 32895060 PMCID: PMC7476427 DOI: 10.1186/s12904-020-00644-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that telehealth applications in palliative care are feasible, can improve quality of care, and reduce costs but few studies have focused on user acceptance of current technology applications in palliative care. Furthermore, the perspectives of health administrators have not been explored in palliative care and yet they are often heavily involved, alongside providers, in the coordination and use of health technologies. The study aim was to explore both health care provider and administrator perceptions regarding the usefulness and ease of using technology in palliative care. METHODS The Technology Acceptance Model (TAM) was used as the guiding theoretical framework to provide insight into two key determinants that influence user acceptance of technology (perceived usefulness and ease of use). Semi-structured interviews (n = 18) with health providers and administrators with experience coordinating or using technology in palliative care explored the usefulness of technologies in palliative care and recommendations to support adoption. Interview data were analyzed using inductive thematic analysis to identify common, meaningful themes. RESULTS Four themes were identified; themes related to perceived usefulness were: enabling remote connection and information-sharing platform. Themes surrounding ease of use included: integration with existing IT systems and user-friendly with ready access to technical support. Telehealth can enable remote connection between patients and providers to help address insufficiencies in the current palliative care environment. Telehealth, as an information sharing platform, could support the coordination and collaboration of interdisciplinary providers caring for patients with palliative needs. However, health technologies need to passively integrate with existing IT systems to enhance providers' workflow and productivity. User-friendliness with ready access to technical support was considered especially important in palliative care as patients often experience diminished function. CONCLUSION Participants' perspectives of technology acceptance in palliative care were largely dependent on their potential to help address major challenges in the field without imposing significant burden on providers and patients.
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Affiliation(s)
- M Nguyen
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada.
| | - J Fujioka
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - K Wentlandt
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - N Onabajo
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - I Wong
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - R S Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - O Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
| | - V Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, 6th Floor, Toronto, Ontaro, M5S 1B2, Canada
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Ecker AH, Amspoker AB, Hogan JB, Lindsay JA. The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilization Among Rural Veterans. ACTA ACUST UNITED AC 2020; 6:314-319. [PMID: 32838029 PMCID: PMC7409619 DOI: 10.1007/s41347-020-00150-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022]
Abstract
Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders. Compounding risk for poor outcomes related to these disorders, individuals living in rural areas face barriers receiving evidence-based mental health treatment. Video to home telehealth (VTH) has been implemented broadly within the Veterans Health Administration to improve access to care for rural veterans. However, VTH may not be utilized equally across disorders and comorbidities, including co-occurring anxiety and alcohol use disorders, potentially contributing to gaps in care that are not available in person. A cohort of veterans who received at least one VTH mental health visit between fiscal years 2016–2019 was compiled from VA administrative data. Multilevel linear growth curve models were used to examine growth in VTH use over time among veterans with anxiety only, alcohol use disorder only, and co-occurring disorders. Fixed effects were significant for both time and diagnosis group and a significant interaction between time and group. For each subsequent fiscal year, the percentage of total MH visits that were VTH increased for all groups but less so for those with co-occurring anxiety and alcohol use diagnoses. Despite VTH being an important tool to reach underserved rural veterans, rural veterans with AUD and co-occurring anxiety and AUD are at risk for not receiving care using this modality. Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services.
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Affiliation(s)
- Anthony H. Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX USA
| | - Amber B. Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX USA
| | - Julianna B. Hogan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX USA
| | - Jan A. Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX USA
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Hensel J, Graham R, Isaak C, Ahmed N, Sareen J, Bolton J. A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation: Un nouveau programme de télépsychiatrie d'urgence en milieu urbain canadien: Identifier et aborder les obstacles perçus d'une mise en œuvre réussie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:559-567. [PMID: 31969011 PMCID: PMC7492888 DOI: 10.1177/0706743719900465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. METHODS We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided. RESULTS Survey respondents (N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers. CONCLUSIONS By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.
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Affiliation(s)
- Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Reid Graham
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Naweed Ahmed
- Department of Family Practice, University of British Columbia, Victoria, British Columbia, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Andrews JA, Craven MP, Jamnadas-Khoda J, Lang AR, Morriss R, Hollis C. Health Care Professionals' Views on Using Remote Measurement Technology in Managing Central Nervous System Disorders: Qualitative Interview Study. J Med Internet Res 2020; 22:e17414. [PMID: 32706664 PMCID: PMC7414408 DOI: 10.2196/17414] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Remote measurement technologies (RMT) can be used to collect data on a variety of bio-behavioral variables, which may improve the care of patients with central nervous system disorders. Although various studies have explored their potential, prior work has highlighted a knowledge gap in health care professionals’ (HCPs) perceptions of the value of RMT in clinical practice. Objective This study aims to understand HCPs’ perspectives on using RMT in health care practice for the care of patients with depression, epilepsy, or multiple sclerosis (MS). Methods Semistructured interviews were conducted with 26 multidisciplinary primary and secondary care HCPs who care for patients with epilepsy, depression, or MS. Interviews were transcribed verbatim and analyzed using thematic analysis. Results A total of 8 main themes emerged from the analysis: (1) potential clinical value of RMT data; (2) when to use RMT in care pathways; (3) roles of health care staff who may use RMT data; (4) presentation and accessibility of data; (5) obstacles to successful use of RMT; (6) limits to the role of RMT; (7) empowering patients; and (8) considerations around alert-based systems. Conclusions RMT could add value to the system of care for patients with central nervous system disorders by providing clinicians with graphic summaries of data in the patient record. Barriers of both technical and human nature should be considered when using these technologies, as should the limits to the benefits they can offer.
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Affiliation(s)
- Jacob A Andrews
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Michael P Craven
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Jennifer Jamnadas-Khoda
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Alexandra R Lang
- NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Richard Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
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- The RADAR-CNS Consortium, London, United Kingdom
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Abstract
The COVID-19 pandemic has necessitated a rapid escalation in the use of telepsychiatry. Herein we revisit some of the ethical issues regarding its use, including patient benefice, distributive justice, privacy, and autonomy. Based on these considerations we would hold that telepsychiatry is a vital aspect of providing psychiatric care, and ethically should be offered as a format for treatment, likely beyond the pandemic period. Investigative and advocacy efforts will need to continue to determine its exact role within psychiatric care, and expand its availability for those most in need.
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Chen CK, Nehrig N, Wash L, Schneider JA, Ashkenazi S, Cairo E, Guyton AF, Palfrey A. When distance brings us closer: leveraging tele-psychotherapy to build deeper connection. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2020.1779031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Cory K. Chen
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Nicole Nehrig
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Lauren Wash
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
| | - Jennifer A. Schneider
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Sagiv Ashkenazi
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
| | - Elana Cairo
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
| | - Angel F. Guyton
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
| | - Amy Palfrey
- Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, Psychology Service, New York, USA
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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Lepage C, Garber G, Corrin R, Galanakis C, Leonard L, Cooper C. Telemedicine successfully engages marginalized rural hepatitis C patients in curative care. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:87-97. [PMID: 36338186 PMCID: PMC9602883 DOI: 10.3138/jammi-2019-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/04/2020] [Indexed: 04/16/2023]
Abstract
BACKGROUND Rurally located individuals living with hepatitis C virus (HCV) face barriers to engagement and retention in care. Telemedicine technologies coupled with highly curative direct acting antiviral (DAA) treatments may increase accessibility to HCV care while achieving high sustained virologic response (SVR) rates. We compared clinical and socio-economic characteristics, SVR, and loss to follow-up among telemedicine (TM), mixed delivery (MD), and outpatient clinic (OPC) patients receiving care through The Ottawa Hospital Viral Hepatitis Program (TOHVHP). METHODS TOHVHP clinical database was used to evaluate patients engaging HCV care between January 1, 2012, and December 31, 2016. SVR rates by HCV care delivery method (TM versus OPC versus MD) were calculated. RESULTS Analysis included 1,454 patients who engaged with TOHVHP at least once. Patients were aged almost 50 years on average and were predominately male and Caucasian. A greater proportion of TM patients were rurally based, were Indigenous, had a history of substance use, and had previously been incarcerated. Per-protocol DAA SVR rates for TM, OPC, and MD patients were 100% (26/26), 93% (440/472), and 94% (44/47), respectively. Loss-to-follow-up rates for HCV-treated TM and MD patients were higher (27% [10/37], 95% CI 0.58 to 0.88, and 11% [7/62], 95% CI 0.81 to 0.97, respectively) than for those followed exclusively in the OPC (5% [39/800], 95% CI 0.94 to 0.97). CONCLUSIONS TM can successfully engage, retain, and cure rurally based HCV patients facing barriers to care. Strategies to improve TM retention of patients initiating HCV antiviral treatment are key to optimizing the impact of this model of care.
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Affiliation(s)
- Candis Lepage
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Garber
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raymond Corrin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lynne Leonard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Curtis Cooper
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Correspondence: Curtis Cooper, Department of Medicine, University of Ottawa, 501 Smyth Road, Box 223, Ottawa, Ontario K1H 8L6 Canada. Telephone: 613-737-8899 ext. 72296. E-mail:
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Slightam C, Gregory AJ, Hu J, Jacobs J, Gurmessa T, Kimerling R, Blonigen D, Zulman DM. Patient Perceptions of Video Visits Using Veterans Affairs Telehealth Tablets: Survey Study. J Med Internet Res 2020; 22:e15682. [PMID: 32293573 PMCID: PMC7191342 DOI: 10.2196/15682] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/05/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Video-based health care can help address access gaps for patients and is rapidly being offered by health care organizations. However, patients who lack access to technology may be left behind in these initiatives. In 2016, the US Department of Veterans Affairs (VA) began distributing video-enabled tablets to provide video visits to veterans with health care access barriers. OBJECTIVE This study aimed to evaluate veterans' experiences with VA-issued tablets and identify patient characteristics associated with preferences for video visits vs in-person care. METHODS A baseline survey was sent to the tablet recipients, and a follow-up survey was sent to the respondents 3 to 6 months later. Multivariate logistic regression was used to identify patient characteristics associated with preferences for care, and we examined qualitative themes around care preferences using standard content analysis methods for coding the data collected in the open-ended questions. RESULTS Patient-reported access barriers centered around transportation and health-related challenges, outside commitments, and feeling uncomfortable or uneasy at the VA. Satisfaction with the tablet program was high, and in the follow-up survey, approximately two-thirds of tablet recipients preferred care via a tablet (194/604, 32.1%) or expressed that video-based and in-person care were "about the same" (216/604, 35.7%), whereas one-third (192/604, 31.7%) indicated a preference for in-person care. Patients were significantly more likely to report a preference for video visits (vs a preference for in-person visits or rating them "about the same") if they felt uncomfortable in a VA setting, reported a collaborative communication style with their doctor, had a substance use disorder diagnosis, or lived in a place with better broadband coverage. Patients were less likely to report a preference for video visits if they had more chronic conditions. Qualitative analyses identified four themes related to preferences for video-based care: perceived improvements in access to care, perceived differential quality of care, feasibility of obtaining necessary care, and technology-related challenges. CONCLUSIONS Many recipients of VA-issued tablets report that video care is equivalent to or preferred to in-person care. Results may inform efforts to identify good candidates for virtual care and interventions to support individuals who experience technical challenges.
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Affiliation(s)
- Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Amy J Gregory
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jiaqi Hu
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Josephine Jacobs
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Tolessa Gurmessa
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Program Evaluation and Resource Center, Veterans Health Administration, Menlo Park, CA, United States
| | - Rachel Kimerling
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- National Center for Post-Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Daniel Blonigen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
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Muir SD, de Boer K, Thomas N, Seabrook E, Nedeljkovic M, Meyer D. Videoconferencing Psychotherapy in the Public Sector: Synthesis and Model for Implementation. JMIR Ment Health 2020; 7:e14996. [PMID: 31961334 PMCID: PMC7001045 DOI: 10.2196/14996] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Videoconferencing psychotherapy (VCP) is a growing practice among mental health professionals. Early adopters have predominantly been in private practice settings, and more recent adoption has occurred in larger organizations, such as the military. The implementation of VCP into larger health service providers in the public sector is an important step in reaching and helping vulnerable and at-risk individuals; however, several additional implementation challenges exist for public sector organizations. OBJECTIVE The aim of this study was to offer an implementation model for effectively introducing VCP into public sector organizations. This model will also provide practical guidelines for planning and executing an embedded service trial to assess the effectiveness of the VCP modality once implemented. METHODS An iterative search strategy was employed, drawing on multiple fields of research across mental health, information technology, and organizational psychology. Previous VCP implementation papers were considered in detail to provide a synthesis of the barriers, facilitators, and lessons learned from the implementation attempts in the military and other public sector settings. RESULTS A model was formulated, which draws on change management for technology integration and considers the specific needs for VCP integration in larger organizations. A total of 6 phases were formulated and were further broken down into practical and measurable steps. The model explicitly considers the barriers often encountered in large organizational settings and suggests steps to increase facilitating factors. CONCLUSIONS Although the model proposed is time and resource intensive, it draws on a comprehensive understanding of larger organizational needs and the unique challenge that the introduction of VCP presents to such organizations.
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Affiliation(s)
- Samuel David Muir
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Kathleen de Boer
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Elizabeth Seabrook
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
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74
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Connolly SL, Miller CJ, Lindsay JA, Bauer MS. A systematic review of providers' attitudes toward telemental health via videoconferencing. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020; 27:10.1111/cpsp.12311. [PMID: 35966216 PMCID: PMC9367168 DOI: 10.1111/cpsp.12311] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
Telemental health conducted via videoconferencing (TMH-V) has the potential to improve access to care, and providers' attitudes toward this innovation play a crucial role in its uptake. This systematic review examined providers' attitudes toward TMH-V through the lens of the unified theory of acceptance and use of technology (UTAUT). Findings suggest that providers have positive overall attitudes toward TMH-V despite describing multiple drawbacks. Therefore, the relative advantages of TMH-V, such as its ability to increase access to care, may outweigh its disadvantages, including technological problems, increased hassle, and perceptions of impersonality. Providers' attitudes may also be related to their degree of prior TMH-V experience, and acceptance may increase with use. Limitations and implications of findings for implementation efforts are discussed.
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Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Christopher J. Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jan A. Lindsay
- HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Mark S. Bauer
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Abstract
Telemental health is a demonstrated and effective aspect of the overall mental health system and considered a standard of care for many treatments. Adoption has not been as robust as expected and failure to properly develop implementation plans is a significant barrier. This article provides an overview of a step-by-step planning process to more effectively implement and sustain telemental health programs.
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Affiliation(s)
- Matthew C Mishkind
- Departments of Family Medicine and Psychiatry, Johnson Depression Center, University of Colorado School of Medicine, 13199 East Montview Boulevard, Suite 330, Aurora, CO 80045, USA.
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76
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Cowan KE, McKean AJ, Gentry MT, Hilty DM. Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers. Mayo Clin Proc 2019; 94:2510-2523. [PMID: 31806104 DOI: 10.1016/j.mayocp.2019.04.018] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
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Affiliation(s)
- Kirsten E Cowan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN; Essentia Health, Duluth, MN
| | | | - Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
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Lindsay JA, Day SC, Amspoker AB, Fletcher TL, Hogan J, Day G, Helm A, Stanley MA, Martin LA. Personalized Implementation of Video Telehealth. Psychiatr Clin North Am 2019; 42:563-574. [PMID: 31672207 DOI: 10.1016/j.psc.2019.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes the Personalized Implementation for Video Telehealth strategy to increase adoption of video telehealth to home (VTH) across a large, urban Veterans Health Administration medical center and applications for broader use in non-VHA settings. The authors fully integrated VTH into existing mental health clinics, resulting in (1) a significant increase in the number of patients receiving VTH, (2) a significant increase in the number of VTH visits relative to median national improvement, (3) a greater number of unique specialty mental health clinics offering VTH in Houston, and (4) a greater number of community clinics active in delivering VTH.
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Affiliation(s)
- Jan A Lindsay
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Stephanie C Day
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Terri L Fletcher
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Julianna Hogan
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Giselle Day
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ashley Helm
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center); Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Melinda A Stanley
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Lindsey A Martin
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Petersen D, Salazar B, Kertz SJ. Therapist and Treatment-Seeking Students’ Perceptions of Telemental Health. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00116-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Campbell J, Theodoros D, Russell T, Gillespie N, Hartley N. Client, provider and community referrer perceptions of telehealth for the delivery of rural paediatric allied health services. Aust J Rural Health 2019; 27:419-426. [DOI: 10.1111/ajr.12519] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/29/2019] [Accepted: 04/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jessica Campbell
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Queensland Australia
- School of Medicine Centre for Research Excellence in Telehealth The University of Queensland Brisbane Queensland Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Queensland Australia
- School of Medicine Centre for Research Excellence in Telehealth The University of Queensland Brisbane Queensland Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Queensland Australia
- School of Medicine Centre for Research Excellence in Telehealth The University of Queensland Brisbane Queensland Australia
| | - Nicole Gillespie
- School of Medicine Centre for Research Excellence in Telehealth The University of Queensland Brisbane Queensland Australia
- UQ Business School The University of Queensland Brisbane Queensland Australia
| | - Nicole Hartley
- School of Medicine Centre for Research Excellence in Telehealth The University of Queensland Brisbane Queensland Australia
- UQ Business School The University of Queensland Brisbane Queensland Australia
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Fortney JC, Veith RC, Bauer AM, Pfeiffer PN, Valenstein M, Pyne JM, Dalack GW, Kramer TL, Ferro LJ, Metzger K, Shore JH, Carlo AD, Coates S, Ward‐Jones S, Larkins E, Hafer E, Shushan S, Weaver DL, Unützer J. Developing Telemental Health Partnerships Between State Medical Schools and Federally Qualified Health Centers: Navigating the Regulatory Landscape and Policy Recommendations. J Rural Health 2019; 35:287-297. [PMID: 30288797 PMCID: PMC7379613 DOI: 10.1111/jrh.12323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Federally Qualified Health Centers (FQHCs) deliver care to 26 million Americans living in underserved areas, but few offer telemental health (TMH) services. The social missions of FQHCs and publicly funded state medical schools create a compelling argument for the development of TMH partnerships. In this paper, we share our experience and recommendations from launching TMH partnerships between 12 rural FQHCs and 3 state medical schools. EXPERIENCE There was consensus that medical school TMH providers should practice as part of the FQHC team to promote integration, enhance quality and safety, and ensure financial sustainability. For TMH providers to practice and bill as FQHC providers, the following issues must be addressed: (1) credentialing and privileging the TMH providers at the FQHC, (2) expanding FQHC Scope of Project to include telepsychiatry, (3) remote access to medical records, (4) insurance credentialing/paneling, billing, and supplemental payments, (5) contracting with the medical school, and (6) indemnity coverage for TMH. RECOMMENDATIONS We make recommendations to both state medical schools and FQHCs about how to overcome existing barriers to TMH partnerships. We also make recommendations about changes to policy that would mitigate the impact of these barriers. Specifically, we make recommendations to the Centers for Medicare and Medicaid about insurance credentialing, facility fees, eligibility of TMH encounters for supplemental payments, and Medicare eligibility rules for TMH billing by FQHCs. We also make recommendations to the Health Resources and Services Administration about restrictions on adding telepsychiatry to the FQHCs' Scope of Project and the eligibility of TMH providers for indemnity coverage under the Federal Tort Claims Act.
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Affiliation(s)
- John C. Fortney
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
- Department of Veterans Affairs, Health Services Research and DevelopmentCenter of Innovation for Veteran‐Centered and Value‐Driven CareSeattleWashington
| | - Richard C. Veith
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Amy M. Bauer
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Paul N. Pfeiffer
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
- VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichigan
| | - Marcia Valenstein
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
- VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichigan
| | - Jeffrey M. Pyne
- Department of Psychiatry, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
- Department of Veterans Affairs, Health Services Research and DevelopmentCenter for Mental Healthcare and Outcomes ResearchLittle RockArkansas
| | - Gregory W. Dalack
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Teresa L. Kramer
- Department of Psychiatry, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Lori J. Ferro
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Karla Metzger
- Department of PsychiatryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Jay H. Shore
- Helen and Arthur E. Johnson Depression CenterUniversity of Colorado Anschutz Medical CampusAuroraColorado
| | - Andrew D. Carlo
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
| | - Sara Coates
- Michigan Primary Care AssociationLansingMichigan
| | | | - Ed Larkins
- Family Medical Center of MichiganTemperanceMichigan
| | - Erin Hafer
- Community Health Plan of WashingtonSeattleWashington
| | | | - Donald L. Weaver
- National Association of Community Health CentersBethesdaMaryland
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashington
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81
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Caver KA, Shearer EM, Burks DJ, Perry K, De Paul NF, McGinn MM, Felker BL. Telemental health training in the Veterans Administration Puget Sound Health Care System. J Clin Psychol 2019; 76:1108-1124. [PMID: 31115049 DOI: 10.1002/jclp.22797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/13/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
As a pioneer of training in the field of psychology, the Veterans Affairs (VA) HealthCare System serves as a leader in the training in and provision of Telemental Health (TMH) services in the United States. To meet goals toward continued expansion of these services, the VA TMH training program includes both web-based didactic courses and a skills competency test at a basic level with supervision and consultation in TMH for more advanced training and is available to staff psychologists and psychologist trainees. Despite these efforts, barriers for training in and implementation of TMH occur at the provider, system, and patient level. At the national level, the VA is actively working to resolve these barriers and we share site-specific examples implemented by the VA Puget Sound Health Care System promoting access through TMH team to further address barriers to training and implementation.
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Affiliation(s)
- Kelly A Caver
- VA Puget Sound Health Care System, Seattle, Washington
| | | | - Derek J Burks
- VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Kristen Perry
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | | | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Bradford L Felker
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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Perry K, Gold S, Shearer EM. Identifying and addressing mental health providers' perceived barriers to clinical video telehealth utilization. J Clin Psychol 2019; 76:1125-1134. [PMID: 30859573 DOI: 10.1002/jclp.22770] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/06/2018] [Accepted: 02/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Clinical video telehealth (CVT) is an innovative modality to provide care directly to Veterans' homes. Despite prior training initiatives, CVT remains underutilized. This project sought to better understand barriers to implementation and to compare responses of CVT utilizers versus nonutilizers. METHOD Mental health staff were invited to complete an online anonymous survey on their use of CVT in clinical practice. RESULTS A total of 159 mental health staff completed the survey. Although the majority of the sample endorsed personal use of a video chat program, less than half reported using CVT for patient care. Among nonutilizers, lack of training was the most frequently endorsed barrier to CVT use whereas administrative burden was the most frequently endorsed barrier by utilizers. CONCLUSIONS This study extends existing literature by determining barriers to CVT adoption. It identifies several barriers among utilizers versus nonutilizers. Discussion includes potential guidelines for overcoming barriers to CVT utilization.
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Affiliation(s)
- Kristen Perry
- VA Puget Sound Health Care System, Tacoma, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Sari Gold
- VA Puget Sound Health Care System, Tacoma, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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83
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Mahmoud H, Vogt EL, Sers M, Fattal O, Ballout S. Overcoming Barriers to Larger-Scale Adoption of Telepsychiatry. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181228-02] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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84
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Telemental Health in Low- and Middle-Income Countries: A Systematic Review. Int J Telemed Appl 2018; 2018:9602821. [PMID: 30519259 PMCID: PMC6241375 DOI: 10.1155/2018/9602821] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction The rising incidence of mental illness and its impact on individuals, families, and societies is becoming a major public health concern, especially in resource-constrained countries. Consequently, there is an increasing demand for mental health services in many middle- and low-income countries (LMIC). Challenges such as inequality in access, lack of staff and hospital beds, and underfunding, often present in the LMIC, might in part be addressed by telemental health services. However, little is known about telemental health in the LMIC. Methods A systematic review was performed, drawing on several electronic databases, including PubMed, PsycINFO, Web of Science, Springer Link, and Google Scholar. Original English language studies on the practice of telemental health in LMIC, involving patients and published between 1 January 2000 and 16 February 2017, were included. Results Nineteen studies met the inclusion criteria. Most of the articles were recent, which may reflect an increasing focus on telemental health in the LMIC. Eight of these studies were from Asia. Eight of the studies were interventional/randomized controlled trials, and 11 examined general mental health issues. Videoconferencing was the most frequently (6) studied telemental modality. Other modalities studied were online decision support systems (3), text messaging and bibliotherapy (1), e-chatting combined with videoconferencing (1), online therapy (2), e-counseling (1), store-and-forward technology (1), telephone follow-up (1), online discussion groups (1), audiovisual therapy and bibliotherapy (1), and computerized occupational therapy (1). Although many of the studies showed that telemental services had positive outcomes, some studies reported no postintervention improvements. Conclusion The review shows a rising trend in telemental activity in the LMIC. There is a greater need for telemental health in the LMIC, but more research is needed on empirical and theoretical aspects of telemental activity in the LMIC and on direct comparisons between telemental activity in the LMIC and the non-LMIC.
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85
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Polhemus AM, Kadhim H, Barnes S, Zebrowski SE, Simmonds A, Masand SN, Banner J, Dupont M. Accelerating Adoption of Patient-Facing Technologies in Clinical Trials: A Pharmaceutical Industry Perspective on Opportunities and Challenges. Ther Innov Regul Sci 2018; 53:8-24. [PMID: 30373404 DOI: 10.1177/2168479018801566] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient-facing digital technologies (also called "Patient Technology" [PT]) have the potential to serve a variety of functions in clinical trials, such as capturing clinical endpoints, engaging patients, and facilitating remote study conduct. However, these technologies are not yet accepted as mainstream research tools, and the opportunities, challenges, and facilitators associated with their implementation in clinical trials have not been fully characterized. METHODS In order to understand the factors affecting PT adoption, the TransCelerate Patient Technology Initiative conducted a series of surveys, interviews, and focus groups with approximately 600 subject matter experts, including pharmaceutical company representatives, clinical trial investigators at a number of trial sites worldwide, and clinical trial participants. All interview and survey responses were blinded and aggregated by a third-party consultant and themes were extracted. RESULTS There was general consensus around the potential value of patient-facing technology as a clinical research tool, though a variety of challenges faced by each stakeholder were discussed. Detailed accounts of opportunities (improved patient experience, compliance, and engagement; clinical trial efficiencies; improved data quality and insights) and barriers (organizational and corporate cultural challenges, business-related challenges, user willingness and burden, and regulatory challenges) are reported. CONCLUSIONS While the barriers to PT adoption explored here were numerous, they were also generally consistent. A number of proposals for establishing more holistic, collaborative, and strategic approaches to PT implementation in clinical trials are discussed. Such approaches could facilitate more effective, widespread adoption of PT, and thereby a more patient-centric clinical trial paradigm.
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Affiliation(s)
- Ashley M Polhemus
- 1 MSD Global IT Innovation Center, Merck, Sharpe & Dohme Corp, Prague, Czech Republic
| | - Hassan Kadhim
- 2 IT Clinical Trial Planning & Management, Boehringer Ingelheim, Ridgefield, CT, USA
| | - Shelly Barnes
- 3 Site and Patient Solutions, UCB Biosciences Inc, Raleigh, NC, USA
| | - Susan E Zebrowski
- 4 Technology Platform Operations, Shared Solutions, Janssen Research & Development, Malvern, PA, USA
| | - Alex Simmonds
- 5 Digital Clinical, R&D IT, Bristol-Myers Squibb, New York, NY, USA
| | | | - Jaclyn Banner
- 7 Clinical Data Management, Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | - Melissa Dupont
- 8 Clinical Trial Operations, Sanofi, Bridgewater, NJ, USA
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Tuerk PW, Keller SM, Acierno R. Treatment for Anxiety and Depression via Clinical Videoconferencing: Evidence Base and Barriers to Expanded Access in Practice. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:363-369. [PMID: 31975928 DOI: 10.1176/appi.focus.20180027] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review summarizes six decades of clinical outcome research relevant to evidence-based practices for depression and anxiety delivered via clinical videoconferencing. The authors conducted a literature search of previous systematic reviews and an updated search of publications specific to anxiety and depression. Overall, strong evidence supports the safety and clinical effectiveness of administering evidence-based psychotherapy for anxiety and depression via clinical videoconferencing among heterogeneous populations and age ranges, and in multiple care settings, with similar outcomes to in-person care. Despite the overall clinical effectiveness of the modality, the authors discuss common logistical and institutional barriers to long-term effective implementation. Future systems-level research is required to investigate replicable and sustainable models for implementing and expanding access to evidence-based psychotherapies via clinical videoconferencing.
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Affiliation(s)
- Peter W Tuerk
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Stephanie M Keller
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Ron Acierno
- Dr. Tuerk and Dr. Keller are with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; Dr. Acierno is with the College of Nursing, Medical University of South Carolina. Dr. Tuerk is also with the Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville; Dr. Keller and Dr. Acierno are also with the Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Pruitt LD, Vuletic S, Smolenski DJ, Wagner A, Luxton DD, Gahm GA. Predicting post treatment client satisfaction between behavioural activation for depression delivered either in-person or via home-based telehealth. J Telemed Telecare 2018; 25:460-467. [DOI: 10.1177/1357633x18784103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Treatment engagement, adherence, cancellations and other patient-centric data are important predictors of treatment outcome. But often these data are only examined retrospectively. In this investigation, we analysed data from a clinical trial focused on innovative delivery of depression treatment to identify which patients are likely to prefer either in-home or in-person treatment based on pre-treatment characteristics. Methods Patient satisfaction was assessed in a trial of individuals with depression treated using identical behavioural activation therapy protocols in person or through videoconferencing to the home ( N = 87 at post treatment: 42 in-person and 45 in-home participants). The Client Satisfaction Questionnaire was administered at the end of the treatment. A Tobit regression model was used to assess moderation using treatment assignment. Regression lines were generated to model treatment satisfaction as a function of treatment assignment and to identify whether and where the groups intersected. We examined the distributions of the contributing moderators to the subsets of participants above and below the intersection point to identify differences. Results While no significant differences in patient satisfaction were observed between the two groups, or between patients receiving treatment by different providers, baseline characteristics of the sample could be used to differentiate those with a preference for traditional, in-office care from those preferring in-home care. Discussion Participants who were more likely to prefer in-home care were characterized by larger proportions of veterans and lower-ranked enlisted service members. They also had more severe symptoms at baseline and less formal education. Understanding client reactions when selecting treatment modality may allow for a more satisfying patient experience.
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Affiliation(s)
- Larry D Pruitt
- Psychological Health Center of Excellence, Defense Health Agency, Silver Springs, USA
| | - Simona Vuletic
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Silver Springs, USA
| | - Amy Wagner
- VA Portland Health Care System, Portland, USA
| | - David D Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- National Center for Telehealth & Technology (T2), Joint Base Lewis-McChord, WA, USA
| | - Gregory A Gahm
- National Center for Telehealth & Technology (T2), Joint Base Lewis-McChord, WA, USA
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88
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Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, Yano EM, Haskell SG, Hamilton AB. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Womens Health Issues 2018; 28:181-187. [DOI: 10.1016/j.whi.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
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89
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Abstract
Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment.
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90
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Wang JJ, Lavigueur O, Sheridan M, Stern E. Implementation of a simulation-based telemedicine curriculum. MEDICAL EDUCATION 2017; 51:1178-1179. [PMID: 28913892 DOI: 10.1111/medu.13433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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91
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Bauer MS, Krawczyk L, Tuozzo K, Frigand C, Holmes S, Miller CJ, Abel E, Osser DN, Franz A, Brandt C, Rooney M, Fleming J, Smith E, Godleski L. Implementing and Sustaining Team-Based Telecare for Bipolar Disorder: Lessons Learned from a Model-Guided, Mixed Methods Analysis. Telemed J E Health 2017; 24:45-53. [PMID: 28665773 DOI: 10.1089/tmj.2017.0017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Telemental health interventions have empirical support from clinical trials and structured demonstration projects. However, their implementation and sustainability under less structured clinical conditions are not well demonstrated. INTRODUCTION We conducted a follow-up analysis of the implementation and sustainability of a clinical video teleconference-based collaborative care model for individuals with bipolar disorder treated in the Department of Veterans Affairs to (a) characterize the extent of implementation and sustainability of the program after its establishment and (b) identify barriers and facilitators to implementation and sustainability. MATERIALS AND METHODS We conducted a mixed methods program evaluation, assessing quantitative aspects of implementation according to the Reach, Efficacy, Adoption, Implementation, and Maintenance implementation framework. We conducted qualitative analysis of semistructured interviews with 16 of the providers who submitted consults, utilizing the Integrated Promoting Action on Research Implementation in the Health Services implementation framework. RESULTS The program demonstrated linear growth in sites (n = 35) and consults (n = 915) from late 2011 through mid-2016. Site-based analysis indicated statistically significant sustainability beyond the first year of operation. Qualitative analysis identified key facilitators, including consult content, ease of use via electronic health record, and national infrastructure. Barriers included availability of telehealth space, equipment, and staff at the sites, as well as the labor-intensive nature of scheduling. DISCUSSION The program achieved continuous growth over almost 5 years due to (1) successfully filling a need perceived by providers, (2) developing in a supportive context, and (3) receiving effective facilitation by national and local infrastructure. CONCLUSION Clinical video teleconference-based interventions, even multicomponent collaborative care interventions for individuals with complex mental health conditions, can grow vigorously under appropriate conditions.
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Affiliation(s)
- Mark S Bauer
- 1 VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, Massachusetts.,2 Harvard Medical School Department of Psychiatry and VA Boston Healthcare System , Boston, Massachusetts
| | - Lois Krawczyk
- 2 Harvard Medical School Department of Psychiatry and VA Boston Healthcare System , Boston, Massachusetts
| | - Kathy Tuozzo
- 3 Department of Psychiatry, Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.,6 VA Central Office, Office of Connected Care, West Haven, Connecticut
| | - Cara Frigand
- 1 VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, Massachusetts
| | - Sally Holmes
- 1 VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, Massachusetts
| | - Christopher J Miller
- 1 VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, Massachusetts.,2 Harvard Medical School Department of Psychiatry and VA Boston Healthcare System , Boston, Massachusetts
| | - Erica Abel
- 3 Department of Psychiatry, Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - David N Osser
- 2 Harvard Medical School Department of Psychiatry and VA Boston Healthcare System , Boston, Massachusetts
| | - Aleda Franz
- 3 Department of Psychiatry, Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - Cynthia Brandt
- 3 Department of Psychiatry, Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - Meghan Rooney
- 4 Hunter Holmes McGuire VA Medical Center , Richmond, Virginia
| | - Jerry Fleming
- 2 Harvard Medical School Department of Psychiatry and VA Boston Healthcare System , Boston, Massachusetts
| | - Eric Smith
- 1 VA Center for Healthcare Organization and Implementation Research, Boston and Bedford, Massachusetts.,5 Department of Psychiatry, University of Massachusetts School of Medicine , Boston, Massachusetts
| | - Linda Godleski
- 3 Department of Psychiatry, Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.,6 VA Central Office, Office of Connected Care, West Haven, Connecticut
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92
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Miller CJ, McInnes DK, Stolzmann K, Bauer MS. Interest in Use of Technology for Healthcare Among Veterans Receiving Treatment for Mental Health. Telemed J E Health 2016; 22:847-854. [DOI: 10.1089/tmj.2015.0190] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher J. Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - D. Keith McInnes
- Edith Nourse Rogers Memorial VA Medical Center, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Stolzmann
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
| | - Mark S. Bauer
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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93
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Yellowlees P, Richard Chan S, Burke Parish M. The hybrid doctor-patient relationship in the age of technology - Telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry 2016; 27:476-89. [PMID: 26493089 DOI: 10.3109/09540261.2015.1082987] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The doctor-patient relationship is evolving and changing through the impact of many technological, social and environmental factors. These factors will be examined, especially the impact of changing attitudes among younger generations of physicians and patients who live in an information-driven networked world. Telepsychiatry is already over 50 years old and has a strong evidence base which suggests that it is a better form of practice compared with the traditional in-person consultation for certain patient groups. In particular, telepsychiatry encourages intimacy in relationships through the use of the 'virtual space' in the consultation, better collaboration between psychiatrists and primary care physicians, and improved patient satisfaction. The practice of psychiatry will change through the use of mobile devices, asynchronous consultations, and the opportunities that automated interpretation and translation bring to work across cultures. The future will likely bring many psychiatrists working increasingly in a hybrid model, both in-person, and online, using the strengths of both approaches to improve patient care.
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Affiliation(s)
- Peter Yellowlees
- a Department of Psychiatry , University of California , Davis , California and
| | - Steven Richard Chan
- a Department of Psychiatry , University of California , Davis , California and
| | - Michelle Burke Parish
- a Department of Psychiatry , University of California , Davis , California and.,b Betty Irene More School of Nursing , University of California , Davis , California , USA
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94
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Whealin JM, Seibert-Hatalsky LA, Howell JW, Tsai J. E-mental health preferences of Veterans with and without probable posttraumatic stress disorder. ACTA ACUST UNITED AC 2016; 52:725-38. [PMID: 26562090 DOI: 10.1682/jrrd.2014.04.0113] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/03/2015] [Indexed: 11/05/2022]
Abstract
Mental health care practices supported by electronic communication, referred to as e-mental health, offer ways to increase access to mental health resources. In recent years, e-mental health interventions using clinical video teleconferencing, Internet-based interventions, social networking sites, and telephones have emerged as viable, cost-effective methods to augment traditional service delivery. Whereas some research evaluates attitudes about e-mental health, few studies have assessed interest in using these approaches in a contemporary sample of U.S. Veterans. This study sought to understand willingness to use e-mental health in a diverse group of Veterans residing in Hawaii. Mailed surveys were completed by 600 Operation Iraqi Freedom/Operation Enduring Freedom Veterans and National Guard members. Results suggest that overall willingness to use e-mental health ranged from 32.2% to 56.7% depending on modality type. Importantly, Veterans who screened positive for posttraumatic stress disorder (PTSD) were significantly less likely to report willingness to use each e-mental health modality than their peers without PTSD, despite their greater desire for mental health services. These results suggest that despite solutions to logistical barriers afforded via e-mental health services, certain barriers to mental health care may persist, especially among Veterans who screen positive for PTSD.
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Affiliation(s)
- Julia M Whealin
- Department of Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, HI
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95
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de Grood C, Raissi A, Kwon Y, Santana MJ. Adoption of e-health technology by physicians: a scoping review. J Multidiscip Healthc 2016; 9:335-44. [PMID: 27536128 PMCID: PMC4975159 DOI: 10.2147/jmdh.s103881] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The goal of this scoping review was to summarize the current literature identifying barriers and opportunities that facilitate adoption of e-health technology by physicians. DESIGN Scoping review. SETTING MEDLINE, EMBASE, and PsycINFO databases as provided by Ovid were searched from their inception to July 2015. Studies captured by the search strategy were screened by two reviewers and included if the focus was on barriers and facilitators of e-health technology adoption by physicians. RESULTS Full-text screening yielded 74 studies to be included in the scoping review. Within those studies, eleven themes were identified, including cost and liability issues, unwillingness to use e-health technology, and training and support. CONCLUSION Cost and liability issues, unwillingness to use e-health technology, and training and support were the most frequently mentioned barriers and facilitators to the adoption of e-health technology. Government-level payment incentives and privacy laws to protect health information may be the key to overcome cost and liability issues. The adoption of e-health technology may be facilitated by tailoring to the individual physician's knowledge of the e-health technology and the use of follow-up sessions for physicians and on-site experts to support their use of the e-health technology. To ensure the effective uptake of e-health technologies, physician perspectives need to be considered in creating an environment that enables the adoption of e-health strategies.
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Affiliation(s)
- Chloe de Grood
- Department of Community Health Sciences, W21C Research and Innovation Centre, University of Calgary, Calgary
| | | | | | - Maria Jose Santana
- Department of Community Health Sciences, W21C Research and Innovation Centre, University of Calgary, Calgary
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96
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Abstracts from The American Telemedicine Association 2016 Annual Meeting and Trade Show. Telemed J E Health 2016; 22:A1-A102. [DOI: 10.1089/tmj.2016.29004-a.abstracts] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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97
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Hilty DM, Shoemaker EZ, Myers K, Snowdy CE, Yellowlees PM, Yager J. Need for and Steps Toward a Clinical Guideline for the Telemental Healthcare of Children and Adolescents. J Child Adolesc Psychopharmacol 2016; 26:283-95. [PMID: 26871510 DOI: 10.1089/cap.2015.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This article identifies and describes key considerations toward the development of a clinical guideline intended to optimize telemental healthcare (TMH) of children and adolescents. METHODS The literature was searched with key terms and title words. Of 2824 articles that met primary or secondary key word search criteria, 326 met both criteria, and 118 thematically related directly to child and adolescent TMH. Only 44 studies met levels of evidence I-III and expert recommendation criteria used in clinical guidelines; review of their references found 8 additional studies (52 total). Data from adult, child, and adolescent in-person psychiatric care and adult TMH were applied to provide context in developing the key considerations. RESULTS TMH guidelines for adults are well delineated, and TMH guidelines for children and adolescents are likely to closely overlap in terms of general clinical, technical, and administrative issues. However, for a child and adolescent focus, modifications of existing general guidelines appear necessary; for example, based on developmental status, family involvement, and patient-site modifications for space and sound. Additional clinical issues include specify who, exactly, is the "patient" (i.e., the patient, family, and /or other stakeholders), modalities of care (i.e., age-related psychotherapies such as play therapy or behavior management), and psychopharmacology. CONCLUSIONS Specific clinical, administrative, and technical issues are key considerations - based on the nuances of established child and adolescent mental healthcare - and must be considered in developing a clinical guideline for TMH of these patients. Developing such guidance should proceed from a careful review of the growing evidence base, and through expert consensus processes.
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Affiliation(s)
- Donald M Hilty
- 1 Kaweah Delta Medical Center, Visalia, California.,2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Erica Z Shoemaker
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California.,3 Child and Adolescent Services Los Angeles County and University of Southern California Medical Center , Los Angeles, California
| | - Kathleen Myers
- 4 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,5 Telemental Health Service, Seattle Children's Hospital , Seattle, Washington
| | - Christopher E Snowdy
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Peter M Yellowlees
- 6 Department of Psychiatry, UC Davis School of Medicine , Davis, California
| | - Joel Yager
- 7 Department of Psychiatry, University of Colorado at Denver School of Medicine , Denver, Colorado
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98
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Kramer GM, Luxton DD. Telemental Health for Children and Adolescents: An Overview of Legal, Regulatory, and Risk Management Issues. J Child Adolesc Psychopharmacol 2016; 26:198-203. [PMID: 26259027 DOI: 10.1089/cap.2015.0018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The use of technology to provide telemental healthcare continues to increase; however, little has been written about the legal and regulatory issues involved in providing this form of care to children and adolescents. METHODS This article reviews existing laws and regulations to summarize the risk management issues relevant to providing telemental healthcare to children and adolescents. RESULTS There are several legal and regulatory areas in which telemental health clinicians need to have awareness. These areas include: 1) Licensure, 2) malpractice liability, 3) credentialing and privileging, 4) informed consent, 5) security and privacy, and 6) emergency management. CONCLUSIONS Although legal and regulatory challenges remain in providing telemental healthcare to children and adolescents, it is possible to overcome these challenges with knowledge of the issues and appropriate risk management strategies. We provide general knowledge of these key legal and regulatory issues, along with some risk management recommendations.
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Affiliation(s)
- Gregory M Kramer
- 1 National Center for Telehealth and Technology (T2) , Joint Base Lewis-McChord, Tacoma, Washington
| | - David D Luxton
- 1 National Center for Telehealth and Technology (T2) , Joint Base Lewis-McChord, Tacoma, Washington.,2 University of Washington School of Medicine , Seattle, Washington
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99
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Cain S, Sharp S. Telepharmacotherapy for Child and Adolescent Psychiatric Patients. J Child Adolesc Psychopharmacol 2016; 26:221-8. [PMID: 26745771 DOI: 10.1089/cap.2015.0039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study is to review and discuss the status of telepsychiatry practice, particularly as applied to treating children and adolescents with psychotropic medications, which is termed "telepharmacotherapy." METHODS The literature pertinent to telepsychiatry practice is reviewed, followed by a presentation of the challenges to implementing telepharmacotherapy, potential solutions, current controversies, and future directions, combining insights from the literature with the authors' own experiences. RESULTS Telepsychiatry services for children and adolescents are expanding, and provide needed pharmacotherapy for patients who are underserved by available resources. The evidence base supporting the effectiveness of telepsychiatry practice and telepharmacotherapy is still emerging, and consists mainly of feasibility and satisfaction studies with limited outcome data. Although a number of challenges to this mode of care delivery currently exist, the authors outline potential solutions for those challenges that are consistent with existing guidelines for clinical practice. CONCLUSIONS Telepsychiatry appears to be a feasible and satisfactory alternative to in-person care, and a valid option for increasing access to psychopharmacotherapy for children and adolescents. Although the evidence base is still emerging, and practitioners may face a number of challenges, solutions are presented that may help to overcome those challenges.
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Affiliation(s)
- Sharon Cain
- Department of Psychiatry and Behavioral Sciences, Kansas University Medical Center , Kansas City, Kansas
| | - Susan Sharp
- Department of Psychiatry and Behavioral Sciences, Kansas University Medical Center , Kansas City, Kansas
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100
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Bauer MS, Krawczyk L, Miller CJ, Abel E, Osser DN, Franz A, Brandt C, Rooney M, Fleming J, Godleski L. Team-Based Telecare for Bipolar Disorder. Telemed J E Health 2016; 22:855-864. [PMID: 26906927 DOI: 10.1089/tmj.2015.0255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Numerous randomized controlled trials indicate that collaborative chronic care models improve outcome in a wide variety of mental health conditions, including bipolar disorder. However, their spread into clinical practice is limited by the need for a critical mass of patients and specialty providers in the same locale. Clinical videoconferencing has the potential to overcome these geographic limitations. MATERIALS AND METHODS A videoconference-based collaborative care program for bipolar disorder was implemented in the Department of Veterans Affairs. Program evaluation assessed experience with the first 400 participants, guided by five domains specified by the American Telemedicine Association: treatment engagement, including identification of subpopulations at risk for not being reached; participation in treatment; clinical impact; patient safety; and quality of care. RESULTS Participation rates resembled those for facility-based collaborative care. No participant characteristics predicted nonengagement. Program completers demonstrated significant improvements in several clinical indices, without evidence of compromise in patient safety. Guideline-based quality of care assessment after 1 year indicated increased lithium use, decreased antidepressant use, and increased prazosin use in individuals with comorbid post-traumatic stress disorder, but no impact on already high rates of lithium serum level monitoring. DISCUSSION Clinical videoconferencing can extend the reach of collaborative care models for bipolar disorder. The next step involves assessment of the videoconference-based collaborative care for other serious mental health conditions, investigation of barriers and facilitators of broad implementation of the model, and evaluation of the business case for deployment and sustainability in clinical practice.
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Affiliation(s)
- Mark S Bauer
- 1 VA Center for Healthcare Organization and Implementation Research , Boston, Massachusetts.,2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Lois Krawczyk
- 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Christopher J Miller
- 1 VA Center for Healthcare Organization and Implementation Research , Boston, Massachusetts.,2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Erica Abel
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - David N Osser
- 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Aleda Franz
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - Cynthia Brandt
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut
| | - Meghan Rooney
- 4 Hunter Holmes McGuire VA Medical Center , Richmond, Virginia
| | - Jerry Fleming
- 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts
| | - Linda Godleski
- 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.,5 VA Central Office , Office of Telehealth Services, West Haven, Connecticut
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