1
|
Zhang Y, Lal LS, Lin YY, Swint JM, Zhang Y, Summers RL, Jones BF, Chandra S, Ladner ME. Tele-Mental Health Service: Unveiling the Disparity and Impact on Healthcare Access and Expenditures during the COVID-19 Pandemic in Mississippi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:819. [PMID: 39063396 PMCID: PMC11276461 DOI: 10.3390/ijerph21070819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.
Collapse
Affiliation(s)
- Yunxi Zhang
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA; (Y.-Y.L.); (S.C.)
| | - Lincy S. Lal
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX 77030, USA; (L.S.L.); (J.M.S.)
| | - Yueh-Yun Lin
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA; (Y.-Y.L.); (S.C.)
| | - J. Michael Swint
- Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX 77030, USA; (L.S.L.); (J.M.S.)
- John P and Katherine G McGovern Medical School, Institute for Clinical Research and Learning Healthcare, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Ying Zhang
- Center for Informatics and Analytics, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Richard L. Summers
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Barbara F. Jones
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA; (B.F.J.); (M.E.L.)
| | - Saurabh Chandra
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA; (Y.-Y.L.); (S.C.)
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mark E. Ladner
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA; (B.F.J.); (M.E.L.)
| |
Collapse
|
2
|
Krakowczyk JB, Truijens F, Teufel M, Lalgi T, Heinen J, Schug C, Erim Y, Pantförder M, Graf J, Bäuerle A. Evaluation of the e-Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial. JMIR Cancer 2024; 10:e53117. [PMID: 38592764 DOI: 10.2196/53117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/23/2023] [Accepted: 01/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Make It Training is an e-mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. OBJECTIVE This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. METHODS In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. RESULTS Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. CONCLUSIONS e-Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support.
Collapse
Affiliation(s)
- Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Femke Truijens
- Department of Psychology, Educational and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Tania Lalgi
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Jana Heinen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, University Hospital Erlangen, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center, University Hospital Erlangen, Erlangen, Germany
| | - Michael Pantförder
- Fraunhofer Institute for Software and Systems Engineering, Dortmund, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Comprehensive Cancer Center, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
3
|
Wolemonwu VC, Ike CG, Barcaro R, Midolo E. ICoME and the moral significance of telemedicine. JOURNAL OF MEDICAL ETHICS 2024; 50:171-172. [PMID: 38071549 DOI: 10.1136/jme-2023-109669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/28/2023] [Indexed: 02/22/2024]
Affiliation(s)
| | | | - Rosangela Barcaro
- Interdepartmental Center for Research Ethics and Integrity (CID Ethics) National Research Council Rome - Italy, Rome, Italy
| | - Emanuela Midolo
- CNR Interdepartmental Center for Research Ethics and Integrity, Rome, Italy
| |
Collapse
|
4
|
Hardeberg Bach M, Ahrens C, Olff M, Armour C, Krogh SS, Hansen M. EHealth for Sexual Assault: A Systematic Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:102-116. [PMID: 36632639 DOI: 10.1177/15248380221143355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Providing efficient psychosocial support for survivors of sexual assault is of critical societal importance. Around the globe, technology-based solutions (eHealth) are increasingly being used to accomplish this task, especially following COVID-19. Despite increased importance and reliance on eHealth for sexual assault, minimal efforts have been made to systematically synthesize research in this area. The present study therefore sought to synthesize what is known about eHealth targeting sexual assault survivors' psychosocial needs using a systematic scoping review methodology. To this end, five databases (CINAHL, Embase, PsycINFO, MEDLINE, and Scopus) were systematically searched for studies published from 2010 onwards using terms such as "sexual assault", "eHealth", "digital health", "telehealth", and variations thereof. Of the 6,491 records screened for eligibility, 85 studies were included in the review. We included empirical studies from all countries pertaining to eHealth for sexual assault for survivors 13 years or older. Many innovative eHealth applications for sexual assault exist today, and the included studies suggested that survivors generally experience eHealth positively and seem to benefit from it. Nevertheless, much more clinical and empirical work is needed to ensure accessible and effective solutions for all.
Collapse
Affiliation(s)
| | | | | | | | | | - Maj Hansen
- University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Shetty SR, Vaddar T, Munoli RN. A qualitative study to assess satisfaction with the Manipal model of telepsychiatry among patients and caregivers. Indian J Psychiatry 2024; 66:43-50. [PMID: 38419921 PMCID: PMC10898534 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_634_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 03/02/2024] Open
Abstract
Context Telepsychiatry in India is nearly two decades old and is witnessing rapid adaptation in clinical services. This warrants studying the satisfaction with this mode from healthcare seekers' point of view. Aim This study aimed to study the treatment satisfaction among persons with psychiatric disorders and their caregivers receiving telepsychiatry services via the Manipal model. Settings and Design This was a qualitative cross-sectional study conducted in three centers, which were part of the Manipal model of telepsychiatry, namely community healthcare centers at Hebri, community healthcare centers at Byndoor, and primary healthcare center (PHC) at Kandlur of Udupi District. Methods and Material Semi-structured interview schedule and focused group discussions were conducted to assess the treatment satisfaction. Statistical Analysis Used Descriptive statistics were used to analyze sociodemographic data, and data generated from focused group discussions were qualitatively analyzed. Collected data were coded, and themes were generated from the codes. Results A total of 45 persons with psychiatric disorders and 28 of the caregivers receiving telepsychiatry services were recruited into this study. Results revealed high satisfaction among patients and caregivers with telepsychiatry services provided to them. Qualitative results of this study revealed high satisfaction among patients and caregivers with telepsychiatry services in different domains such as time, cost of treatment, convenience, doctor-patient communication, and healthcare quality. Conclusion This study witnessed that patients and caregivers were highly satisfied with telepsychiatry services provided to them. These findings clearly indicate the importance of telepsychiatry services in the country, where the concept of telepsychiatry and its practice is rising.
Collapse
Affiliation(s)
| | - Thippeswamy Vaddar
- Department of Psychaitric Social Work, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Ravindra N. Munoli
- Department of Psychiatry, Kasturba Medical College, Manipal Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India
| |
Collapse
|
6
|
Won GH, Lee HJ, Lee JH, Choi TY, Hong HL, Jung CY. Impact of a Psychiatric Consultation Program on COVID-19 Patients: An Experimental Study. Psychiatry Investig 2023; 20:471-480. [PMID: 37253473 DOI: 10.30773/pi.2022.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/17/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Following the coronavirus disease-2019 (COVID-19) outbreak, the importance of addressing acute stress induced by psychological burdens of diseases became apparent. This study attempted to evaluate the effectiveness of a new mode of psychiatric intervention designed to target similar psychological crises. METHODS Participants included 32 out of 114 COVID inpatients at a hospital in Daegu, Korea, who were assessed between March 30 and April 7, 2020. Multiple scales for screening psychological difficulties such as depressed mood, anxiety, insomnia, acute stress, and suicidality were done. Psychological problem evaluations and interventions were conducted in the form of consultations to alleviate participants' psychological challenges via telepsychiatry. The interventions' effects, as well as clinical improvements before and after the intervention, were analyzed. RESULTS As a result of screening, 21 patients were experiencing psychological difficulties beyond clinical thresholds after COVID-19 infection (screening positive group). The remaining 11 were screening negative groups. The two groups differed significantly in past psychiatric histories (p=0.034), with the former having a higher number of diagnoses. The effect of the intervention was analyzed, and clinical improvement before and after the intervention was observed. Our intervention was found to be effective in reducing the overall emotional difficulties. CONCLUSION This study highlighted the usefulness of new interventions required in the context of healthcare following the COVID-19 pandemic.
Collapse
Affiliation(s)
- Geun Hui Won
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hye Jeong Lee
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jong Hun Lee
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Tae Young Choi
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Chi Young Jung
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| |
Collapse
|
7
|
Watson JD, Pierce BS, Tyler CM, Donovan EK, Merced K, Mallon M, Autler A, Perrin PB. Barriers and Facilitators to Psychologists' Telepsychology Uptake during the Beginning of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085467. [PMID: 37107748 PMCID: PMC10139141 DOI: 10.3390/ijerph20085467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 05/11/2023]
Abstract
The COVID-19 pandemic transformed the delivery of psychological services as many psychologists adopted telepsychology for the first time or dramatically increased their use of it. The current study examined qualitative and quantitative data provided by 2619 practicing psychologists to identify variables facilitating and impeding the adoption of telepsychology in the U.S. at the beginning of the COVID-19 pandemic. The top five reported barriers were: inadequate access to technology, diminished therapeutic alliance, technological issues, diminished quality of delivered care or effectiveness, and privacy concerns. The top five reported facilitators were: increased safety, better access to patient care, patient demand, efficient use of time, and adequate technology for telepsychology use. Psychologists' demographic and practice characteristics robustly predicted their endorsement of telepsychology barriers and facilitators. These findings provide important context into the implementation of telepsychology at the beginning of the pandemic and may serve future implementation strategies in clinics and healthcare organizations attempting to increase telepsychology utilization.
Collapse
Affiliation(s)
- Jack D. Watson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Bradford S. Pierce
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Carmen M. Tyler
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Emily K. Donovan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kritzia Merced
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
| | - Margaret Mallon
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Aaron Autler
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Paul B. Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
- School of Data Science and Department of Psychology, University of Virginia, Charlottesville, VA 22903, USA
- Correspondence:
| |
Collapse
|
8
|
La Valle C, Johnston E, Tager-Flusberg H. A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104269. [PMID: 35636261 PMCID: PMC10521149 DOI: 10.1016/j.ridd.2022.104269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments. AIM This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality. METHOD AND PROCEDURES Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools. OUTCOMES AND RESULTS Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality. CONCLUSIONS AND IMPLICATIONS Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.
Collapse
Affiliation(s)
- Chelsea La Valle
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Emily Johnston
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| |
Collapse
|
9
|
Finak P, Hastings-Truelove A, Fecica A, Batorowicz B. Therapy services for children and youth living in rural areas of high-income countries: a scoping review. Disabil Rehabil 2022; 45:1893-1915. [PMID: 35611460 DOI: 10.1080/09638288.2022.2074552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify and describe therapeutic services provided to children and youth with disabilities living in rural areas of mid- and high-income countries and to summarize the benefits, positive outcomes, and challenges related to these services. METHODS This scoping review involved a systematic search of four academic electronic databases: MEDLINE, EMBASE, CINAHL, and Psych INFO, using a combination of subject headings and keywords related to (1) child disabilities; (2) rehabilitation: occupational therapists, speech-language pathologists, physiotherapists, audiologists, and recreation therapists; (3) multidisciplinary care team; (4) rural areas. Charting involved an iterative process whereby the full text articles meeting the inclusion criteria were abstracted using the charting form by two independent reviewers. RESULTS Thirty-seven articles from seven high-income countries were included in the analysis. Twenty-seven articles reported on in-person services, and 19 on telepractice (nine evaluated in-person and telepractice). In person services included outreach programs and specialized on-site programs. Positive outcomes and challenges of in person and telepractice services in rural areas are described. CONCLUSIONS Findings of this review highlight the need for further research on service delivery models offered in rural areas of upper middle and high-income countries, especially those focusing specifically on the rural communities, with a clear description of services. IMPLICATIONS FOR REHABILITATIONThis scoping review helps to advance the understanding of how therapy services are offered in rural areas of high-income countries.Telepractice was found to enhance ease of access to services for families living in rural areas.The findings of this review suggest that telepractice may be an effective means of providing therapy services to children and youth with disabilities living in rural areas of high-income countries, pending families' access to technology.
Collapse
|
10
|
Cox SM, Butcher JL, Sadhwani A, Sananes R, Sanz JH, Blumenfeld E, Cassidy AR, Cowin JC, Ilardi D, Kasparian NA, Kenowitz J, Kroll K, Miller TA, Wolfe KR. Integrating Telehealth Into Neurodevelopmental Assessment: A Model From the Cardiac Neurodevelopmental Outcome Collaborative. J Pediatr Psychol 2022; 47:707-713. [PMID: 35146508 PMCID: PMC9383469 DOI: 10.1093/jpepsy/jsac003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 11/14/2022] Open
Abstract
Objective In the wake of the COVID-19 pandemic, psychologists were pushed to look beyond traditional in-person models of neurodevelopmental assessment to maintain continuity of care. A wealth of data demonstrates that telehealth is efficacious for pediatric behavioral intervention; however, best practices for incorporating telehealth into neurodevelopmental assessment are yet to be developed. In this topical review, we propose a conceptual model to demonstrate how telehealth can be incorporated into various components of neurodevelopmental assessment. Methods Harnessing existing literature and expertise from a multidisciplinary task force comprised of clinicians, researchers, and patient/parent representatives from the subspecialty of cardiac neurodevelopmental care, a conceptual framework for telehealth neurodevelopmental assessment was developed. Considerations for health equity and access to care are discussed, as well as general guidelines for clinical implementation and gaps in existing literature. Results There are opportunities to integrate telehealth within each stage of neurodevelopmental assessment, from intake to testing, through to follow-up care. Further research is needed to determine whether telehealth mitigates or exacerbates disparities in access to care for vulnerable populations as well as to provide evidence of validity for a wider range of neurodevelopmental measures to be administered via telehealth. Conclusions While many practices are returning to traditional, face-to-face neurodevelopmental assessment services, psychologists have a unique opportunity to harness the momentum for telehealth care initiated during the pandemic to optimize the use of clinical resources, broaden service delivery, and increase access to care for pediatric neurodevelopmental assessment.
Collapse
Affiliation(s)
- Stephany M Cox
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California-San Francisco, USA
| | - Jennifer L Butcher
- Department of Pediatrics, University of Michigan School of Medicine & C.S. Mott Children's Hospital, USA
| | - Anjali Sadhwani
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, USA
| | - Renee Sananes
- Labatt Family Heart Centre, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Canada
| | - Jacqueline H Sanz
- Division of Neuropsychology, Children's National Hospital, Departments of Psychiatry and Behavioral Sciences & Pediatrics, George Washington University School of Medicine, USA
| | | | - Adam R Cassidy
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, USA.,Department of Psychiatry and Psychology, Mayo Clinic, USA
| | | | - Dawn Ilardi
- Department of Neuropsychology, Children's Healthcare of Atlanta, and Department of Rehabilitation Medicine, Emory University, USA
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Joslyn Kenowitz
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, USA.,Department of Pediatrics, Thomas Jefferson University, USA
| | - Kristin Kroll
- Department of Pediatrics, Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsin, USA
| | | | - Kelly R Wolfe
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, USA
| |
Collapse
|
11
|
An ontological analysis of the barriers to and facilitators of access to healthcare. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
12
|
Alazzam MB, Al Khatib H, Mohammad WT, Alassery F. E-Health System Characteristics, Medical Performance, and Healthcare Quality at Jordan's Health Centers. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5887911. [PMID: 34868523 PMCID: PMC8642007 DOI: 10.1155/2021/5887911] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022]
Abstract
This research explores how e-health systems' features (information quality, quality of the system, usability perceived, and perceived usefulness) contribute to improving medical personnel performance in medical centers, patient care, and physician-patient interactions in Jordan. The objective is to evaluate a single integrated model consisting of the technology acceptance model. This study used the logical research method and approach. A collection of data from 212 medical personnel working in 19 healthcare facilities throughout Jordan were gathered. To analyze the data collected and test the hypotheses of the research, a partially square/structural equation modeling method has been employed. The study found that the health information system (HIS) information quality has a direct and indirect beneficial effect on the performance of the staff, beneficial effects on patient care alone, and only favorable, indirect effects on the doctor-patient relationship. On the contrary, system quality was shown to influence directly and indirectly and to have a direct and indirect beneficial effect both on the connection between doctors and patients. Remember that the HIS has accessibility, speed, and mistake detection and avoids error issues. These shortcomings are suggested to be rectified in conjunction with improved user perception towards easy usage and utilization of the system.
Collapse
Affiliation(s)
- Malik Bader Alazzam
- Faculty of Computer Science and Informatics, Amman Arab University, Amman, Jordan
| | | | - Walid Theib Mohammad
- Assistant Professor Organization Al-Hussein Bin Talal University, Princess Aisha Bint Al-Hussein Faculty of Nursing, Princess Aisha Nursing College Ma'an, Ma'an, Jordan
| | - Fawaz Alassery
- Department of Computer Engineering, College of Computers and Information Technology, Taif University, Taif, Saudi Arabia
| |
Collapse
|
13
|
An Evaluation of Cognitive Behaviour Therapy with Mindfulness (CBTm) Classes and Telepsychology Utility in Rural Community Settings. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Murphy L, Markey K, O' Donnell C, Moloney M, Doody O. The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review. Arch Psychiatr Nurs 2021; 35:375-394. [PMID: 34176579 PMCID: PMC9759111 DOI: 10.1016/j.apnu.2021.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/26/2021] [Accepted: 05/01/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Globally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. OBJECTIVES To identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. METHODS A scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions. RESULTS COVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection. IMPLICATIONS The importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources. ACCESSIBLE SUMMARY.
Collapse
Affiliation(s)
- Louise Murphy
- School of Nursing and Midwifery, National University of Ireland Galway, Aras Moyola, University Road, Galway, Ireland.
| | - Kathleen Markey
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Claire O' Donnell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Mairead Moloney
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.
| |
Collapse
|
15
|
Goldenson J, Josefowitz N. Remote Forensic Psychological Assessment in Civil Cases: Considerations for Experts Assessing Harms from Early Life Abuse. PSYCHOLOGICAL INJURY & LAW 2021; 14:89-103. [PMID: 33758640 PMCID: PMC7970781 DOI: 10.1007/s12207-021-09404-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/21/2021] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic has brought to the fore the question of whether psycho-legal assessments can be executed remotely in a manner that adheres to the rigorous standards applied during in-person assessments. General guidelines have evolved, but to date, there are no explicit directives about whether and how to proceed. This paper reviews professional, ethical, and legal challenges that experts should consider before conducting such an evaluation remotely. Although the discussion is more widely applicable, remote forensic psychological assessment of adults alleging childhood abuse is used as an example throughout, due to the complexity of these cases, the ethical dilemmas they can present, and the need to carefully assess non-verbal trauma-related symptoms. The use of videoconferencing technology is considered in terms of potential benefits of this medium, as well as challenges this method could pose to aspects of interviewing and psychometric testing. The global pandemic is also considered with respect to its effects on functioning and mental health and the confounding impact such a crisis has on assessing the relationship between childhood abuse and current psychological functioning. Finally, for those evaluators who want to engage in remote assessment, practice considerations are discussed.
Collapse
Affiliation(s)
- Julie Goldenson
- Department of Applied Psychology and Human Behaviour, Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON M5S1V6 Canada
| | - Nina Josefowitz
- Department of Applied Psychology and Human Behaviour, Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON M5S1V6 Canada
| |
Collapse
|
16
|
Liu J, Gao L. Analysis of topics and characteristics of user reviews on different online psychological counseling methods. Int J Med Inform 2020; 147:104367. [PMID: 33401170 DOI: 10.1016/j.ijmedinf.2020.104367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychological support is available more widely supported by emerging technologies as an addition to face-to-face consultations, more and more people are accessing psychological support using online resources. OBJECTIVE This research provides insights into the perception of the key factors that affect the effectiveness of different online psychological counseling methods through the user reviews of four online psychological counseling modes and the tendency to choose the different counseling methods for users with different psychological problems. METHODS Using topic modeling analysis, Gooseeker content analysis, and the TextMind Chinese psychological analysis system, we analyzed 163,377 online reviews from 2,375 psychological consultants extracted from a leading online psychological consultation platform in China. RESULTS (1) Telephone counseling gains the most preferences among users. Text counseling has strong privacy protection. Video and face-to-face consultations are more authentic and comprehensive. (2) Parent-child education consultation users are more likely to choose face-to-face consultation, patients with common mental illnesses are more inclined to choose online counseling methods than offline consultation, career planning consultation clients prefer video consultation, and text counseling is more consistent with the periodical characteristics of relationship counseling. CONCLUSION The research examined user reviews and used content analysis to understand patients' views on the effectiveness of online counseling methods, which supplement the current research gap through innovation in research methods.
Collapse
Affiliation(s)
- Jingfang Liu
- School of Management, Shanghai University, Shanghai, 201800, China
| | - Lu Gao
- School of Management, Shanghai University, Shanghai, 201800, China.
| |
Collapse
|
17
|
Abstract
The utilization of telemedicine and telepsychiatry (TP) services in the outpatient department (OPD) has been increasing in recent years. The information about the technological, administrative, and clinical challenges is being addressed by the telemedicine and TP guidelines published by several individual nations. TP aims to address the treatment gaps, barriers for utilization, accessibility, diagnostic validity, financial implications, and individual client preferences. Utilization of TP in the OPD varies from country to country depending upon their healthcare delivery systems. It also varies in populations utilizing the TP services-urban, rural, child and adolescent, geriatric, and differently abled. TP services in the OPDs are being incorporated differentially by government organizations, insurance recognized psychiatric healthcare organizations, private psychiatric group practice deliverers, and individual, standalone psychiatric healthcare deliverers. TP may not replace the traditional in-person consultations completely. Covid-19 pandemic has hastened its utilization across several healthcare delivery systems. Healthcare organizations, clinicians, other healthcare deliverers, and end users are in the process of adapting to the new scenario. Incorporation of the big data, machine learning, artificial intelligence, virtual reality, and other technological advances in the psychiatric healthcare delivery systems into TP services in the OPDs would significantly contribute to the overall quality and efficacy of the psychiatric healthcare delivery systems in the future.
Collapse
Affiliation(s)
| | | | - Amala Emani
- Columbus Hospital, Hyderabad, Telangana, India
| | | |
Collapse
|
18
|
Melville C. Digital provision of sexual and reproductive healthcare: promising but not a panacea. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:239-241. [PMID: 32883684 DOI: 10.1136/bmjsrh-2020-200668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
|
19
|
e-health usage and health workers' motivation and job satisfaction in Ghana. PLoS One 2020; 15:e0239454. [PMID: 32966323 PMCID: PMC7510985 DOI: 10.1371/journal.pone.0239454] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background The application of digital technology to improve health service delivery is increasing rapidly in Low- and Middle- Income Countries (LMICs). Digital tools such as electronic health (e-health) have been shown to improve healthcare quality, efficiency and patient satisfaction. However, evidence on health workers’ experiences using e-health services is limited in LMICs. This study examined the relationship between e-health usage and health workers’ motivation and job satisfaction. Methods This was a cross-sectional survey design involving health workers across public and private hospitals in the Accra Metropolitan Assembly (AMA). A structured questionnaire was designed and self-administered to 305 respondents. Partial Least Square-Structural Equation Modelling (PLS-SEM) was employed to analyse the data. Results Findings showed a significant positive association of job satisfaction with e-health (p < 0.01) and type of hospital (p < 0.01) but not motivation (p = 0.42). Although type of hospital significantly influenced job satisfaction (p < 0.01), it had no significant mediating effect on the relationship between e-health and job satisfaction. Finally, type of hospital interacted with e-health to moderate the association between e-health usage and job satisfaction. Conclusion The findings suggest that e-health systems can catalyse health workers job satisfaction. Thus, measures to strengthen e-health structures to improve on their efficiency and effectiveness is crucial.
Collapse
|
20
|
Johnson KF, Rehfuss M. Telehealth Interprofessional Education: Benefits, Desires, and Concerns of Counselor Trainees. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2020. [DOI: 10.1080/15401383.2020.1751766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Mark Rehfuss
- Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
21
|
Hilty DM, Gentry MT, McKean AJ, Cowan KE, Lim RF, Lu FG. Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches. Mhealth 2020; 6:20. [PMID: 32270012 PMCID: PMC7136658 DOI: 10.21037/mhealth.2019.10.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 - July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and other databases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.
Collapse
Affiliation(s)
- Donald M. Hilty
- Northern California Veterans Administration Health Care System, Mather, CA 95655, USA
- Department of Psychiatry & Behavioral Sciences, UC Davis, Mather, CA 95655, USA
| | - Melanie T. Gentry
- Geriatric Psychiatry Fellowship, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Alastair J. McKean
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Kirsten E. Cowan
- Essentia Health and Child Psychiatrist Affiliated with Mayo Clinic Department of Psychiatry and Psychology, Hinckley, MN 55037, USA
| | - Russell F. Lim
- Emeritus Clinical Professor of Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Francis G. Lu
- Clinical Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| |
Collapse
|
22
|
Arsenijevic J, Tummers L, Bosma N. Adherence to Electronic Health Tools Among Vulnerable Groups: Systematic Literature Review and Meta-Analysis. J Med Internet Res 2020; 22:e11613. [PMID: 32027311 PMCID: PMC7055852 DOI: 10.2196/11613] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/26/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023] Open
Abstract
Background Electronic health (eHealth) tools are increasingly being applied in health care. They are expected to improve access to health care, quality of health care, and health outcomes. Although the advantages of using these tools in health care are well described, it is unknown to what extent eHealth tools are effective when used by vulnerable population groups, such as the elderly, people with low socioeconomic status, single parents, minorities, or immigrants. Objective This study aimed to examine whether the design and implementation characteristics of eHealth tools contribute to better use of these tools among vulnerable groups. Methods In this systematic review, we assessed the design and implementation characteristics of eHealth tools that are used by vulnerable groups. In the meta-analysis, we used the adherence rate as an effect size measure. The adherence rate is defined as the number of people who are repetitive users (ie, use the eHealth tool more than once). We also performed a meta-regression analysis to examine how different design and implementation characteristics influenced the adherence rate. Results Currently, eHealth tools are continuously used by vulnerable groups but to a small extent. eHealth tools that use multimodal content (such as videos) and have the possibility for direct communication with providers show improved adherence among vulnerable groups. Conclusions eHealth tools that use multimodal content and provide the possibility for direct communication with providers have a higher adherence among vulnerable groups. However, most of the eHealth tools are not embedded within the health care system. They are usually focused on specific problems, such as diabetes or obesity. Hence, they do not provide comprehensive services for patients. This limits the use of eHealth tools as a replacement for existing health care services.
Collapse
Affiliation(s)
- Jelena Arsenijevic
- Utrecht University School of Governance, Faculty of Law Economics and Governance, Utrecht, Netherlands
| | - Lars Tummers
- Utrecht University School of Governance, Faculty of Law Economics and Governance, Utrecht, Netherlands
| | - Niels Bosma
- Utrecht University School of Economics, Faculty of Law Economics and Governance, Utrecht, Netherlands
| |
Collapse
|
23
|
Pierce BS, Perrin PB, McDonald SD. Path analytic modeling of psychologists’ openness to performing clinical work with telepsychology: A national study. J Clin Psychol 2019; 76:1135-1150. [DOI: 10.1002/jclp.22851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Paul B. Perrin
- Psychology DepartmentVirginia Commonwealth University Virginia
| | - Scott D. McDonald
- Psychology DepartmentVirginia Commonwealth University Virginia
- Mental Health ServicesHunter Holmes McGuire VA Medical CenterRichmond Virginia
| |
Collapse
|
24
|
Serhal E, Lazor T, Kurdyak P, Crawford A, de Oliveira C, Hancock-Howard R, Coyte PC. A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities. J Telemed Telecare 2019; 26:607-618. [DOI: 10.1177/1357633x19853139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Residents of Northern Ontario have limited access to local psychiatric care. To address this, three program models exist: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist. Evidence shows that telepsychiatry has comparable outcomes to in-person consultations. The objective of this study was to determine the cost difference between programs. Methods A cost-minimization analysis estimating cost per visit from a public healthcare payer economic costing perspective was conducted. Data on fixed and variable costs were obtained. Evidence-based assumptions were made where relevant. Base-case scenarios and a break-even analysis were completed, as well as deterministic and probabilistic sensitivity analyses, to explore the effects of parameter variability on program costs. Results Costs per visit were lowest in telepsychiatry (CAD$360) followed by traveling physicians (CAD$558) and patient reimbursement (CAD$620). Among the 100,000 Monte Carlo simulations, results showed telepsychiatry was the least costly program in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively. The break-even analysis found telepsychiatry was the least costly program after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients). Discussion Our analyses support telepsychiatry as the least costly program. These results have important implications for program planning, including the prioritization of telepsychiatry, increased integration of telepsychiatry with other modalities of outreach psychiatry, and limiting use of the patient remuneration program to where medically necessary, to reduce overall cost.
Collapse
Affiliation(s)
- Eva Serhal
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tanya Lazor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
25
|
Ashwick R, Turgoose D, Murphy D. Exploring the acceptability of delivering Cognitive Processing Therapy (CPT) to UK veterans with PTSD over Skype: a qualitative study. Eur J Psychotraumatol 2019; 10:1573128. [PMID: 30774784 PMCID: PMC6366402 DOI: 10.1080/20008198.2019.1573128] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/31/2018] [Accepted: 01/15/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Research shows that veterans with mental health difficulties are reluctant to engage with treatment due to a number of practical and psychological barriers. Tele-therapy has been proposed as an alternative method of delivering therapy to ensure hard-to-reach groups receive the care they need. Objective: This study aimed to explore the acceptability of using tele-therapy for treating PTSD in a sample of UK veterans. Methods: Sixteen participants who had engaged with tele-therapy for PTSD were contacted following the cessation of their treatment, including those who had not completed the full course of therapy. Semi-structured qualitative interviews were conducted and the transcripts were analysed using thematic analysis. Results: Five key themes emerged: Effect of your own environment, Importance of good therapeutic alliance, Technicalities and practicalities, Personal accountability and Measuring change. Effect of your own environment was described with sub-themes of control over your own environment, lack of support between sessions and snap back to reality. The Importance of good therapeutic alliance encompassed putting a face to the name, impersonal feeling and no different from being in the room. Technicalities and practicalities depicted good preparation is key, the flexibility of Skype, technical aspects and session length and timing. Personal accountability detailed finding the time and space, managing attendance and engagement and moving forward. Measuring change illustrated negative past experiences with therapy, improving self-recognition and managing symptoms. Discussion: Tele-therapy appeared to be acceptable within this sample of veterans with many reporting overall positive experiences and improvements to their health. Future research is needed to foster a more supportive environment during and after therapy.
Collapse
Affiliation(s)
| | | | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, UK.,Department of Psychological Medicine, King's Centre for Military Health Research, King's College London, London, UK
| |
Collapse
|
26
|
Schure MB, Howard M, Bailey SJ, Bryan B, Greist J. Exploring Perceptions of a Computerized Cognitive Behavior Therapy Program in a U.S. Rural Western State. RURAL MENTAL HEALTH 2018; 42:174-183. [PMID: 30740195 PMCID: PMC6366631 DOI: 10.1037/rmh0000102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Computerized mental health interventions have the potential to address existing mental health care disparities in rural communities. The aim of this study was to conduct an exploratory examination on the acceptability of an interactive computerized cognitive behavior therapy program to reduce depressive symptoms for adults in a rural Western state. Partnering with the land-grant university Extension system and a state non-profit organization, we identified and interviewed 18 key informants and conducted 19 focus groups in 15 rural communities to ascertain attitudes and perspectives about the program. Key informants were provided access to the Thrive program prior to the interviews. Focus group participants were provided a brief demonstration of the program and asked to provide feedback. Content analyses of interview and focus group transcripts yielded four general themes of program acceptability: privacy, accessibility, user-friendliness, and cultural inappropriateness. Overall, participants indicated that the Thrive program would be useful for many in their communities. They also reported that the program could be improved by making videos that better represent rural community members' lifestyles and experiences. The study team members acted on these findings to improve the Thrive program for rural Western populations.
Collapse
Affiliation(s)
- Mark B. Schure
- Health & Human Development, Montana State University, Bozeman, MT
| | - Meredith Howard
- Health & Human Development, Montana State University, Bozeman, MT
| | - Sandra J. Bailey
- Health & Human Development, Montana State University, Bozeman, MT
| | | | - John Greist
- Center for Mental Health Research & Recovery, Montana State University, Bozeman, MT
| |
Collapse
|
27
|
Telehealth for Rural Diverse Populations: Cultural and Telebehavioral Competencies and Practical Approaches for Clinical Services. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41347-018-0054-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
28
|
Stewart RW, Orengo-Aguayo RE, Cohen JA, Mannarino AP, de Arellano MA. A Pilot Study of Trauma-Focused Cognitive-Behavioral Therapy Delivered via Telehealth Technology. CHILD MALTREATMENT 2017; 22:324-333. [PMID: 28868894 DOI: 10.1177/1077559517725403] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Significant barriers exist in access to evidence-based, trauma-focused treatment among youth from economically disadvantaged backgrounds, those living in rural areas, and belonging to a racial and ethnic minority group, despite the high prevalence rates of trauma exposure among these underserved groups. The present study is proof-of-concept pilot of trauma-focused cognitive-behavioral therapy (TF-CBT) delivered to underserved trauma-exposed youth ( N = 15) via telehealth technology (i.e., via one-on-one videoconferencing), aimed at addressing barriers in access to TF treatment. This pilot study provides preliminary evidence of the ability to successfully deliver TF-CBT via a telehealth delivery format. Results demonstrated clinically meaningful symptom change posttreatment (large effect sizes for youth-reported ( d = 2.93) and caregiver-reported ( d = 1.38) reduction in posttraumatic stress disorder symptoms), with no treatment attrition (0% dropout). These findings are promising in showing treatment effects that are comparable with TF-CBT delivered in an in-person, office-based setting and an important first step in determining how to best address the mental health needs of trauma-exposed youth with barriers in access to care.
Collapse
Affiliation(s)
- Regan W Stewart
- 1 Department of Psychology and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rosaura E Orengo-Aguayo
- 1 Department of Psychology and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Michael A de Arellano
- 1 Department of Psychology and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
29
|
Ouhbi S, Fernández-Alemán JL, Carrillo-de-Gea JM, Toval A, Idri A. E-health internationalization requirements for audit purposes. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 144:49-60. [PMID: 28495006 DOI: 10.1016/j.cmpb.2017.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 03/01/2017] [Accepted: 03/15/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVE In the 21st century, e-health is proving to be one of the strongest drivers for the global transformation of the health care industry. Health information is currently truly ubiquitous and widespread, but in order to guarantee that everyone can appropriately access and understand this information, regardless of their origin, it is essential to bridge the international gap. The diversity of health information seekers languages and cultures signifies that e-health applications must be adapted to satisfy their needs. METHODS In order to achieve this objective, current and future e-health programs should take into account the internationalization aspects. This paper presents an internationalization requirements specification in the form of a reusable requirements catalog, obtained from the principal related standards, and describes the key methodological elements needed to perform an e-health software audit by using the internationalization knowledge previously gathered. RESULTS S Health, a relevant, well-known Android application that has more than 150 million users in over 130 countries, was selected as a target for the e-health internationalization audit method and requirements specification presented above. This application example helped us to put into practice the proposal and show that the procedure is realistic and effective. CONCLUSIONS The approach presented in this study is subject to continuous improvement through the incorporation of new knowledge originating from additional information sources, such as other standards or stakeholders. The application example is useful for early evaluation and serves to assess the applicability of the internationalization catalog and audit methodology, and to improve them. It would be advisable to develop of an automated tool with which to carry out the audit method.
Collapse
Affiliation(s)
- Sofia Ouhbi
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | - José Luis Fernández-Alemán
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | | | - Ambrosio Toval
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| | - Ali Idri
- Software Project Management Research Team, ENSIAS, Mohammed V University in Rabat, Rabat, Morocco.
| |
Collapse
|
30
|
Stewart RW, Orengo-Aguayo RE, Gilmore AK, de Arellano M. Addressing Barriers to Care Among Hispanic Youth: Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy. THE BEHAVIOR THERAPIST 2017; 40:112-118. [PMID: 28670047 PMCID: PMC5488804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
31
|
Fortney JC, Pyne JM, Turner EE, Farris KM, Normoyle TM, Avery MD, Hilty DM, Unützer J. Telepsychiatry integration of mental health services into rural primary care settings. Int Rev Psychiatry 2016; 27:525-39. [PMID: 26634618 DOI: 10.3109/09540261.2015.1085838] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
From a population health perspective, the mental health care system in the USA faces two fundamental challenges: (1) a lack of capacity and (2) an inequitable geographic distribution of services. Telepsychiatry can help address the equity problem, and if applied thoughtfully, can also help address the capacity problem. In this paper we describe how telepsychiatry can be used to address the capacity and equity challenges related to the delivery of mental health services in rural areas. Five models of telepsychiatry are described, including (1) the traditional telepsychiatry referral model, (2) The telepsychiatry collaborative care model, (3) the telepsychiatry behavioural health consultant model, (4) the telepsychiatry consultation-liaison model, and (5) the telepsychiatry curbside consultation model. The strong empirical evidence for the telepsychiatry collaborative care model is presented along with two case studies of telepsychiatry consultation in the context of the telepsychiatry collaborative care model. By placing telepsychiatrists and tele-therapists in consultation roles, telepsychiatry collaborative care has the potential to leverage scarce specialist mental health resources to reach more patients, thereby allowing these providers to have a greater population level impact compared to traditional referral models of care. Comparative effectiveness trials are needed to identify which models of telepsychiatry are the most appropriate for patients with complex psychiatric disorders.
Collapse
Affiliation(s)
- John C Fortney
- a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington.,b Department of Veterans Affairs, Health Services Research and Development , Center of Innovation for Veteran-Centered and Value-Driven Care , Seattle , Washington
| | - Jeffrey M Pyne
- c Department of Psychiatry, College of Medicine , University of Arkansas for Medical Sciences , Little Rock Arkansas.,d Department of Veterans Affairs, Health Services Research and Development , Center for Mental Healthcare and Outcomes Research , Little Rock Arkansas
| | - Eric E Turner
- a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington.,e Seattle Children's Research Institute , Seattle , Washington
| | | | | | - Marc D Avery
- a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington
| | - Donald M Hilty
- h Department of Psychiatry and Behavioral Sciences, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Jürgen Unützer
- a Department of Psychiatry, School of Medicine , University of Washington , Seattle , Washington
| |
Collapse
|
32
|
Hilty DM, Shoemaker EZ, Myers K, Snowdy CE, Yellowlees PM, Yager J. Need for and Steps Toward a Clinical Guideline for the Telemental Healthcare of Children and Adolescents. J Child Adolesc Psychopharmacol 2016; 26:283-95. [PMID: 26871510 DOI: 10.1089/cap.2015.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This article identifies and describes key considerations toward the development of a clinical guideline intended to optimize telemental healthcare (TMH) of children and adolescents. METHODS The literature was searched with key terms and title words. Of 2824 articles that met primary or secondary key word search criteria, 326 met both criteria, and 118 thematically related directly to child and adolescent TMH. Only 44 studies met levels of evidence I-III and expert recommendation criteria used in clinical guidelines; review of their references found 8 additional studies (52 total). Data from adult, child, and adolescent in-person psychiatric care and adult TMH were applied to provide context in developing the key considerations. RESULTS TMH guidelines for adults are well delineated, and TMH guidelines for children and adolescents are likely to closely overlap in terms of general clinical, technical, and administrative issues. However, for a child and adolescent focus, modifications of existing general guidelines appear necessary; for example, based on developmental status, family involvement, and patient-site modifications for space and sound. Additional clinical issues include specify who, exactly, is the "patient" (i.e., the patient, family, and /or other stakeholders), modalities of care (i.e., age-related psychotherapies such as play therapy or behavior management), and psychopharmacology. CONCLUSIONS Specific clinical, administrative, and technical issues are key considerations - based on the nuances of established child and adolescent mental healthcare - and must be considered in developing a clinical guideline for TMH of these patients. Developing such guidance should proceed from a careful review of the growing evidence base, and through expert consensus processes.
Collapse
Affiliation(s)
- Donald M Hilty
- 1 Kaweah Delta Medical Center, Visalia, California.,2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Erica Z Shoemaker
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California.,3 Child and Adolescent Services Los Angeles County and University of Southern California Medical Center , Los Angeles, California
| | - Kathleen Myers
- 4 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,5 Telemental Health Service, Seattle Children's Hospital , Seattle, Washington
| | - Christopher E Snowdy
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Peter M Yellowlees
- 6 Department of Psychiatry, UC Davis School of Medicine , Davis, California
| | - Joel Yager
- 7 Department of Psychiatry, University of Colorado at Denver School of Medicine , Denver, Colorado
| |
Collapse
|
33
|
Goldstein F, Glueck D. Developing Rapport and Therapeutic Alliance During Telemental Health Sessions with Children and Adolescents. J Child Adolesc Psychopharmacol 2016; 26:204-11. [PMID: 26491890 DOI: 10.1089/cap.2015.0022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the special considerations for building rapport and establishing a therapeutic alliance when conducting mental health evaluations for children and adolescents via videoconferencing. METHODS The authors review the literature and describe their experience in conducting mental health evaluations, developing rapport, and establishing a therapeutic alliance during telemental health practice. RESULTS Clinical need and shortages of clinicians with expertise in evaluating mental conditions for children and adolescents in underserved communities have stimulated the rapid expansion of telemental health programs while the research base continues to develop. The emerging evidence base and clinical experience suggest that teleclinicians can, and do, build rapport and establish a therapeutic alliance during telemental health sessions with youth and families. Families may be more accepting of telemental health approaches than clinicians. The impact that technology, equipment, site staff, community supports, cultural identification, and teleclinicians' characteristics have on building rapport and establishing a therapeutic alliance should be considered when establishing a telemental health service. Staff at the patient site and referring providers have a valuable role in supporting the therapeutic alliance between telemental health providers and their patients, and ultimately supporting the success of a telemental health program. CONCLUSIONS Teleclinicians are creative in transcending the videoconferencing technology to evaluate patients using guideline-based care. Further research is needed to determine how clinicians build rapport and establish a therapeutic alliance during telemental health sessions, and whether the therapeutic alliance is associated with the accuracy of evaluation and outcomes.
Collapse
Affiliation(s)
- Felissa Goldstein
- 1 Department of Child and Adolescent Psychiatry, Marcus Autism Center , Atlanta, Georgia
| | - Dehra Glueck
- 2 Office of Medical Student Education, Washington University in St. Louis School of Medicine , St. Louis, Missouri
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Giles AR, Hognestad S, Brooks LA. The Need for Cultural Safety in Injury Prevention. Public Health Nurs 2015; 32:543-9. [DOI: 10.1111/phn.12210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Audrey R. Giles
- School of Human Kinetics; Faculty of Health Sciences; University of Ottawa; Ottawa Ontario Canada
| | - Sarah Hognestad
- Faculty of Education; University of Ottawa; Ottawa Ontario Canada
| | - Lauren A. Brooks
- School of Human Kinetics; Faculty of Health Sciences; University of Ottawa; Ottawa Ontario Canada
| |
Collapse
|
36
|
Dorstyn DS, Saniotis A, Sobhanian F. A systematic review of telecounselling and its effectiveness in managing depression amongst minority ethnic communities. J Telemed Telecare 2014; 19:338-46. [PMID: 24163298 DOI: 10.1177/1357633x13501767] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Telecounselling--the provision of counselling services by telephone, videoconferencing or Internet media--can assist with disparities in the treatment and management of depression for minority ethnic groups. We therefore reviewed the evidence examining the effectiveness of telecounselling for this population. This involved a search of electronic databases, the grey literature and two peer-reviewed journals. Study quality was examined using the Oxford Centre for Evidence Based Medicine guidelines. Cohen's d effect sizes were additionally calculated for between-study comparisons. The final sample comprised eight independent studies, with a total of 498 adults of Asian, African-American or Spanish origin. None of the studies met the criteria for the highest methodological rating (Level 1) and there were five studies at Level 2. Significant short-term treatment effects were associated with telephone- and Internet-mediated services, including moderate to large improvements across measures of depression, anxiety, quality of life and psychosocial functioning reported. Longer-term treatment effects were also reported, although these results were based on very limited data. The results highlight the need for additional rigorous research to determine the clinical efficacy of telecounselling as a treatment option for depression among minority communities.
Collapse
Affiliation(s)
- Diana S Dorstyn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | | | | |
Collapse
|
37
|
Woodward A, Fyfe M, Handuleh J, Patel P, Godman B, Leather A, Finlayson A. Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers. HUMAN RESOURCES FOR HEALTH 2014; 12:22. [PMID: 24754997 PMCID: PMC4021507 DOI: 10.1186/1478-4491-12-22] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 03/31/2014] [Indexed: 05/14/2023]
Abstract
BACKGROUND Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. METHODS This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. RESULTS All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. CONCLUSIONS Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users.
Collapse
Affiliation(s)
- Aniek Woodward
- King’s International Development Institute, King’s College London, Strand, London, UK
- King’s Centre for Global Health, King’s College London and King’s Health Partners, Weston Education Centre, London, UK
- London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Molly Fyfe
- King’s Centre for Global Health, King’s College London and King’s Health Partners, Weston Education Centre, London, UK
- Department of Education, King’s College London, London, UK
| | | | - Preeti Patel
- The Department of War Studies at King’s College London, The Strand Campus, London, UK
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Srathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | - Andrew Leather
- King’s Centre for Global Health, King’s College London and King’s Health Partners, Weston Education Centre, London, UK
| | - Alexander Finlayson
- Green Templeton College and Department of Primary Care, University of Oxford, Oxford, UK
- Medicine Africa, Oxford, UK
| |
Collapse
|
38
|
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.
Collapse
Affiliation(s)
- Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, Sacramento, California 95817, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Jang Y, Chiriboga DA, Molinari V, Roh S, Park Y, Kwon S, Cha H. Telecounseling for the linguistically isolated: a pilot study with older Korean immigrants. THE GERONTOLOGIST 2013; 54:290-6. [PMID: 23355448 DOI: 10.1093/geront/gns196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Responding to the critical needs of the linguistically isolated, this pilot study tested the use of telehealth technology in providing access to culturally and linguistically appropriate mental health services. The goal of the study was to explore the feasibility and preliminary efficacy of a telecounseling program in the client's native language. DESIGN AND METHODS Using a small sample of older Korean immigrants living in a low-income housing facility in Orlando, Florida, who had concerns about depressive moods (n = 14), the pilot telecounseling program was implemented via videoconferencing. Four weekly sessions were conducted by 4 Korean mental health counselors based in New York. RESULTS A high level of completion (86%) and overall satisfaction with the program were observed. Participants also exhibited a significant reduction in depressive symptom severity shortly after completion of the program. At the 3-month follow-up, the participants' depressive symptom scores remained significantly lower than those at the initial assessment. IMPLICATIONS The findings support the value of telecounseling for linguistically isolated populations and suggest further efforts to extend such programs.
Collapse
Affiliation(s)
- Yuri Jang
- *Address correspondence to Yuri Jang, School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., D3500, Austin, TX 78712. E-mail:
| | | | | | | | | | | | | |
Collapse
|
40
|
Greenstock L, Woodward-Kron R, Fraser C, Bingham A, Naccarella L, Elliott K, Morris M. Telecommunications as a means to access health information: an exploratory study of migrants in australia. J Public Health Res 2012; 1:216-21. [PMID: 25170467 PMCID: PMC4140371 DOI: 10.4081/jphr.2012.e34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/12/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health policies increasingly promote e-health developments (e.g., consumers' access to online health information) to engage patients in their health care. In order to make these developments available for culturally and socially diverse communities, not only do Internet accessibility, literacy and e-health literacy need to be taken into account, but consumers' preferences and information seeking behaviours for accessing health information have also to be understood. These considerations are crucial when designing major new health policy directions, especially for migration destination countries with culturally diverse populations, such as Australia. The aim of this study was to examine how people from a culturally and linguistically diverse (CALD) community use telecommunications (phone, mobile, Internet) to access health information. DESIGN AND METHODS A case study was conducted using a questionnaire exploring the use of telecommunications to access health information among CALD people. The study was carried out at a community health centre in a socially and economically disadvantaged area of Melbourne, a city of 4 million people with a large CALD and migrant population. Questionnaires were translated into three languages and interpreters were provided. Fifty-nine questionnaires were completed by users of the community health centre. RESULTS Most of the CALD participants did not have access to the Internet at home and very few reported using telecommunications to access health information. CONCLUSIONS The findings of the study suggest that telecommunications are not necessarily perceived to be an important channel for accessing health information by members of the CALD community.
Collapse
Affiliation(s)
| | | | - Catriona Fraser
- Australian Health Workforce Institute , Melbourne, Australia
| | - Amie Bingham
- Australian Health Workforce Institute , Melbourne, Australia
| | | | | | | |
Collapse
|
41
|
Shore J, Kaufmann LJ, Brooks E, Bair B, Dailey N, Richardson WJB, Floyd J, Lowe J, Nagamoto H, Phares R, Manson S. Review of American Indian veteran telemental health. Telemed J E Health 2012; 18:87-94. [PMID: 22283396 DOI: 10.1089/tmj.2011.0057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement. The outcomes of these assessments have been documented in a series of published articles, controlled studies, program and case reports, and model descriptions. This article summarizes a decade of experience with the American Indian Telemental Health Clinics, the clinic model, and the literature arising from these clinics and presents lessons learned while establishing, maintaining, and evaluating these clinics. The ability to tailor the clinics to individual sites and cultures and to provide various services has been critical to the operation of the clinics. Culturally specific care through culturally knowledgeable providers, onsite tribal outreach workers, and collaboration with community services has proven essential in operating the clinics, as well as building rapport, trust, and engagement with the target patient population. It is hoped that the lessons learned and practices presented here can not only assist others working to improve the care for rural Native veterans but also serve as a model in the use of telemental health services for improving care and access to rural veteran and non-veteran populations.
Collapse
Affiliation(s)
- Jay Shore
- Veterans Rural Health Resource Center-Western Region, Office of Rural Health, Department of Veterans Affairs, Salt Lake City, Utah, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.
Collapse
Affiliation(s)
- John C Fortney
- Health Services Research and Development (HSR&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
| | | | | | | | | |
Collapse
|
43
|
Yellowlees P, Shore J, Roberts L. Practice guidelines for videoconferencing-based telemental health - October 2009. Telemed J E Health 2011; 16:1074-89. [PMID: 21186991 DOI: 10.1089/tmj.2010.0148] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|
44
|
Abstract
Because of the overwhelming maldistribution of mental health specialists in metropolitan areas and the many underserved families living in rural settings, rural areas are natural homes for the use of telemedicine or videoconferencing technology for clinical services. The authors describe telepsychology services for rural clients, placing best psychology practices within the context of broader telemental health services. The goal is to approximate evidence-based child psychotherapy from face-to-face practice using the videoconferencing technology. Telepsychology is illustrated with a case report of a rural Hispanic teen and her family presenting through the teen's primary care clinic.
Collapse
Affiliation(s)
- Eve-Lynn Nelson
- Kansas University Medical Center, Center for Telemedicine and Department of Pediatrics, 2012 Wahl Annex, MS 1048, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
| | | |
Collapse
|
45
|
Glaser M, Winchell T, Plant P, Wilbright W, Kaiser M, Butler MK, Goldshore M, Magnus M. Provider Satisfaction and Patient Outcomes Associated with a Statewide Prison Telemedicine Program in Louisiana. Telemed J E Health 2010; 16:472-9. [DOI: 10.1089/tmj.2009.0169] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michelle Glaser
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC
| | - Tom Winchell
- LSU Health Sciences Center, New Orleans, Louisiana
| | - Patty Plant
- LSU Health Care Services Division, Baton Rouge, Louisiana
| | | | - Michael Kaiser
- LSU Health Care Services Division, Baton Rouge, Louisiana
| | | | - Matthew Goldshore
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC
| |
Collapse
|
46
|
Abstract
A telepsychiatry project was conducted to improve access to culturally appropriate care providers (i.e. culturally competent, bilingual clinicians) by the use of videoconferencing. A self-completed retrospective questionnaire survey was conducted with asylum seekers, refugees and migrants. The purpose of the referral was either for diagnostic assessment with a subsequent treatment recommendation, or for treatment via telepsychiatry. The service was free of charge for the patients involved. Over a period of 34 months (starting in January 2005), 61 patients participated in the pilot project. The patients' residency status was: refugees (n = 45), asylum seekers (n = 12), migrants (n = 3) and domestic (n = 1). A total of 318 telepsychiatry sessions (lasting 35-45 min) was conducted, with an average of 5.2 sessions per patient. Nine languages were spoken during the study period (Danish, Arabic, Farsi, Somali, Kurdish, Polish, Bosnian, Serbian and Croatian). A total of 52 patients completed the questionnaire. Patients reported a high level of satisfaction and willingness to use telepsychiatry again and recommend it to others. They preferred telepsychiatry via their mother tongue, rather than interpreter-assisted care.
Collapse
Affiliation(s)
- Davor Mucic
- Little Prince Psychiatric Centre, Copenhagen, Denmark.
| |
Collapse
|
47
|
George SM, Hamilton A, Baker R. Pre-experience perceptions about telemedicine among African Americans and Latinos in South Central Los Angeles. Telemed J E Health 2009; 15:525-30. [PMID: 19566397 DOI: 10.1089/tmj.2008.0152] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study explores perceptions about telemedicine among urban underserved African American and Latino populations. Telemedicine has been advanced as a vehicle to increase access to specialty care among the urban underserved, yet little is known about its acceptability among these populations. We conducted 10 focus groups with African American and Latino participants (n = 87) in urban Los Angeles in order to explore perceptions about this novel type of care. We found that concerns about telemedicine varied between the two racial/ethnic groups. These findings have implications for important issues such as adoption of telemedicine, patient satisfaction, and doctor-patient interaction. It will be critical to consider perceptions of this healthcare innovation in the development of strategies to market and implement telemedicine among urban, underserved African American and Latino populations.
Collapse
Affiliation(s)
- Sheba M George
- Biomedical Research Center, Charles Drew University of Medicine and Science, Los Angeles, California 90262, USA.
| | | | | |
Collapse
|