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Doering JJ, Wichman CL, Laszewski A, Kuehn S, Ke W. Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners. Birth 2023; 50:764-772. [PMID: 36939290 DOI: 10.1111/birt.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/15/2021] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. METHODS This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. RESULTS After completion of triage, the psychiatrist returned the practitioner's call ≤5 min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. CONCLUSIONS This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.
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Affiliation(s)
- Jennifer J Doering
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Christina L Wichman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Audrey Laszewski
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelby Kuehn
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Weiming Ke
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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2
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Shoib S, Armiya'u AY, Roza TH, Saeed F, Swed S, Arif N, Park C, Chandradasa M. Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers and prospects. Asian J Psychiatr 2022; 75:103203. [PMID: 35870308 DOI: 10.1016/j.ajp.2022.103203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/17/2023]
Abstract
Telehealth is being broadly developed in all fields of medicine, and online visits seem a particularly suitable alternative to in-person visits in outpatient psychiatry especially in conflict setting. Telepsychiatry has numerous advantages over in-person visits.
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Affiliation(s)
- Sheikh Shoib
- Jawaharlal Nehru Memorial hospital, Directorate of Health Services, Jammu and Kashmir, India.
| | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, College of Medical Sciences, Abubakar Tafawa Balewa University, University Teaching Hospital Bauchi state, Nigeria.
| | - Thiago Henrique Roza
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fahimeh Saeed
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Nigar Arif
- Republican Psychiatric Hospital, Azerbaijan.
| | - Chan Park
- 2nd year Resident at UCLA-VA Psychiatry Residency Program, United States.
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3
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Peyton D, Goods M, Hiscock H. The Effect of Digital Health Interventions on Parents' Mental Health Literacy and Help Seeking for Their Child's Mental Health Problem: Systematic Review. J Med Internet Res 2022; 24:e28771. [PMID: 35142623 PMCID: PMC8874802 DOI: 10.2196/28771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/20/2021] [Accepted: 12/10/2021] [Indexed: 01/17/2023] Open
Abstract
Background Many children with mental health problems do not receive professional help. Despite the frequent use of digital health interventions (DHIs) such as websites or web-based service navigation platforms, their effects on parents’ mental health literacy, help seeking, or uptake of professional services are unclear. Objective This study aims to provide a systematic review and narrative synthesis to describe whether DHIs improve the aforementioned parental outcomes. Methods Databases, including CINAHL, Embase, MEDLINE OVID, PsycINFO, and PubMed (2000-2020), were accessed. Studies were included if they evaluated quantitative changes in mental health literacy, help seeking, or the uptake of services by parents of children with mental health problems. Theoretical frameworks, sample sizes, participant demographics, recruitment, interventions, DHI use, results, and health economic measures were used for data extraction. Results Of the 11,379 search results, 5 (0.04%) studies met the inclusion criteria. One randomized controlled trial found the reduced uptake of services after using a DHI coupled with a telephone coach for a child’s behavioral problem. Of 3 studies, 2 (66.7%) found statistically significant improvement in mental health literacy for attention-deficit/hyperactivity disorder but had no control group. One study found nonsignificant improvement in mental health literacy and help-seeking attitudes toward anxiety and depression compared with those in active controls. All studies were rated as having a high or serious risk of bias. Search results were affected because of a single reviewer screening articles, overall low-quality studies, and a lack of consistent nomenclature. Conclusions There is no high-quality evidence that DHIs can improve parents’ mental health literacy, help seeking, or uptake of services. More research is needed to evaluate DHIs by using rigorous study designs and consistent measures. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020130074; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020130074
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Affiliation(s)
- Daniel Peyton
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Australia
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4
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Lieng MK, Aurora MS, Kang Y, Kim JM, Marcin JP, Chan SR, Mouzoon JL, Tancredi DJ, Parish M, Gonzalez AD, Scher L, Xiong G, McCarron RM, Yellowlees P. Primary Care Physician Adherence to Telepsychiatry Recommendations: Intermediate Outcomes from a Randomized Clinical Trial. Telemed J E Health 2021; 28:838-846. [PMID: 34726542 DOI: 10.1089/tmj.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To compare clinical recommendations given by psychiatrists and the adherence to these recommendations by primary care physicians (PCP) following consultations conducted by asynchronous telepsychiatry (ATP) and synchronous telepsychiatry (STP). Materials and Methods: ATP and STP consultations were compared using intermediate data from a randomized clinical trial with adult participant enrollment between April 2014 and December 2017. In both study arms, PCPs received written recommendations from the psychiatrist after each encounter. Independent clinicians reviewed PCP documentation to measure adherence to those recommendations in the 6 months following the baseline consultation. Results: Medical records were reviewed for 645 psychiatrists' consult recommendations; 344 from 61 ATP consultations and 301 from 62 STP consultations. Of those recommendations, 191 (56%) and 173 (58%) were rated fully adherent by two independent raters for ATP and STP, respectively. In a multilevel ordinal logistic regression model adjusted for recommendation type and recommended implementation timing, there was no statistically significant difference in adherence to recommendations for ATP compared with STP (adjusted odds ratio = 0.91, 95% confidence interval = 0.51-1.62). The profiles of recommendation type were comparable between ATP and STP. Conclusions: This is the first PCP adherence study comparing two forms of telemedicine. Although we did not find evidence of a difference between ATP and STP; this study supports the feasibility and acceptability of ATP and STP for the provision of collaborative psychiatric care. Clinical Trial Identifier NCT02084979.
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Affiliation(s)
- Monica K Lieng
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,School of Medicine, University of California Davis Health, Sacramento, California, USA
| | - Magi S Aurora
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,Department of Family Medicine, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Young Kang
- School of Medicine, University of California Davis Health, Sacramento, California, USA.,Department of Internal Medicine, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Joseph M Kim
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,Department of Internal Medicine, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Steven R Chan
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA.,Veterans Health Administration, Palo Alto Health Care System, Palo Alto, California, USA
| | - Jamie L Mouzoon
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Daniel J Tancredi
- Department of Pediatrics, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Michelle Parish
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Alvaro D Gonzalez
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Glen Xiong
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
| | - Robert M McCarron
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Peter Yellowlees
- Department of Psychiatry, Center for Health and Technology, University of California Davis Health, Sacramento, California, USA
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5
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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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6
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Shang Z, Arnaert A, Hindle Y, Debe Z, Côté-Leblanc G, Saadi A. Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec. BMC Health Serv Res 2021; 21:85. [PMID: 33485327 PMCID: PMC7825224 DOI: 10.1186/s12913-021-06072-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background Due to regional, professional, and resource limitations, access to mental health care for Canada’s Indigenous peoples can be difficult. Telemental health (TMH) offers the opportunity to provide care across vast distances and has been proven to be as effective as face-to-face services. To our knowledge, there has been no qualitative study exploring the experiences of TMH staff serving the Indigenous peoples in Northern Quebec, Canada; which is the purpose of this study. Methods Using a qualitative descriptive design, the entire staff of a TMH clinic was recruited, comprising of four psychiatrists and four support staff. Individual semi-structured interviews were conducted through videoconferencing, and results were thematically analyzed. Results To address the mental health gap in Northern communities, all psychiatrists believe in the necessity of in-person care and note the synergistic effect of combining in-person care and TMH services. This approach to care allows psychiatrists to maintain both an insider and outsider identity. However, if a patient’s condition requires hospitalization, then the TMH staff face a new set of information sharing and communication challenges with the inpatient staff. TMH staff believe that the provision of culturally sensitive care to Northern patients at the inpatient unit is progressing; however, more work needs to be done. Despite the strong collegial atmosphere within the clinic and collective efforts to provide quality TMH services, all participants express a sense of frustration with the paper-based and scattered documentation system. Conclusion The TMH team works in cohesion to offer TMH services to Indigenous peoples; yet, automatization is needed to improve the workflow efficiency within the clinic and collaboration with the Northern clinics. More research is needed on the functioning of TMH teams and the separate but important roles of each team member. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06072-5.
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Affiliation(s)
- Zhida Shang
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada.
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Yvonne Hindle
- Centre Intégré Universitaire de Santé et Services Sociaux de l'Ouest-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Zoumanan Debe
- Centre Intégré Universitaire de Santé et Services Sociaux de l'Ouest-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Geneviève Côté-Leblanc
- Centre Intégré Universitaire de Santé et Services Sociaux de l'Ouest-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Amine Saadi
- Centre Intégré Universitaire de Santé et Services Sociaux de l'Ouest-de-L'Île-de-Montréal, Montréal, Québec, Canada
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7
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Shoemaker EZ, Myint MT, Joshi SV, Hilty DM. Low-Resource Project-Based Interprofessional Development with Psychiatry Faculty. Psychiatr Clin North Am 2019; 42:413-423. [PMID: 31358121 DOI: 10.1016/j.psc.2019.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Projects done in interprofessional groups can foster faculty development with minimal resources beyond what is already available at the university or medical center. Each project can yield multiple "wins" in individual faculty growth while meeting the needs of academic medical centers. These projects can build collaborative skills and a sense of community among faculty, trainees, and staff. The combination of low costs, high yields, and improvements in team skills make these approaches appealing and sustainable in resource-constrained medical centers. The authors describe 4 sample projects and their teams, needed resources, and outcomes.
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Affiliation(s)
- Erica Z Shoemaker
- Child and Adolescent Psychiatry, Keck School of Medicine, University of Southern California, LAC+ USC Medical Center, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA.
| | - Myo Thwin Myint
- Triple Board & Child and Adolescent Psychiatry Programs, Tulane University School of Medicine, 1430 Tulane Avenue, #8055, New Orleans, LA 70112, USA
| | - Shashank V Joshi
- Lucile Packard Children's Hospital @ Stanford, 401 Quarry Road, Stanford, CA 94305-5719, USA
| | - Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, 10535 Hospital Way, Mather, CA 95655 (116/SAC), USA; Department of Psychiatry and Behavioral Sciences, UC Davis, Davis, CA, USA
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8
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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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9
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Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
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Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
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10
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Community based telepsychiatry service for older adults residing in a rural and remote region- utilization pattern and satisfaction among stakeholders. BMC Psychiatry 2018; 18:316. [PMID: 30261845 PMCID: PMC6161443 DOI: 10.1186/s12888-018-1896-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Evaluation of telepsychiatry (via videoconference) for older adults is mostly focussed on nursing homes or inpatients. We evaluated the role of a community based program for older adults in rural and remote regions of South Australia. METHOD The utilization pattern was studied using retrospective chart review of telepsychiatry assessments over 24 months (2010-2011). Satisfaction was evaluated through prospective post-consultation feedback (using a 5-point Likert scale), from patients, community based clinicians and psychiatrist participating in consecutive assessments from April-November 2012. Descriptive analysis was used for the utilization. Mean scores and proportions were calculated for the feedback. Mann Whitney U test was used to compare patient subgroups based on age, gender, prior exposure to telepsychiatry services and inpatient/ outpatient status. Feedback comments were analysed for emerging themes. RESULTS On retrospective review of 134 consults, mean age was 75.89 years (SD 7.55), 60.4% (81) were females, and 71.6% (96) lived independently. Patients had a broad range of psychiatric disorders, from mood disorders to delirium and dementia, with co-morbid medical illness in 83.5% (112). On feedback evaluation (N = 98), mean scores ranged from 3.88-4.41 for patients, 4.36-4.73 for clinicians and 3.67-4.45 for psychiatrists. Feedback from inpatients (14 out of 37) was significantly lower compared to outpatients (37 out of 61) (chi sq. = 0.808, p < 0.05), and they were significantly less satisfied with the wait time (U = 163.0, p < 0.05) and visual clarity (U = 160.5, p < 0.05). Audio clarity was the most common aspect of dissatisfaction (mean score less than 3) among patients (6, 11%). Psychiatrists reported a preference for telepsychiatry over face to face in 55.4% (46) assessments. However, they expressed discomfort in situations of cognitive or sensory disabilities in patients. CONCLUSIONS In rural and remote areas, community-based telepsychiatry program can be a useful adjunct for psychiatrist input in the care of older adults. Innovations to overcome sensory deficits and collaboration with community services should be explored to improve its acceptance among the most vulnerable population.
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11
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Malas N, Klein E, Tengelitsch E, Kramer A, Marcus S, Quigley J. Exploring the Telepsychiatry Experience: Primary Care Provider Perception of the Michigan Child Collaborative Care (MC3) Program. PSYCHOSOMATICS 2018; 60:179-189. [PMID: 30097288 DOI: 10.1016/j.psym.2018.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pediatric mental healthcare is a growing component of primary care practice. However, there is a lack of access to mental health services, particularly those provided by Child and Adolescent Psychiatrists. The Michigan Child Collaborative Care (MC3) Program is a telepsychiatry service that offers embedded behavioral health consultants within primary care practices, telephonic consultation, video consultation and embedded care. Primary care provider (PCP) utilization of telepsychiatry services is predicated on perceiving the consultation service as user-friendly, helpful, and feasible in their practice. OBJECTIVE A survey of PCPs was conducted over a 5-year period to assess PCP attitudes and perceptions regarding MC3 consultation, including measures of efficiency, user-friendliness, and confidence in providing mental healthcare. The survey contained 4 items, (2 quantitative and 2 qualitative), and took less than 2 minutes to complete. RESULTS 649 responses were received out of 1475 possible responses (44% response rate). Common themes elicited from the qualitative items included perception of improved patient care for youth with mental illness (45.3%), improved comfort and confidence in caring for youth with mental illness (30.9%), greater comfort with the prescribing and monitoring of psychotropics (25.9%) and improved access to mental healthcare for youth (23.1%). PCPs strongly agreed that MC3 was user-friendly, efficient, and enhanced their confidence in managing pediatric mental health concerns. CONCLUSIONS This study demonstrates that the MC3 Telepsychiatry Program is well accepted by PCPs with self-reported improvements in providing mental healthcare to patients. Future research should explore how PCP perception impacts PCP practice, knowledge, as well as outcomes for patients and families longitudinally.
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Affiliation(s)
- Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI.
| | - Edwin Klein
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Anne Kramer
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Sheila Marcus
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Joanna Quigley
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI
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12
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Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. PSYCHOSOMATICS 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California, Veterans Administration Health Care System, Mather, CA; Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC).
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine, Burlington, Vermont; Division of Consultation Psychiatry and Psychosomatic Medicine, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Robert M McCarron
- Psychiatry & Behavioral Sciences and Department of Internal Medicine, University of California, Irvine Health System, Irvine, CA
| | - David J Katzelnick
- Department of Psychiatry and Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA; Behavioral Health Integration Program (BHIP) and Washington State's Mental Health Integration Program (MHIP), Seattle, WA
| | - John Fortney
- Division of Population Health, Seattle, WA; Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA
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Turvey C, Fortney J. The Use of Telemedicine and Mobile Technology to Promote Population Health and Population Management for Psychiatric Disorders. Curr Psychiatry Rep 2017; 19:88. [PMID: 29035422 DOI: 10.1007/s11920-017-0844-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This article discusses recent applications in telemedicine to promote the goals of population health and population management for people suffering psychiatric disorders. RECENT FINDINGS The use of telemedicine to promote collaborative care, self-monitoring and chronic disease management, and population screening has demonstrated broad applicability and effectiveness. Collaborative care using videoconferencing to facilitate mental health specialty consults has demonstrated effectiveness in the treatment of depression, PTSD, and also ADHD in pediatric populations. Mobile health is currently being harnessed to monitor patient symptom trajectories with the goal of using machine learning algorithms to predict illness relapse. Patient portals serve as a bridge between patients and providers. They provide an electronically secure shared space for providers and patients to collaborate and optimize care. To date, research has supported the effectiveness of telemedicine in promoting population health. Future endeavors should focus on developing the most effective clinical protocols for using these technologies to ensure long-term use and maximum effectiveness in reducing population burden of mental health.
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Affiliation(s)
- Carolyn Turvey
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System (152), 601 Highway West, Iowa City, IA, 52246, USA. .,Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - John Fortney
- HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry, University of Washington, Seattle, WA, USA
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Myers K, Nelson EL, Rabinowitz T, Hilty D, Baker D, Barnwell SS, Boyce G, Bufka LF, Cain S, Chui L, Comer JS, Cradock C, Goldstein F, Johnston B, Krupinski E, Lo K, Luxton DD, McSwain SD, McWilliams J, North S, Ostrowski J, Pignatiello A, Roth D, Shore J, Turvey C, Varrell JR, Wright S, Bernard J. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health 2017; 23:779-804. [DOI: 10.1089/tmj.2017.0177] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Eve-Lynn Nelson
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, Vermont
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Donald Hilty
- Psychiatry & Addiction Medicine, Kaweah Delta Medical Center, UC Irvine Affiliate, Visalia, California
- Department of Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, California
- Research and Health Services, Aligned Telehealth, Calabasas, California
| | - Deborah Baker
- Office of Legal and Regulatory Affairs, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sara Smucker Barnwell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Seattle Psychology PLLC, Seattle, Washington
| | | | - Lynn F. Bufka
- Practice Research and Policy, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sharon Cain
- Child and Adolescent Psychiatry Division, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Chui
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan S. Comer
- Center for Children and Families, Florida International University, Miami, Florida
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida
| | | | | | | | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Katherine Lo
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Office of Forensic Mental Health Services, State of Washington, Olympia, Washington
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Telehealth Optimization, Medical University of South Carolina, Charleston, South Carolina
| | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
- Mission Virtual Care, Spruce Pine, North Carolina
| | - Jay Ostrowski
- Behavioral Health Innovation, Charlotte, North Carolina
| | - Antonio Pignatiello
- TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David Roth
- Mind and Body Works, Inc., Honolulu, Hawaii
| | - Jay Shore
- Department of Psychiatry, Center for American Indian and Alaska Native Health, University of Colorado, Denver, Colorado
- Telepsychiatry Committee, American Psychiatric Association, Arlington, Virginia
| | - Carolyn Turvey
- Department of Psychiatry, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Shawna Wright
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Wright Psychological Services, Chanute, Kansas
| | - Jordana Bernard
- American Telemedicine Association, Washington, District of Columbia
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Rockhill CM, Tse YJ, Fesinmeyer MD, Garcia J, Myers K. Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study. J Child Adolesc Psychopharmacol 2016; 26:662-671. [PMID: 26258927 PMCID: PMC5069727 DOI: 10.1089/cap.2015.0017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the prescribing strategies that telepsychiatrists used to provide pharmacologic treatment in the Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS). METHODS CATTS was a randomized controlled trial that demonstrated the superiority of a telehealth service delivery model for the treatment of ADHD with combined pharmacotherapy and behavior training (n=111), compared with management in primary care augmented with a telepsychiatry consultation (n=112). A diagnosis of ADHD was established with the Computerized Diagnostic Interview Schedule for Children (CDISC), and comorbidity for oppositional defiant disorder (ODD) and anxiety disorders (AD) was established using the CDISC and the Child Behavior Checklist. Telepsychiatrists used the Texas Children's Medication Algorithm Project (TCMAP) for ADHD to guide pharmacotherapy and the treat-to-target model to encourage their assertive medication management to a predetermined goal of 50% reduction in ADHD-related symptoms. We assessed whether telepsychiatrists' decision making about making medication changes was associated with baseline ADHD symptom severity, comorbidity, and attainment of the treat-to-target goal. RESULTS Telepsychiatrists showed high fidelity (91%) to their chosen algorithms in medication management. At the end of the trial, the CATTS intervention showed 46.0% attainment of the treat-to-target goal compared with 13.6% for the augmented primary care condition, and significantly greater attainment of the goal by comorbidity status for the ADHD with one and ADHD with two comorbidities groups. Telepsychiatrists' were more likely to decide to make medication adjustments for youth with higher baseline ADHD severity and the presence of disorders comorbid with ADHD. Multiple mixed methods regression analyses controlling for baseline ADHD severity and comorbidity status indicated that the telepsychiatrists also based their decision making session to session on attainment of the treat-to-target goal. CONCLUSIONS Telepsychiatry is an effective service delivery model for providing pharmacotherapy for ADHD, and the CATTS telepsychiatrists showed high fidelity to evidence-based protocols.
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Affiliation(s)
- Carol M. Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Yuet Juhn Tse
- Department of Education, University of Washington, Seattle, Washington
| | - Megan D. Fesinmeyer
- Child Health, Behavior and Development Center, Seattle Children's Research Institute, Seattle, Washington
| | - Jessica Garcia
- Child Health, Behavior and Development Center, Seattle Children's Research Institute, Seattle, Washington
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Child Health, Behavior and Development Center, Seattle Children's Research Institute, Seattle, Washington
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Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry 2016; 6:269-82. [PMID: 27354970 PMCID: PMC4919267 DOI: 10.5498/wjp.v6.i2.269] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/27/2016] [Accepted: 03/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To conduct a review of the telepsychiatry literature. METHODS We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to: (1) be published in a peer-reviewed journal after the year 2000; (2) be written in English; (3) use videoconferencing technology for the provision of mental health assessment or treatment services; and (4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in PubMed (Medline database), Ovid medline, PsychInfo, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories: (1) satisfaction; (2) reliability; (3) treatment outcomes; (4) implementation outcomes; (5) cost effectiveness; and (6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion. RESULTS Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry. CONCLUSION A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.
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Winpenny E, Miani C, Pitchforth E, Ball S, Nolte E, King S, Greenhalgh J, Roland M. Outpatient services and primary care: scoping review, substudies and international comparisons. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | - Ellen Nolte
- RAND Europe, Cambridge, UK
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Greenhalgh
- Faculty of Education, Social Sciences and Law, University of Leeds, Leeds, UK
| | - Martin Roland
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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McWilliams JK. Integrating Telemental Healthcare with the Patient-Centered Medical Home Model. J Child Adolesc Psychopharmacol 2016; 26:278-82. [PMID: 26258461 DOI: 10.1089/cap.2015.0044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this article is to discuss how telemental healthcare and the patient-centered medical home (PCMH) can be integrated to improve the quality of mental healthcare available. METHODS This article outlines the components of a PCMH, and how the needs of this type of system of care can benefit from telemental healthcare. RESULTS The princples of PCMHs are being increasingly promoted in a variety of settings. In order to fulfill these principles, mental heathcare must be a integral part of the care provided to patients within the PCMH. The mental healthcare workforce is inadequate to provide care for patients, particularly in rural and high-poverty areas. Telemental healthcare provides a means to extend mental health services to the PCMHs using a variety of models. CONCLUSIONS Telemental healthcare offers unique opportunities to bridge the need for mental healthcare integration in the PCMH for all patients.
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O'Gorman LD, Hogenbirk JC, Warry W. Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network. Telemed J E Health 2015; 22:473-9. [PMID: 26544163 PMCID: PMC4892212 DOI: 10.1089/tmj.2015.0166] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction:Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km2. The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province.Materials and Methods:We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care.Results:There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south.Conclusions:Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.
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Affiliation(s)
- Laurel D O'Gorman
- Center for Rural and Northern Health Research, Laurentian University , Sudbury, Ontario, Canada
| | - John C Hogenbirk
- Center for Rural and Northern Health Research, Laurentian University , Sudbury, Ontario, Canada
| | - Wayne Warry
- Center for Rural and Northern Health Research, Laurentian University , Sudbury, Ontario, Canada
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Psychogeriatric SOS (services-on-screen) - a unique e-health model of psychogeriatric rural and remote outreach. Int Psychogeriatr 2015. [PMID: 26219837 DOI: 10.1017/s1041610215001131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mental health service delivery to rural and remote communities can be significantly impeded by the tyranny of distance. In Australia, rural and remote mental health services are characterized by limited resources stretched across geographically large and socio-economically disadvantaged regions (Inderet al., 2012; Thomaset al., 2012). Internationally, rural and remote area mental health workforce shortages are common, especially in relation to specialist mental health services for older people (McCarthyet al., 2012; Bascuet al., 2012).
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Hilty D, Yellowlees PM, Parrish MB, Chan S. Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery? Psychiatr Clin North Am 2015; 38:559-92. [PMID: 26300039 DOI: 10.1016/j.psc.2015.05.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Patient-centered health care questions how to deliver quality, affordable, and timely care in a variety of settings. Telemedicine empowers patients, increases administrative efficiency, and ensures expertise gets to the place it is most needed--the patient. Telepsychiatry or telemental health is effective, well accepted, and comparable to in-person care. E-models of care offer variety, flexibility, and positive outcomes in most settings, and clinicians are increasingly interested in using technology for care, so much so that telepsychiatry is now being widely introduced around the world.
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Affiliation(s)
- Donald Hilty
- Psychiatry & Behavioral Sciences, Telehealth, USC Care Health System, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC Suite 2200, Los Angeles, CA 90033, USA.
| | - Peter M Yellowlees
- Psychiatry & Behavioral Sciences, Health Informatics Graduate Program, University of California, Davis School of Medicine and Health System, 2450 48th Street, Suite 2800, Sacramento, CA 95817, USA
| | - Michelle B Parrish
- Telepsychiatry and Health Informatics, University of California, Davis School of Medicine & Health System, 2450 48th Street Suite 2800, Sacramento, CA 95817, USA
| | - Steven Chan
- Department of Psychiatry & Behavioral Sciences, University of California, Davis School of Medicine & Health System, 2150 Stockton Boulevard, Sacramento, CA 95817, USA
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Grubbs KM, Fortney JC, Dean T, Williams JS, Godleski L. A Comparison of Mental Health Diagnoses Treated via Interactive Video and Face to Face in the Veterans Healthcare Administration. Telemed J E Health 2015; 21:564-6. [DOI: 10.1089/tmj.2014.0152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
| | - John C. Fortney
- Central Arkansas VA Healthcare System–MIRECC, Little Rock, Arkansas
| | - Tisha Dean
- Central Arkansas VA Healthcare System–MIRECC, Little Rock, Arkansas
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Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M. What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Lindsay Blank
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Lee
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nick Payne
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Melanie Rimmer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Pyne JM, Fortney JC, Mouden S, Lu L, Hudson TJ, Mittal D. Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs. Psychiatr Serv 2015; 66:491-9. [PMID: 25686811 PMCID: PMC5968353 DOI: 10.1176/appi.ps.201400186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Collaborative care for depression in primary care settings is effective and cost-effective. However, there is minimal evidence to support the choice of on-site versus off-site models. This study examined the cost-effectiveness of on-site practice-based collaborative care (PBCC) versus off-site telemedicine-based collaborative care (TBCC) for depression in federally qualified health centers (FQHCs). METHODS In a multisite, randomized, pragmatic comparative cost-effectiveness trial, 19,285 patients were screened for depression, 2,863 (14.8%) screened positive, and 364 were enrolled. Telephone interview data were collected at baseline and at six, 12, and 18 months. Base case analysis used Arkansas FQHC health care costs, and secondary analysis used national cost estimates. Effectiveness measures were depression-free days and quality-adjusted life years (QALYs) derived from depression-free days, the 12-Item Short-Form Survey, and the Quality of Well-Being (QWB) Scale. Nonparametric bootstrap with replacement methods were used to generate an empirical joint distribution of incremental costs and QALYs and acceptability curves. RESULTS The TBCC intervention resulted in more depression-free days and QALYs but at a greater cost than the PBCC intervention. The disease-specific (depression-free day) and generic (QALY) incremental cost-effectiveness ratios (ICERs) were below their respective ICER thresholds for implementation, suggesting that the TBCC intervention was more cost effective than the PBCC intervention. CONCLUSIONS These results support the cost-effectiveness of TBCC in medically underserved primary care settings. Information about whether to insource (make) or outsource (buy) depression care management is important, given the current interest in patient-centered medical homes, value-based purchasing, and bundled payments for depression care.
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Affiliation(s)
- Jeffrey M Pyne
- Dr. Pyne, Ms. Lu, and Dr. Hudson are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (e-mail: ). Dr. Pyne and Dr. Hudson are also with the Department of Psychiatry, Central Arkansas Veterans Healthcare System, North Little Rock, where Dr. Mittal is affiliated. Dr. Fortney is with the Department of Psychiatry and Behavioral Sciences, University of Washington, and with the Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, both in Seattle. Ms. Mouden was with Community Health Centers of Arkansas, Inc., North Little Rock, at the time of this study. A poster of this research was presented at the Academy Health Annual Research Meeting, San Diego, June 8-10, 2014
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Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015; 54:263-74. [PMID: 25791143 PMCID: PMC4406418 DOI: 10.1016/j.jaac.2015.01.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 01/04/2015] [Accepted: 01/23/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. METHOD The Children's ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. RESULTS Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ(2)[4] = 19.47, p < .001), hyperactivity (χ(2)[4] = 11.91, p = .02), combined ADHD (χ(2)[4] = 14.90, p = .005), ODD (χ(2)[4] = 10.05, p = .04), and VADRS-Caregiver role performance (χ(2) [4] = 12.40, p = .01) and CIS-P impairment (χ(2)[4] = 20.52, p < .001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ(2)[4] = 11.28, p = .02) and combined ADHD (χ(2)[4] = 9.72, p = .045). CONCLUSION The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to specialty mental health services. Clinical trial registration information-Children's Attention Deficit Disorder With Hyperactivity (ADHD) Telemental Health Treatment Study; http://clinicaltrials.gov; NCT00830700.
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Sunderji N, Crawford A, Jovanovic M. Telepsychiatry in graduate medical education: a narrative review. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:55-62. [PMID: 25155424 DOI: 10.1007/s40596-014-0176-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/06/2014] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Telepsychiatry is an innovation that addresses disparities in access to care. Despite rigorous clinical research demonstrating its equivalence and effectiveness relative to face-to-face care, many providers are unfamiliar with this technology. Training residents in telepsychiatry is critical to building mental health care capacity in rural and underserviced communities. However, many questions remain regarding the competencies that future psychiatrists require with respect to telepsychiatry, and technology generally, and regarding pedagogical approaches that will promote their attainment. This literature review aims to elucidate evidence-based approaches to developing residents' competence to practice telepsychiatry. METHODS The authors conducted a literature search of telepsychiatry training for psychiatry residents. The authors searched MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, and ERIC using subject headings and keywords; and hand searched reference lists, forward citations of relevant articles, and tables of contents of relevant journals. Articles were included if they were in English, discussed teaching psychiatry residents to provide direct or indirect clinical care via real-time videoconferencing technology, and were published by January 2014. RESULTS In total, 215 unique references yielded 20 relevant publications. The literature on graduate training in telepsychiatry is sparse, heterogeneous, and primarily descriptive. Even brief learning experiences may increase the likelihood that residents will incorporate telepsychiatry into their future practice. Training should address competencies that are (1) technical, (2) collaborative/interprofessional, and (3) administrative. Training typically consists of supervised provision of clinical care to build modality-specific clinical skills and may also include didactic teaching to provide health systems and transcultural and medicolegal perspectives. CONCLUSIONS A more evidence-based approach to telepsychiatry training is needed, including an assessment of residents' learning needs, use of multiple learning modalities, and evaluations of educational curricula. Pedagogically sound curriculum development and evaluation of postgraduate education in telepsychiatry could promote social accountability, cultural competence, interprofessional care, and, ultimately, improve clinical outcomes.
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Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M. Referral interventions from primary to specialist care: a systematic review of international evidence. Br J Gen Pract 2014; 64:e765-74. [PMID: 25452541 PMCID: PMC4240149 DOI: 10.3399/bjgp14x682837] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/11/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Demand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. AIM To review the international evidence on interventions to manage referral from primary to specialist care. DESIGN AND SETTING Systematic review. METHOD Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. RESULTS The searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts. CONCLUSIONS To tackle demand management of primary care services, the focus cannot be on primary care alone; a whole-systems approach is needed because the introduction of interventions in primary care is often just the starting point of the referral process. In addition, more research is needed to develop and evaluate interventions that acknowledge the role of the patient in the referral decision.
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Affiliation(s)
- Lindsay Blank
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Susan Baxter
- School of Health and Related Research, University of Sheffield, Sheffield
| | | | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Andrew Lee
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Nick Payne
- School of Health and Related Research, University of Sheffield, Sheffield
| | - Melanie Rimmer
- School of Health and Related Research, University of Sheffield, Sheffield
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The inflammatory bowel disease live interinstitutional and interdisciplinary videoconference education (IBD LIVE) series. Inflamm Bowel Dis 2014; 20:1687-95. [PMID: 25167213 DOI: 10.1097/mib.0000000000000187] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Managing patients with inflammatory bowel disease requires multidisciplinary coordination. Technological advances have enhanced access to care for patients and improved physician interactions. The primary aim of our project was to convene diverse institutions and specialties through a multisite virtual conferencing platform to discuss complex patient management. METHODS The case conference is designed to include multiple institutions to exchange ideas, review evidence-based data, and provide input on the management of patients with Crohn's disease and ulcerative colitis. Technology is supplied and coordinated by an information technology specialist and Chorus Call, Inc., an international teleconferencing service provider. The Inflammatory Bowel Disease Live Interinstitutional Interdisciplinary Videoconference Education (IBD LIVE) initiative is accredited by the University of Pittsburgh Medical Center (UPMC) Center for Continuing Education in the Health Sciences for 1 AMA PRA Category 1 Credit per weekly session. RESULTS IBD LIVE began in 2009 comprising only adult gastroenterology and pediatric gastroenterology from UPMC Presbyterian and Children's Hospitals. Participation steadily increased from 5 sites in 2010 to 11 sites in 2014. Maximum attendance for a single conference was 73 participants with a median of 48. The Continuing Medical Education scores (1 = worst to 5 = best) have a high median overall score (4.6, range 3.2-5.0) with positive responses with regard to the degree to which the conference changed practice. CONCLUSIONS IBD LIVE has been successful and continues to grow. Implementation of the Crohn's and Colitis Foundation of America Virtual Preceptor Program using the IBD LIVE platform will provide expanded national physician access to this professional education activity.
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Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health 2014; 19:444-54. [PMID: 23697504 DOI: 10.1089/tmj.2013.0075] [Citation(s) in RCA: 550] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The effectiveness of any new technology is typically measured in order to determine whether it successfully achieves equal or superior objectives over what is currently offered. Research in telemental health-in this article mainly referring to telepsychiatry and psychological services-has advanced rapidly since 2003, and a new effectiveness review is needed. MATERIALS AND METHODS The authors reviewed the published literature to synthesize information on what is and what is not effective related to telemental health. Terms for the search included, but were not limited to, telepsychiatry, effectiveness, mental health, e-health, videoconferencing, telemedicine, cost, access, and international. RESULTS Telemental health is effective for diagnosis and assessment across many populations (adult, child, geriatric, and ethnic) and for disorders in many settings (emergency, home health) and appears to be comparable to in-person care. In addition, this review has identified new models of care (i.e., collaborative care, asynchronous, mobile) with equally positive outcomes. CONCLUSIONS Telemental health is effective and increases access to care. Future directions suggest the need for more research on service models, specific disorders, the issues relevant to culture and language, and cost.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, Sacramento, California 95817, USA.
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Myers K, Stoep AV, Lobdell C. Feasibility of conducting a randomized controlled trial of telemental health with children diagnosed with attention-deficit/hyperactivity disorder in underserved communities. J Child Adolesc Psychopharmacol 2013; 23:372-8. [PMID: 23952183 PMCID: PMC3749708 DOI: 10.1089/cap.2013.0020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Telemental health (TMH), the use of videoteleconferencing to provide care that is usually delivered in person, is increasingly used to rectify disparities in access to care. Few studies, however, have been conducted to demonstrate the effectiveness of TMH as a service delivery model. The Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) is a randomized clinical trial (RCT) of TMH conducted in multiple underserved communities. This article reports on the feasibility of conducting an effectiveness trial of TMH with children. METHODS The CATTS trial used videoteleconferencing to provide guideline-based care and secure web sites to coordinate key aspects of trial implementation, such as participant recruitment and retention, intervention fidelity, and completion of assessments. RESULTS The CATTS trial engaged seven communities and 150 primary care providers as partners in the study, and enrolled 223 children 5.5-12.9 years old. The intervention group completed an average of 5.3 of 6.0 planned sessions and 96% of controls completed a TMH consultation. Both groups completed an average of 4.8 of the 5.0 assessments. Clinicians demonstrated high fidelity to their treatment protocols. Minor technical difficulties did not interfere with providing care. CONCLUSIONS The CATTS trial demonstrated the feasibility of conducting an RCT of TMH with children living in multiple underserved communities. Telecommunications technologies can facilitate the coordination of research activities across sites and clinicians. Future trials should work closely with study partners to ensure referral of a representative study sample. Further trials are needed to help establish the effectiveness of TMH as a service delivery model. TRIAL REGISTRATION http://clinicaltrials.gov/show/NCT00830700 .
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Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington 98105, USA.
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Caitlin Lobdell
- Department of Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
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Using technology in the delivery of mental health and substance abuse treatment in rural communities: a review. J Behav Health Serv Res 2013; 40:111-20. [PMID: 23093443 DOI: 10.1007/s11414-012-9299-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Rural communities face tremendous challenges in accessing mental health and substance abuse treatment services. Some of the most promising advancements in the delivery of rural health care services have been in the area of telecommunication technology. These applications have the potential to reduce the disparities in the delivery of substance abuse and mental health services between urban and rural communities. The purpose of this inquiry was to explore the advances and uses of telecommunications technology, and related issues, in the delivery of mental health and substance abuse treatment services within rural areas. A review of the academic literature and other relevant works was conducted and the content was organized into four major themes: (a) advantages of telehealth and applications to rural practice, (b) barriers to implementation in rural practice, (c) utilization in rural areas, and (d) areas for further research.
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Myers KM, Lieberman D. Telemental health: responding to mandates for reform in primary healthcare. Telemed J E Health 2013; 19:438-43. [PMID: 23611641 DOI: 10.1089/tmj.2013.0084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Telemental health (TMH) has established a niche as a feasible, acceptable, and effective service model to improve the mental healthcare and outcomes for individuals who cannot access traditional mental health services. The Accountability Care Act has mandated reforms in the structure, functioning, and financing of primary care that provide an opportunity for TMH to move into the mainstream healthcare system. By partnering with the Integrated Behavioral Healthcare Model, TMH offers a spectrum of tools to unite primary care physicians and mental health specialist in a mind-body view of patients' healthcare needs and to activate patients in their own care. TMH tools include video-teleconferencing to telecommute mental health specialists to the primary care setting to collaborate with a team in caring for patients' mental healthcare needs and to provide direct services to patients who are not progressing optimally with this collaborative model. Asynchronous tools include online therapies that offer an efficient first step to treatment for selected disorders such as depression and anxiety. Patients activate themselves in their care through portals that provide access to their healthcare information and Web sites that offer on-demand information and communication with a healthcare team. These synchronous and asynchronous TMH tools may move the site of mental healthcare from the clinic to the home. The evolving role of social media in facilitating communication among patients or with their healthcare team deserves further consideration as a tool to activate patients and provide more personalized care.
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Affiliation(s)
- Kathleen M Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle Children's Hospital, Seattle, Washington 98105, USA.
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Abstract
Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called 'Mental Health Gap'. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store-forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.
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Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
BACKGROUND The use of telemedicine for the care of mental health problems has developed significantly over the last decade thanks to the emergence of a number of stable telepsychiatry programs in many countries. Parallel to this development, this care modality has also targeted specific populations with higher difficulty in gaining access to mental health services such as the elderly. Telepsychogeriatrics is expected to have an increasing role in providing care to geographically isolated rural communities, with a particular focus on long-term care facilities, in light of the high prevalence of psychiatric disorders in these centers and the lack of available specialized care. METHODS A thorough search of the literature was conducted using Medline, Web of Science, and PsychINFO databases in order to gather available evidence on the applicability of telepsychiatry, specifically the use of videoconferencing for remote consultation, in the elderly population with mental disorders. A succinct description of the selected studies is given along with a general reflection on the state-of-the-art in the field of psychogeriatric clinical practice and research. RESULTS Research on the use of telemedicine in this age group has taken into account their special characteristics, and has focused on demonstrating its applicability, the acceptance and satisfaction of elderly users and their healthcare providers, the possibility of carrying out cognitive and diagnostic assessments, and the efficiency of these programs. CONCLUSIONS Despite limited experience, telepsychogeriatrics appears to be a viable option, well accepted by patients, including those having dementia. More systematized studies are needed in this new field based on larger sample sizes, including comparison with traditional consultations and assessment of the clinical outcomes.
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Jacob MK, Larson JC, Craighead WE. Establishing a telepsychiatry consultation practice in rural Georgia for primary care physicians: a feasibility report. Clin Pediatr (Phila) 2012; 51:1041-7. [PMID: 22523276 DOI: 10.1177/0009922812441671] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE One approach to solving mental health care disparity issues in rural areas is by establishing a telepsychiatry consultation practice for children, in which a psychiatrist sees a child via videoconferencing for a limited number of sessions and then provides a treatment plan to that child's primary care physician and family. METHOD The present study offered a 2-session telepsychiatry consultation clinic, consisting of a psychiatric evaluation session and a recommendation session, with patients located remotely in rural Georgia. RESULTS Fifteen consultations with children aged 4 to 18 years (M = 9.73, SD = 3.39) with varying diagnoses were completed. Parental satisfaction with the telepsychiatry consultation model was high, overall mean of 4.58 (SD = 0.63) on a 5-point scale (n = 11). CONCLUSION Establishing a child telepsychiatry consultation practice is feasible in rural areas. This report describes the benefits and challenges of our telepsychiatry consultation clinic with rural pediatric patients.
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Affiliation(s)
- Maryann K Jacob
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30306, USA.
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Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
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Jameson JP, Farmer MS, Head KJ, Fortney J, Teal CR. VA Community Mental Health Service Providers’ Utilization of and Attitudes Toward Telemental Health Care: The Gatekeeper's Perspective. J Rural Health 2011; 27:425-32. [DOI: 10.1111/j.1748-0361.2011.00364.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
In this article we review practice models for treating common mental disorders in primary care. Novel treatment approaches by primary care providers and specialty providers, including collaborative care and telepsychiatric models, show considerable promise. An understanding of remaining barriers to improved care suggests several possible solutions and future directions for outpatient psychosomatic medicine.
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Vuononvirta T, Timonen M, Keinänen-Kiukaanniemi S, Timonen O, Ylitalo K, Kanste O, Taanila A. The attitudes of multiprofessional teams to telehealth adoption in northern Finland health centres. J Telemed Telecare 2010; 15:290-6. [PMID: 19720766 DOI: 10.1258/jtt.2009.090108] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A telehealth network was established between seven health centres, the local university and the university hospital in the Oulu Arc Subregion in a rural area of northern Finland. During the period 2004-2007, the videophone network was used for different types of teleconsultation (orthopaedics, psychiatry, diabetes, rehabilitation), continuing education and various patient care and administrative meetings. Qualitative research with observation and interviews with 30 professionals (physicians, nurses, psychiatric nurses, physiotherapists) was carried out in early 2007 to find out health-care professionals' attitudes toward telehealth and to see how the attitudes were connected to telehealth usage. Overall, the attitudes were more positive than negative, ranging from negative to enthusiastically positive. Diversity of attitudes occurred in relation to time, situation, profession, health centre and telehealth application. Ten different types of telehealth adopters were recognized: enthusiastic user, positive user, critical user, hesitant user, positive participant, hesitant participant, critical participant, neutral participant, negative participant and positive non-participant. Telehealth was especially well accepted in continuing education and in diabetes teleconsultations. The study showed that a negative attitude was not a definite barrier to telehealth adoption, but it did require additional attention from project workers and managers. Project staff and managers need to take into account the diverse attitudes of health professionals, because different people require different actions to adopt telehealth in their work.
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Affiliation(s)
- Tiina Vuononvirta
- Institute of Health Sciences, University of Oulu, FIN-91100, Finland.
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Leigh H, Cruz H, Mallios R. Telepsychiatry appointments in a continuing care setting: kept, cancelled and no-shows. J Telemed Telecare 2010; 15:286-9. [PMID: 19720765 DOI: 10.1258/jtt.2009.090305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We reviewed the appointment data for a psychiatry service in California that provided consultations and also therapy through telepsychiatry. Over an 18-month period, there were 7523 telepsychiatry appointments and 115,148 conventional (face-to-face) appointments. A higher proportion of the telepsychiatry appointments was kept (92% telepsychiatry vs. 87% non-telepsychiatry). Also, telepsychiatry appointments were significantly less likely to be cancelled by patients (3.5% vs. 4.8%) and significantly less likely to be no-shows (4.2% vs. 7.8%). These findings were similar in three of the four counties where the service was delivered. However, one county was different, and further examination suggested that the morale of the staff and patients may have contributed to the unenthusiastic acceptance of telepsychiatry. We conclude that telepsychiatry can be used effectively in continuing care settings as well as in evaluation settings, and that staff and patient morale are important factors in successful telepsychiatry.
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Affiliation(s)
- Hoyle Leigh
- Department of Psychiatry, University of California, San Francisco, Fresno Medical Education Program, Fresno, CA 93701, USA.
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:323-338. [PMID: 20161010 PMCID: PMC2758653 DOI: 10.1111/j.1468-2850.2009.01170.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Affiliation(s)
| | | | - Anouk L. Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY : A PUBLICATION OF THE DIVISION OF CLINICAL PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2009. [PMID: 20161010 DOI: 10.1111/j.1468‐2850.2009.01170.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Paing WW, Weller RA, Welsh B, Foster T, Birnkrant JM, Weller EB. Telemedicine in children and adolescents. Curr Psychiatry Rep 2009; 11:114-9. [PMID: 19302764 DOI: 10.1007/s11920-009-0018-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Psychiatric care for children and adolescents is limited in remote and underserved areas because of the shortage of child and adolescent psychiatrists. Telepsychiatry has the potential to alleviate this problem. This article reviews the procedures used to develop telepsychiatry, equipment needed for videoconferencing in telepsychiatry, benefits and limitations of telepsychiatry, and confidentiality issues in telepsychiatry. Many questions regarding confidentiality, legality, reimbursement, cost-effectiveness, and technology still need to be resolved. However, telepsychiatry has the potential to be a useful treatment alternative.
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Palmas W, Teresi J, Weinstock RS, Shea S. Acceptability to primary care providers of telemedicine in diabetes case management. J Telemed Telecare 2008; 14:306-8. [PMID: 18776076 DOI: 10.1258/jtt.2008.080410] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We studied the perceptions of primary care providers (PCPs) about the telemedicine intervention in a trial of telemedicine for management of diabetes in medically under-served areas of New York State. A survey was mailed to 206 rural and 159 urban PCPs. The response rates were 25% and 22%, respectively. Eighty percent of respondents believed that a diabetes telemedicine case management system would help their practice. An overall satisfaction score (possible range 0-80) suggested good acceptability (mean 66, SD 12). In multiple linear regression, the rural location and younger age of the PCPs were independent predictors of higher satisfaction (both P < 0.01). Within-PCP comparisons showed a higher perceived impact on patients, as compared to impact on PCP practices (P < 0.001). However, the findings should be interpreted with caution due to the low response rates.
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Affiliation(s)
- Walter Palmas
- Department of Medicine, Columbia University, New York, NY, USA.
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Rowe N, Gibson S, Morley S, Krupinski EA. Ten-Year Experience of a Private Nonprofit Telepsychiatry Service. Telemed J E Health 2008; 14:1078-86. [DOI: 10.1089/tmj.2008.0037] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nancy Rowe
- Northern Arizona Regional Behavioral Health Authority, Flagstaff, Arizona
| | - Sara Gibson
- Northern Arizona Regional Behavioral Health Authority, Flagstaff, Arizona
| | - Susan Morley
- Northern Arizona Regional Behavioral Health Authority, Flagstaff, Arizona
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Abstract
Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. A multidisciplinary treatment approach, group care, and case management are common features of mental health treatment settings only rarely used in primary care practices. Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.
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Affiliation(s)
- Stephen Thielke
- Geriatric Mental Health Services, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195, USA.
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