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Sheinfil AZ, Day G, Walder A, Hogan J, Giordano TP, Lindsay J, Ecker A. Rural Veterans with HIV and Alcohol Use Disorder receive less video telehealth than urban Veterans. J Rural Health 2024; 40:419-429. [PMID: 37759376 PMCID: PMC10965503 DOI: 10.1111/jrh.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is highly prevalent among Veterans with HIV. Rural Veterans with HIV are at especially high risk for not receiving appropriate treatment. This retrospective cohort cross-sectional study aimed to investigate patterns of mental health treatment utilization across delivery modality among Veterans diagnosed with HIV and AUD. It was hypothesized that rural Veterans with HIV and AUD would receive a lower rate of mental health treatment delivered via video telehealth than urban Veterans with HIV and AUD. METHODS A national Veterans Health Association administrative database was used to identify a cohort of Veterans diagnosed with HIV and AUD (N = 2,075). Geocoding was used to categorize rural Veterans (n = 246) and urban Veterans (n = 1,829). Negative binomial regression models tested associations between rurality and mental health treatment delivered via face-to-face, audio-only, and video telehealth modalities. FINDINGS Results demonstrated that rural Veterans with HIV and AUD received fewer mental health treatment sessions delivered via telehealth than urban Veterans with HIV and AUD (incidence rate ratio = 0.62; 95% confidence intervals [0.44, 0.87]; P < .01). No differences were found in terms of treatment delivered face-to-face or by audio-only. CONCLUSIONS Rural Veterans with HIV and AUD represent a vulnerable subpopulation of Veterans who may most benefit from video telehealth. Efforts to increase access and improve the uptake of evidence-based mental health treatment delivered via video telehealth are needed.
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Affiliation(s)
- Alan Z Sheinfil
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Giselle Day
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Annette Walder
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Julianna Hogan
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas P. Giordano
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jan Lindsay
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Rice University’s Baker Institute for Public Policy, Houston, Texas, USA
| | - Anthony Ecker
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Davis KA, Zhao F, Janis RA, Castonguay LG, Hayes JA, Scofield BE. Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychother Res 2024; 34:589-600. [PMID: 37399573 DOI: 10.1080/10503307.2023.2229505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment.Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.
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Affiliation(s)
- Katherine A Davis
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Fanghui Zhao
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Rebecca A Janis
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
| | - Louis G Castonguay
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jeffrey A Hayes
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Brett E Scofield
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
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Goh E, Press I, Anquandah J, White P, Pleat J. Changes in attitudes towards telemedicine in acute burn care following the Covid-19 pandemic. Burns 2024:S0305-4179(24)00150-5. [PMID: 38789335 DOI: 10.1016/j.burns.2024.05.012] [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: 12/16/2023] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Telemedical referrals after burn injury had been shown to be advantageous over telephone referrals for multiple reasons, however there were several key barriers towards complete implementation. The Covid-19 pandemic facilitated the adoption of telemedicine to ensure the safety of both clinicians and patients. Due to the circumstances, it was unclear whether the pre-pandemic barriers still existed despite the complete implementation of telemedicine. This study aims to evaluate clinicians' views about the barriers towards implementation of a specific telemedicine system for burns referrals, and their changing attitudes following the pandemic, to identify key domains for improvement in current and future telemedicine systems. METHODS A questionnaire was created to evaluate the attitudes of referring clinicians towards telemedicine, following literature searches and administration of a pilot questionnaire. This was administered via telephone to staff working in EDs and MIUs which referred to the South-West United Kingdom Burns Network using the Medical Data Solutions and Services (MDSAS) system, in both 2019 and 2022. A statistical analysis was performed to compare the attitudes of clinicians towards telemedicine both pre- and post-pandemic. RESULTS 100 respondents completed the survey in 2019 and 70 in 2022, with similar demographics of respondents. Out of the twelve barriers identified, the lack of reliable Wi-Fi and need to duplicate notes were identified as the main obstacles to implementation in both time periods. In both years, the single greatest barrier reported was poor access to reliable Wi-Fi (p = 0.944). Miscommunication between clinicians using the system, inadequate numbers of devices and financial constraints were identified less frequently as barriers in 2022 than 2019 (p = 0.005, p = 0.047 and p < 0.001 respectively). However, significantly more respondents reported time pressures when waiting for a response to their telemedicine referral in 2022 (p = 0.022). CONCLUSION Overall, clinicians displayed a positive attitude towards the MDSAS system for acute burns, with clinicians identifying fewer concerns with the system following the Covid-19 pandemic. However, concerns over the time pressures that this telemedicine system places on the referring clinician and existing Wi-Fi infrastructure persist. Further streamlining of the system and investment in internet access is recommended, with continued input from all stakeholders.
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Affiliation(s)
- Esther Goh
- Department of Plastic Surgery, Aberdeen Royal Infirmary, UK
| | - Isobel Press
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Jason Anquandah
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Paul White
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
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Chaharshughi BT, Izadi R, Naghavi A. Tele-psychotherapy for individuals with obsessive-compulsive disorder during the COVID-19 outbreak: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:112. [PMID: 38726087 PMCID: PMC11081456 DOI: 10.4103/jehp.jehp_372_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND One way of delivering psychological services is tele-psychotherapy, which has attracted significant attention as a viable approach. This study aimed to identify important variables in the application of tele-counseling and psychotherapy for the treatment of patients with obsessive-compulsive disorder (OCD) in Isfahan, Iran. MATERIALS AND METHODS This research employed an exploratory qualitative methodology. The participants of this study consisted of all the clients with OCD and all the psychotherapists in the city of Isfahan. Purposive sampling was employed, and following a series of semi-structured interviews with 35 individuals with OCD and 11 counselors in this area, the sample size reached a saturation point. The data was analyzed by Braun and Clark's thematic analysis method. RESULTS Based on the findings of Braun and Clark's analysis, three primary themes emerged concerning tele-counseling: opportunities, requirements, and challenges. CONCLUSION According to the feedback received from therapists and clients, remote services could offer promising prospects to both groups by providing accessible locations and flexible time management. However, to get the full benefits of teletherapy, therapists should consider certain factors to enhance the therapeutic alliance. Moreover, there are challenges that need to be addressed.
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Affiliation(s)
- Batul Tadayon Chaharshughi
- PhD Student in Counseling, Faculty of Humanities, Khomeinishar Branch, Islamic Azad University, Khomeinishar, Isfahan, Iran
| | - Razieh Izadi
- Assistant Professor, Department of Psychology, Safahan Institute of Higher Education, Isfahan, Iran
| | - Azam Naghavi
- Associate Professor, Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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Ibemere SO, Silva SG, Affronti ML, Masese R, Tanabe P. Nurse practitioner satisfaction with in-person versus telehealth chronic care delivery. J Am Assoc Nurse Pract 2024; 36:160-170. [PMID: 37962429 DOI: 10.1097/jxx.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The widespread use of telehealth and regulatory changes that enhanced nurse practitioner (NP) practice authority because of the SARS-CoV-2 pandemic offers an opportunity to assess postpandemic NP satisfaction with telehealth care delivery and perceptions of its feasibility compared with in-person visits. PURPOSE Outpatient chronic care delivery satisfaction and preference were compared among NPs who provide care to adults through in-person and/or telehealth visits and examined NP demographic and clinical characteristics associated with overall satisfaction by care delivery type. METHODOLOGY Data were collected using a cross-sectional, descriptive design through online dissemination of The Care Delivery Satisfaction Survey to a nationally representative sample of 586 NPs. RESULTS Compared with NPs using both visit types to deliver care, NPs delivering care in-person only had significantly lower satisfaction scores for interpersonal manner ( p = .0076) and communication ( p = .0108). NPs using telehealth only had significantly higher overall satisfaction and satisfaction subscale scores (all p < .01) compared with NPs using both visit types. Overall, 77% of NPs using both visit types preferred in-person delivery. CONCLUSIONS/IMPLICATIONS NPs delivering telehealth care only were more satisfied with chronic care delivery than NPs using both delivery types. NPs using both types were more satisfied with interpersonal manner and communication compared with NPs delivering in-person care only. Most NPs using both types preferred in-person care delivery. Given increased telehealth use, health systems, academic institutions, and insurance companies can use these study findings to inform policy on telehealth resources and infrastructure.
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Affiliation(s)
- Stephanie O Ibemere
- Duke University School of Nursing, Durham, North Carolina
- Duke Global Health Institute, Durham, North Carolina
| | - Susan G Silva
- Duke University School of Nursing, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
| | - Mary Lou Affronti
- Duke University School of Nursing, Durham, North Carolina
- Preston Robert Tisch Brain Tumor Center, Duke Health System, Duke Neuro-surgery, Durham, North Carolina
| | - Rita Masese
- Duke University School of Nursing, Durham, North Carolina
| | - Paula Tanabe
- Duke University School of Nursing, Durham, North Carolina
- Duke University School of Medicine, Durham, North Carolina
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Khubchandani R, Avčin T, Ravelli A. Towards telehealth delivery in pediatric rheumatology practice. Pediatr Rheumatol Online J 2023; 21:145. [PMID: 38105249 PMCID: PMC10726584 DOI: 10.1186/s12969-023-00892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Much has been written and spoken about telemedicine since about two decades including an article in this journal at the start of the pandemic. It took a global catastrophe to enforce its usage across the world in various medical specialties. Telemedicine however remains unstructured, unregulated and lacks uniformity. DISCUSSION This article highlights the practical learnings and opinions of the authors who provided over two thousand video consults and asynchronous telemedicine services through the entire pandemic. It includes lessons learnt from emerging economies where pediatric rheumatologists are scarce. Pediatric rheumatology, which relies heavily on history, musculoskeletal and skin examination is aptly suited to exploit telemedicine in its synchronous and asynchronous forms. Pediatric tele rheumatology could temporarily address the shortage and uneven distribution of specialists in vast parts of the globe, besides serving as a method of triage and shared care with the primary physician. Reduction of direct and indirect costs and family/primary physician education are additional benefits. There also exist challenges for all stakeholders and it is important to address the latter. CONCLUSION The learnings of the pandemic suggest a vital role for telemedicine in the practice of pediatric rheumatology. This is a fertile area for research and consensus building by international and national pediatric societies and issue position statements like some adult bodies already have. The authors speculate a hybrid system of care in the not-so-distant future.
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Affiliation(s)
- Raju Khubchandani
- Section of Pediatric Rheumatology, SRCC Childrens Hospital, K Khadye Marg Mumbai, Mumbai, India.
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
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Welsh JW, Sitar SI, Parks MJ, Patton SC, Braughton JE, Waller LA, Ngo QM. Association Between Clinician-Level Factors and Patient Outcomes in Virtual and In-Person Outpatient Treatment for Substance Use Disorders: Multilevel Analysis. JMIR Hum Factors 2023; 10:e48701. [PMID: 37921853 PMCID: PMC10656667 DOI: 10.2196/48701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The use of virtual treatment services increased dramatically during the COVID-19 pandemic. Unfortunately, large-scale research on virtual treatment for substance use disorder (SUD), including factors that may influence outcomes, has not advanced with the rapidly changing landscape. OBJECTIVE This study aims to evaluate the link between clinician-level factors and patient outcomes in populations receiving virtual and in-person intensive outpatient services. METHODS Data came from patients (n=1410) treated in a virtual intensive outpatient program (VIOP) and an in-person intensive outpatient program (IOP), who were discharged between January 2020 and March 2021 from a national treatment organization. Patient data were nested by treatment providers (n=58) examining associations with no-shows and discharge with staff approval. Empathy, comfort with technology, perceived stress, resistance to change, and demographic covariates were examined at the clinician level. RESULTS The VIOP (β=-5.71; P=.03) and the personal distress subscale measure (β=-6.31; P=.003) were negatively associated with the percentage of no-shows. The VIOP was positively associated with discharges with staff approval (odds ratio [OR] 2.38, 95% CI 1.50-3.76). Clinician scores on perspective taking (β=-9.22; P=.02), personal distress (β=-9.44; P=.02), and male clinician gender (β=-6.43; P=.04) were negatively associated with in-person no-shows. Patient load was positively associated with discharge with staff approval (OR 1.04, 95% CI 1.02-1.06). CONCLUSIONS Overall, patients in the VIOP had fewer no-shows and a higher rate of successful discharge. Few clinician-level characteristics were significantly associated with patient outcomes. Further research is necessary to understand the relationships among factors such as clinician gender, patient load, personal distress, and patient retention.
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Affiliation(s)
- Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Siara I Sitar
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael J Parks
- Butler Center for Research, Hazelden Betty Ford Foundation, Center City, MN, United States
| | - Samantha C Patton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Jacqueline E Braughton
- Butler Center for Research, Hazelden Betty Ford Foundation, Center City, MN, United States
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Quyen M Ngo
- Butler Center for Research, Hazelden Betty Ford Foundation, Center City, MN, United States
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Marks VA, Hsiang WR, Nie J, Umer W, Haleem A, Galal B, Pak I, Kim D, Salazar MC, Pantel H, Berger ER, Boffa DJ, Cavallo JA, Leapman MS. Telehealth Availability for Cancer Care During the COVID-19 Pandemic: Cross-Sectional Study. JMIR Cancer 2023; 9:e45518. [PMID: 37917149 PMCID: PMC10654905 DOI: 10.2196/45518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/07/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Telehealth was an important strategy for maintaining continuity of cancer care during the coronavirus pandemic and has continued to play a role in outpatient care; however, it is unknown whether services are equally available across cancer hospitals. OBJECTIVE This study aimed to assess telehealth availability at cancer hospitals for new and established patients with common cancers to contextualize the impact of access barriers to technology on overall access to health care. METHODS We conducted a national cross-sectional secret shopper study from June to November 2020 to assess telehealth availability at cancer hospitals for new and established patients with colorectal, breast, and skin (melanoma) cancer. We examined facility-level factors to determine predictors of telehealth availability. RESULTS Of the 312 investigated facilities, 97.1% (n=303) provided telehealth services for at least 1 cancer site. Telehealth was less available to new compared to established patients (n=226, 72% vs n=301, 97.1%). The surveyed cancer hospitals more commonly offered telehealth visits for breast cancer care (n=266, 85%) and provided lower access to telehealth for skin (melanoma) cancer care (n=231, 74%). Most hospitals (n=163, 52%) offered telehealth for all 3 cancer types. Telehealth availability was weakly correlated across cancer types within a given facility for new (r=0.16, 95% CI 0.09-0.23) and established (r=0.14, 95% CI 0.08-0.21) patients. Telehealth was more commonly available for new patients at National Cancer Institute-designated facilities, medical school-affiliated facilities, and major teaching sites, with high total admissions and below-average timeliness of care. Telehealth availability for established patients was highest at Academic Comprehensive Cancer Programs, nongovernment and nonprofit facilities, medical school-affiliated facilities, Accountable Care Organizations, and facilities with a high number of total admissions. CONCLUSIONS Despite an increase in telehealth services for patients with cancer during the COVID-19 pandemic, we identified differences in access across cancer hospitals, which may relate to measures of clinical volume, affiliation, and infrastructure.
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Affiliation(s)
| | - Walter R Hsiang
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - James Nie
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Waez Umer
- The College of New Jersey, Ewing, NJ, United States
| | - Afash Haleem
- The College of New Jersey, Ewing, NJ, United States
| | - Bayan Galal
- Yale School of Medicine, New Haven, CT, United States
| | - Irene Pak
- Yale School of Medicine, New Haven, CT, United States
| | - Dana Kim
- Yale School of Medicine, New Haven, CT, United States
| | | | - Haddon Pantel
- Yale School of Medicine, New Haven, CT, United States
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Ainslie M, Corvini M, Chadbourne J. Assumptions, Perceptions, and Experiences of Behavioral Health Providers Using Telemedicine: Qualitative Study. JMIR Form Res 2023; 7:e48232. [PMID: 37788059 PMCID: PMC10582816 DOI: 10.2196/48232] [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: 04/16/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The urgent and reactive implementation of telemedicine during the pandemic does not represent a long-term, strategic, and proactive approach to optimizing this technology. The assumptions, perceptions, and experiences of the behavioral health providers using telemedicine can inform system-wide and institutional-level strategies to promote longitudinal maintenance of care delivery, which can reduce the use of high-cost care due to new symptom onset and symptom exacerbation related to service interruptions. OBJECTIVE We aim to identify the assumptions, perspectives, and experiences of behavioral health clinicians and providers using telemedicine to inform the development of an optimized, sustainable approach to telemedicine implementation. METHODS This qualitative study applies the domains of the Consolidated Framework for Implementation Research (CFIR) to structure data collection and analysis from behavioral health providers using telemedicine via an audiovisual connection in the New England region. In total, 12 providers across levels of care were recruited for a 60-minute interview, developed from the CFIR interview guide. Atlas Ti Qualitative Software (version 23; ATLAS.ti Scientific Software Development GmbH) was used to coordinate and facilitate coding among 3 reviewers. Deductive coding was provided from the CFIR interview guide, allowing for data to be categorized by domain and construct. Constructs were analyzed for descriptive themes and tabulated for response frequency. Uncoded data were reviewed and coded in vivo to explore variables contributing to participant perceptions of experience with telemedicine use. Descriptive themes, then analytical themes, were identified. Analytical themes and tabulated frequency of response data were summarized. Finally, a sentiment analysis was completed to derive tone and meaning from the data. RESULTS Results are reported within the CFIR domains: intervention characteristic, outer setting, inner setting, characteristics of individuals, and process. The findings with ≥90% agreement include "best practice standards were not known"; "telemedicine was believed to be efficient and time-saving for the patient and provider, maximizing productivity and thus increasing access to care"; "telemedicine provided an additional option for patients to access services, promoting sustained continuity and timeliness of care"; "participants did not identify any clear goals related to telemedicine use"; "demonstrated positive affective responses to telemedicine use"; "expressed high efficacy with telemedicine utilization"; and "strong leadership support." CONCLUSIONS These findings support the development of interstate compacts advancing licensure across state lines; payment parity across modalities of care to ensure the financial vitality of behavioral health services; improved dissemination of telehealth training and resources, and telehealth training in academic programs of the health professions; seamless, dynamic workflows to accommodate the changing needs of patient and care continuity; emergency response protocols; and community partnerships to provide private spaces needed for a therapeutic encounter. Future research exploring the patient's experience with telemedicine is needed for all stakeholders to be represented in developing a sustainable, integrated system.
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Affiliation(s)
- Marcy Ainslie
- Department of Nursing, University of New Hampshire, Durham, NH, United States
| | - Marguerite Corvini
- Telepractice Center, University of New Hampshire, Durham, NH, United States
| | - Jennifer Chadbourne
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, Durham, NH, United States
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Kusters IS, Amspoker AB, Frosio K, Day SC, Day G, Ecker A, Hogan J, Lindsay JA, Shore J. Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans. JAMA Psychiatry 2023; 80:1055-1060. [PMID: 37494050 PMCID: PMC10372753 DOI: 10.1001/jamapsychiatry.2023.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/15/2023] [Indexed: 07/27/2023]
Abstract
Importance American Indian/Alaska Native veterans experience a high risk for health inequities, including mental health (MH) care access. Rapid virtualization of MH care in response to the COVID-19 pandemic facilitated care continuity across the Veterans Health Administration (VHA), but the association between virtualization of care and health inequities among American Indian/Alaska Native veterans is unknown. Objective To examine differences in video telehealth (VTH) use for MH care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans by rurality and urbanicity. Design, Setting, and Participants In this cohort study, VHA administrative data on VTH use among a veteran cohort that received MH care from October 1, 2019, to February 29, 2020 (prepandemic), and April 1 to December 31, 2020 (early pandemic), were examined. Exposures At least 1 outpatient MH encounter during the study period. Main Outcomes and Measures The main outcome was use of VTH among all study groups (ie, American Indian/Alaska Native, non-American Indian/Alaska Native, rural, or urban) before and during the early pandemic. American Indian/Alaska Native veteran status and rurality were examined as factors associated with VTH utilization through mixed models. Results Of 1 754 311 veterans (mean [SD] age, 54.89 [16.23] years; 85.21% male), 0.48% were rural American Indian/Alaska Native; 29.04%, rural non-American Indian/Alaska Native; 0.77%, urban American Indian/Alaska Native; and 69.71%, urban non-American Indian/Alaska Native. Before the pandemic, a lower percentage of urban (b = -0.91; SE, 0.02; 95% CI, -0.95 to -0.87; P < .001) and non-American Indian/Alaska Native (b = -0.29; SE, 0.09; 95% CI, -0.47 to -0.11; P < .001) veterans used VTH. During the early pandemic period, a greater percentage of urban (b = 1.37; SE, 0.05; 95% CI, 1.27-1.47; P < .001) and non-American Indian/Alaska Native (b = 0.55; SE, 0.19; 95% CI, 0.18-0.92; P = .003) veterans used VTH. There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = -1.49; SE, 0.39; 95% CI, -2.25 to -0.73; P < .001). Urban veterans used VTH more than rural veterans, especially American Indian/Alaska Native veterans (non-American Indian/Alaska Native: rurality b = 1.35 [SE, 0.05; 95% CI, 1.25-1.45; P < .001]; American Indian/Alaska Native: rurality b = 2.91 [SE, 0.38; 95% CI, 2.17-3.65; P < .001]). The mean (SE) increase in VTH was 20.34 (0.38) and 15.35 (0.49) percentage points for American Indian/Alaska Native urban and rural veterans, respectively (difference in differences [DID], 4.99 percentage points; SE, 0.62; 95% CI, 3.77-6.21; t = -7.999; df, 11 000; P < .001), and 12.97 (0.24) and 11.31 (0.44) percentage points for non-American Indian/Alaska Native urban and rural veterans, respectively (DID, 1.66; SE, 0.50; 95% CI, 0.68-2.64; t = -3.32; df, 15 000; P < .001). Conclusions and Relevance In this cohort study, although rapid virtualization of MH care was associated with greater VTH use in all veteran groups studied, a significant difference in VTH use was seen between rural and urban populations, especially among American Indian/Alaska Native veterans. The findings suggest that American Indian/Alaska Native veterans in rural areas may be at risk for VTH access disparities.
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Affiliation(s)
- Isabelle S. Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston–Clear Lake, Houston, Texas
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Amber B. Amspoker
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
| | - Kristen Frosio
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Stephanie C. Day
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Giselle Day
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Anthony Ecker
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Julianna Hogan
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
| | - Jan A. Lindsay
- Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, Texas
- South Central Mental Illness Research, Education and Clinical Center, US Department of Veterans Affairs
- Baker Institute for Public Policy, Rice University, Houston, Texas
| | - Jay Shore
- Veterans Rural Health Resource Center, Veterans Health Administration Office of Rural Health, Salt Lake City, Utah
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora
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11
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Khademi M, Vaziri-Harami R, Mashadi AM, Seif P, Babazadehdezfoly A. The Effectiveness of Telephone-based Psychological Services to COVID-19. Clin Pract Epidemiol Ment Health 2023; 19:e174501792307270. [PMID: 37916207 PMCID: PMC10507215 DOI: 10.2174/17450179-v19-230824-2023-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 11/03/2023]
Abstract
Background The COVID-19 pandemic has disrupted the delivery of mental health services, leading to the development of telepsychiatry. Aim The present study investigates the effectiveness of telephone-delivered treatment for psychological disorders of COVID-19 survivors in Tehran, the capital of Iran. Methods In this non-randomized controlled trial, 91 COVID-19 survivors, primarily residents were enrolled. Participants completed a baseline questionnaire and a psychological screening questionnaire. The intervention included the telephone-based psychological services provided by trained psychiatric residents. The Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) was administered to assess the presence of PTSD symptoms. Symptoms of anxiety and depression were measured by the Patient Health Questionnaire. Results The General Health Questionnaire (GHQ) adjusted mean difference was significantly lower in the intervention group than in the control group. There was a significant negative correlation between the Spost-GHQ score and history of going to the clinic and history of psychiatric disorders, but no relationship with the history of hospitalization. All participants completed the satisfaction form, with almost half of them being "satisfied" or "very satisfied" with the telehealth calls. Conclusion Telephonic delivery of psychological services showed an effective way of providing evidence-based psychological support during the pandemic. This telehealth program can offer much-needed assistance to individuals with COVID-19 improving their psychological wellbeing.
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Affiliation(s)
- Mojgan Khademi
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Vaziri-Harami
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Mahouram Mashadi
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Seif
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Babazadehdezfoly
- Clinical Research Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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van Kessel R, Roman-Urrestarazu A, Anderson M, Kyriopoulos I, Field S, Monti G, Reed SD, Pavlova M, Wharton G, Mossialos E. Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review. J Med Internet Res 2023; 25:e48000. [PMID: 37490322 PMCID: PMC10410406 DOI: 10.2196/48000] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Samantha Field
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giovanni Monti
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, Netherlands
| | - George Wharton
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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13
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Fast N, van Kessel R, Humphreys K, Ward NF, Roman-Urrestarazu A. The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review. CURRENT ADDICTION REPORTS 2023; 10:187-197. [PMID: 37266192 PMCID: PMC10126560 DOI: 10.1007/s40429-023-00480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.
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Affiliation(s)
- Noam Fast
- START Treatment & Recovery Centers, New York City, USA
- Addiction Psychiatry Fellowship Faculty, Department of Psychiatry, Columbia University, New York City, USA
| | - Robin van Kessel
- Department of Health Policy, London School of Economics and Political Science, LSE Health, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Natalie Frances Ward
- Department of International Development Studies, University of Amsterdam, Amsterdam, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Kister K, Laskowski J, Dybała E, Makarewicz A. Are we ready for Telepsychiatry? Benefits and challenges of digital
psychotherapy. CURRENT PROBLEMS OF PSYCHIATRY 2023. [DOI: 10.12923/2353-8627/2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Telemedicine is one of the most modern and fastest-growing branches of medicine. The most common form is video consultation. We distinguish between synchronous and asynchronous telepsychiatry. This study aims to show the benefits of using telepsychiatry services, the challenges it poses to users, and to evaluate its use against traditional therapy.
Materials and methods: A review of literature from 1956-2023 in EMBASE, OpenKnowledge and PubMed databases was conducted. Keywords used were: telepsychiatry, teletherapy, and digital psychiatry. Ninety-eight articles were included.
Discussion: Telepsychiatry is an opportunity for regions affected by medical staff shortages. It bypasses cultural barriers, the problem of traveling and reduces the cost of medical point-of-service. Telepsychiatry is an opportunity for patients who do not use psychiatrists due to discrimination in a conservative society. Groups that may find it challenging include the elderly, the blind, and the deaf. Creating a healthy therapeutic alliance through a screen can be impossible, making it difficult to achieve successful therapy. A barrier to developing telepsychiatry is the need for more guidelines for dealing with medical errors.
Conclusions: Telemedicine can help in accessing specialized care regardless of location. Telepsychiatry provides a safe and anonymous environment for patients reluctant to receive inpatient therapy. The effectiveness of online therapy is primarily debated. Telepsychiatry should be limited to follow-up consultations and well-known patients - it is a form of complementing the diagnosis and treatment process. The authors point to the need for developing specific guidelines for conducting teletherapy with particular attention to the problem of suicide.
Keywords: telepsychiatry, teletherapy, digital psychiatry.
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Affiliation(s)
- Klaudia Kister
- I Departmentof Psychiatry, Psychoterapy and Early Intervention of Medical University in Lublin, Poland - Students Research Group
| | - Jakub Laskowski
- Department of Paediatrician Oncology, Transplantology and Haematology Medical University of Lublin, Poland - Students Research Group
| | | | - Agata Makarewicz
- I Department of Psychiatry, Psychoterapy and Early Intervention, Medical University of Lublin, Poland
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15
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Del Hoyo J, Millán M, Garrido-Marín A, Aguas M. Are we ready for telemonitoring inflammatory bowel disease? A review of advances, enablers, and barriers. World J Gastroenterol 2023; 29:1139-1156. [PMID: 36926667 PMCID: PMC10011957 DOI: 10.3748/wjg.v29.i7.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 02/09/2023] [Indexed: 02/21/2023] Open
Abstract
This review summarizes the evidence about telemonitoring in patients with inflammatory bowel disease (IBD). To give an overview of the advances performed, as well as the enablers and barriers which favoured/hindered telemonitoring implementation. We performed a literature search in PubMed, EMBASE, MEDLINE, Cochrane Database, Web of Science and Conference Proceedings. Titles and abstracts published up to September 2022 were screened for a set of inclusion criteria: telemonitoring intervention, IBD as the main disease, and a primary study performed. Ninety-seven reports were selected for full review. Finally, 20 were included for data extraction and critical appraisal. Most studies used telemonitoring combined with tele-education, and programs evolved from home telemanagement systems towards web portals through mHealth applications. Web systems demonstrated patients’ acceptance, improvement in quality of life, disease activity and knowledge, with a good cost-effectiveness profile in the short-term. Initially, telemonitoring was almost restricted to ulcerative colitis, but new patient reported outcome measures, home-based tests and mobile devices favoured its expansion to different patients´ categories. However, technological and knowledge advances led to legal, ethical, economical and logistic issues. Standardization of remote healthcare is necessary, to improve the interoperability of systems as well as to address liability concerns and users´ preferences. Telemonitoring IBD is well accepted and improves clinical outcomes at a lower cost in the short-term. Funders, policymakers, providers, and patients need to align their interests to overcome the emerging barriers for its full implementation.
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Affiliation(s)
- Javier Del Hoyo
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mónica Millán
- Department of Surgery, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Alejandro Garrido-Marín
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Mariam Aguas
- Department of Gastroenterology, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
- Health Research Institute La Fe, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
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16
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Yu L, Liu YC, Cornelius SL, Scodari BT, Brooks GA, O'Malley AJ, Onega T, Moen EL. Telehealth Use Following COVID-19 Within Patient-Sharing Physician Networks at a Rural Comprehensive Cancer Center: Cross-sectional Analysis. JMIR Cancer 2023; 9:e42334. [PMID: 36595737 PMCID: PMC9848440 DOI: 10.2196/42334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, cancer centers rapidly adopted telehealth to deliver care remotely. Telehealth will likely remain a model of care for years to come and may not only affect the way oncologists deliver care to their own patients but also the physicians with whom they share patients. OBJECTIVE This study aimed to examine oncologist characteristics associated with telehealth use and compare patient-sharing networks before and after the COVID-19 pandemic in a rural catchment area with a particular focus on the ties between physicians at the comprehensive cancer center and regional facilities. METHODS In this retrospective observational study, we obtained deidentified electronic health record data for individuals diagnosed with breast, colorectal, or lung cancer at Dartmouth Health in New Hampshire from 2018-2020. Hierarchical logistic regression was used to identify physician factors associated with telehealth encounters post COVID-19. Patient-sharing networks for each cancer type before and post COVID-19 were characterized with global network measures. Exponential-family random graph models were performed to estimate homophily terms for the likelihood of ties existing between physicians colocated at the hub comprehensive cancer center. RESULTS Of the 12,559 encounters between patients and oncologists post COVID-19, 1228 (9.8%) were via telehealth. Patient encounters with breast oncologists who practiced at the hub hospital were over twice as likely to occur via telehealth compared to encounters with oncologists who practiced in regional facilities (odds ratio 2.2, 95% CI 1.17-4.15; P=.01). Patient encounters with oncologists who practiced in multiple locations were less likely to occur via telehealth, and this association was statistically significant for lung cancer care (odds ratio 0.26, 95% CI 0.09-0.76; P=.01). We observed an increase in ties between oncologists at the hub hospital and oncologists at regional facilities in the lung cancer network post COVID-19 compared to before COVID-19 (93/318, 29.3%, vs 79/370, 21.6%, respectively), which was also reflected in the lower homophily coefficients post COVID-19 compared to before COVID-19 for physicians being colocated at the hub hospital (estimate: 1.92, 95% CI 1.46-2.51, vs 2.45, 95% CI 1.98-3.02). There were no significant differences observed in breast cancer or colorectal cancer networks. CONCLUSIONS Telehealth use and associated changes to patient-sharing patterns associated with telehealth varied by cancer type, suggesting disparate approaches for integrating telehealth across clinical groups within this health system. The limited changes to the patient-sharing patterns between oncologists at the hub hospital and regional facilities suggest that telehealth was less likely to create new referral patterns between these types of facilities and rather replace care that would otherwise have been delivered in person. However, this study was limited to the 2 years immediately following the initial outbreak of COVID-19, and longer-term follow-up may uncover delayed effects that were not observed in this study period.
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Affiliation(s)
- Liyang Yu
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - You-Chi Liu
- Quantitative Social Sciences program, Dartmouth College, Hanover, NH, United States
| | - Sarah L Cornelius
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Bruno T Scodari
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - Gabriel A Brooks
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Alistair James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States
| | - Tracy Onega
- Department of Population Sciences, University of Utah, Salt Lake City, NH, United States
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States
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Burzyńska J, Bartosiewicz A, Januszewicz P. Dr. Google: Physicians-The Web-Patients Triangle: Digital Skills and Attitudes towards e-Health Solutions among Physicians in South Eastern Poland-A Cross-Sectional Study in a Pre-COVID-19 Era. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:978. [PMID: 36673740 PMCID: PMC9858975 DOI: 10.3390/ijerph20020978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 05/27/2023]
Abstract
The investment in digital e-health services is a priority direction in the development of global healthcare systems. While people are increasingly using the Web for health information, it is not entirely clear what physicians' attitudes are towards digital transformation, as well as the acceptance of new technologies in healthcare. The aim of this cross-sectional survey study was to investigate physicians' self-digital skills and their opinions on obtaining online health knowledge by patients, as well as the recognition of physicians' attitudes towards e-health solutions. Principal component analysis (PCA) was performed to emerge the variables from self-designed questionnaire and cross-sectional analysis, comparing descriptive statistics and correlations for dependent variables using the one-way ANOVA (F-test). A total of 307 physicians participated in the study, reported as using the internet mainly several times a day (66.8%). Most participants (70.4%) were familiar with new technologies and rated their e-health literacy high, although 84.0% reported the need for additional training in this field and reported a need to introduce a larger number of subjects shaping digital skills (75.9%). 53.4% of physicians perceived Internet-sourced information as sometimes reliable and, in general, assessed the effects of its use by their patients negatively (41.7%). Digital skills increased significantly with frequency of internet use (F = 13.167; p = 0.0001) and decreased with physicians' age and the need for training. Those who claimed that patients often experienced health benefits from online health showed higher digital skills (-1.06). Physicians most often recommended their patients to obtain laboratory test results online (32.2%) and to arrange medical appointments via the Internet (27.0%). Along with the deterioration of physicians' digital skills, the recommendation of e-health solutions decreased (r = 0.413) and lowered the assessment of e-health solutions for the patient (r = 0.449). Physicians perceive digitization as a sign of the times and frequently use its tools in daily practice. The evaluation of Dr. Google's phenomenon and online health is directly related to their own e-health literacy skills, but there is still a need for practical training to deal with the digital revolution.
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Affiliation(s)
- Joanna Burzyńska
- Institute of Health Sciences, Medical College of Rzeszow University, 35-959 Rzeszów, Poland
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Telehealth Management of Dysphagia in Adults: A Survey of Speech Language Pathologists' Experiences and Perceptions. Dysphagia 2022:10.1007/s00455-022-10544-z. [PMID: 36515730 PMCID: PMC9749630 DOI: 10.1007/s00455-022-10544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
The goal of this study was to explore telehealth use for dysphagia management in response to COVID-19 to understand variables associated with clinician confidence and perceived effectiveness of this service delivery model and determine clinician-perceived benefits and challenges of managing dysphagia via telehealth. Speech-language pathologists (SLPs, n = 235) completed a web-based survey, providing information on demographics, telehealth use during the pandemic, and perspectives on current and future tele-management of dysphagia. Analyses included descriptive statistics to examine usage patterns; logistic regression to determine which variables were associated with telehealth use, clinician confidence, and perceived-effectiveness; and conventional content analysis to analyze responses to open-ended questions. Results revealed a sharp increase in the tele-management of dysphagia during the pandemic. Years of experience with dysphagia management (p = .031) and pre-pandemic use of telehealth (p < .001) were significantly associated with current use patterns. Working in the outpatient setting was associated with greater clinician confidence (p = .003) and perceived effectiveness (p = .007), and use of guidelines (p = .042) was also associated with greater clinician confidence. Key challenges identified included inadequate technological infrastructure, inadequate patient digital literacy, and reimbursement restrictions. Key benefits were treatment continuity, improving access to care, and time savings. The majority (67%) of respondents reported that they would use telehealth in the future. These findings demonstrate SLPs' abilities and desire to expand their practice patterns to include telehealth for dysphagia management. Therefore, clinician training and more research on best practices for assessment and treatment of dysphagia via telehealth is warranted to refine models of care for dysphagia tele-management.
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Belakovskiy A, Jones EK, Murphy CN, Kelley S, Gallagher K, Furst W, Furgal A, Heidelbaugh J. Socially Distanced Teaching: Faculty Feedback on Teaching During Telemedicine. MEDICAL SCIENCE EDUCATOR 2022; 32:1305-1307. [PMID: 36415500 PMCID: PMC9673886 DOI: 10.1007/s40670-022-01685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The purpose of our study was to evaluate the perceptions of clinical faculty while working with medical students in a novel setting of virtual care following the COVID-19 pandemic. ACTIVITY A survey of faculty, fellows, and residents was conducted to assess educators' perceptions of virtual teaching before trying it and after 3 months of experience. RESULTS Perceived effectiveness of teaching students acute care significantly improved as did perceived effectiveness of teaching chronic care. DISCUSSION We anticipate that continued experience and comfort with virtual platforms would boost this perception further, allowing faculty development to be honed for optimal teaching in this new paradigm. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01685-9.
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Affiliation(s)
- Aleksandr Belakovskiy
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Elizabeth K. Jones
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Christina Nisonger Murphy
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Scott Kelley
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Kristina Gallagher
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Wendy Furst
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Allison Furgal
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Joel Heidelbaugh
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
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20
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Implementation of telemedicine consultations for people with mental health conditions in the community: a protocol for a systematic review. HRB Open Res 2022; 4:125. [PMID: 36348659 PMCID: PMC9627101 DOI: 10.12688/hrbopenres.13435.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The COVID-19 pandemic response has led to an exponential increase in the use and spread of telemedicine internationally. In community mental health care settings, telemedicine services were implemented within a few weeks, with little time for rigorous planning. Despite the reported acceptability of telemedicine by patients and clinicians, barriers to its implementation have come to light. There is now a need to investigate these barriers, and facilitators, as telemedicine begins to show potential promise beyond the pandemic. We propose a review that aims to identify the factors affecting the implementation of telemedicine consultations for patients with mental health conditions in the community. Methods: A systematic review will be conducted and reported according to the PRISMA guidelines. Five electronic databases will be searched using a pre-defined search strategy from 2016 to 2021. Only studies of synchronous, interactive telemedicine consultations conducted via video, phone or live messaging between patients and providers will be included. Quantitative, qualitative and mixed methods studies will be eligible for inclusion. Only studies published in the English language will be included. Titles and abstracts will be screened by two reviewers. Full text articles will be screened by two reviewers. The methodological quality of studies will be assessed using the Mixed Method Appraisal Tool (MMAT) by two reviewers. Data will be extracted and tabulated to address the aims of the review. A narrative synthesis will be conducted and reported factors will be mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Conclusion: By identifying the factors that influence the implementation of telemedicine consultations for patients with mental conditions in the community, consideration can be given to both barriers and facilitators that could be addressed in future mental health services planning. PROSPERO registration:CRD42021273422 (04/10/2021)
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Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Etain Quigley
- National University of Ireland, Maynooth, Maynooth, Ireland
| | | | | | | | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Freytag J, Touchett HN, Bryan JL, Lindsay JA, Gould CE. Advances in Psychotherapy for Older Adults Using Video-to-Home Treatment. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2022; 2:71-78. [PMID: 38013747 PMCID: PMC9458515 DOI: 10.1016/j.ypsc.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Providing telemental health services to older adults has become especially important during the COVID-19 pandemic. Video-to-home (VTH) treatment is an effective treatment modality; research shows that older adults are open to using VTH. However, there are unique barriers to using VTH with older adults. Barriers include access to technology, acceptance of technology, and physical and cognitive limitations. Additional concerns include establishing rapport with older patients and the policy and ethical concerns surrounding the use of VTH. Methods of addressing these barriers have been developed, and more research is needed to develop evidence-based VTH practice.
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Affiliation(s)
- Jennifer Freytag
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
| | - Hilary N Touchett
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
| | - Jennifer L Bryan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030, USA
- VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Bldg. 58, North Little Rock, AR 72114, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Lee and Joe Jamail Specialty Care Center, 1977 Butler Boulevard, Houston, TX 77030, USA
| | - Christine E Gould
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304-1207, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA 94305-5101, USA
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22
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Rojas-Ocaña MJ, García-Navarro EB, García-Navarro S, Macías-Colorado ME, Baz-Montero SM, Araujo-Hernández M. Influence of the COVID-19 Pandemic on Medication Reconciliation in Frail Elderly People at Hospital Discharge: Perception of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10348. [PMID: 36011982 PMCID: PMC9408442 DOI: 10.3390/ijerph191610348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
The current demographic panorama in Spain corresponds to an aging population; this situation is characterized by the need to care for an elderly population, which contains polymedicated and pluripathological individuals. Polymedication is a criterion of frailty in the elderly and a risk factor for mortality and morbidity due to the increased risk of drug interactions and medication errors. There are numerous studies that measure reconciliation at hospital discharge and at admission, and even the methodology of reconciliation, but we have not found many studies that measure reconciliation in the context of the COVID-19 pandemic from the point of view of health professionals regarding difficulties and the strategies carried out, which is essential to begin to glimpse solutions. METHODS This was a qualitative study based on 21 in-depth interviews and two discussion groups, conducted between January and April 2021 (13 nurses and 8 doctors, in rural and urban areas). The discourse was analyzed according to the Taylor-Bodgan model and processed using Atlas.ti software. RESULTS The areas altered by the health crisis were access to patients, their reconciliation of medication, and changes in the care modality, including the greater use of telephone communication, changes in work organization, and time dedicated to patient care and family work. Difficulties encountered during COVID-19: change in medication format, the specific characteristics of the patient and their pathologies, and difficulties arising from communication with the patient and their family. The strategies applied: the collaboration of home assistants and caregivers, emphasis on patient-health professional communication, and the use of Information and Communication Technologies (ICT). CONCLUSION The discharge was interrupted by the health crisis caused by COVID-19, in terms of both the traditional access of patients and by the remote care modalities generated by telemedicine.
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Affiliation(s)
- María Jesús Rojas-Ocaña
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Av. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain
| | - E. Begoña García-Navarro
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Av. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain
| | - Sonia García-Navarro
- Distrito Huelva Costa Condado Campiña, Andalusian Health Service, 21700 Huelva, Spain
| | | | | | - Miriam Araujo-Hernández
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, Av. de las Fuerzas Armadas, s/n, 21007 Huelva, Spain
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23
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Xiong Y, Huang R, Jiang J, Asempapa B, Fox S. Online Teaching Self-efficacy of Group Counseling Instructors during the COVID-19 Pandemic. Int J Group Psychother 2022; 72:228-256. [PMID: 38446561 DOI: 10.1080/00207284.2022.2081169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Due to the COVID-19 pandemic, many counseling-related programs switched to online teaching modalities. Group counseling instructors may face various challenges in teaching group counseling courses online. With a mixed-method design, this study explored group counseling instructors' online teaching self-efficacy by collecting survey responses from 39 group counseling instructors and interviewing eight instructors from the programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). The instructors demonstrated a general high teaching self-efficacy with concerns about students' engagement. Facilitating and hindering factors related to online teaching self-efficacy are identified. Implications and recommendations for instructors, counseling-related programs, and the counseling profession are also discussed.
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24
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Kisicki A, Becker S, Chaple M, Gustafson DH, Hartzler BJ, Jacobson N, Murphy AA, Tapscott S, Molfenter T. Behavioral healthcare organizations' experiences related to use of telehealth as a result of the COVID-19 pandemic: an exploratory study. BMC Health Serv Res 2022; 22:775. [PMID: 35698186 PMCID: PMC9189799 DOI: 10.1186/s12913-022-08114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Due to the COVID-19 pandemic, healthcare providers were forced to shift many services quickly from in-person to virtual, including substance use disorder (SUD) and mental health (MH) treatment services. This led to a sharp increase in telehealth services, with health systems seeing patients virtually at hundreds of times the rate as before the onset of the COVID-19 pandemic. By analyzing qualitative data about SUD and MH care organizations’ experiences using telehealth, this study aims to elucidate emergent themes related to telehealth use by the front-line behavioral health workforce. Methods This study uses qualitative data from large-scale web surveys distributed to SUD and MH organizations between May and August 2020. At the end of these surveys, the following question was posed in free-response form: “Is there anything else you would like to say about use of telehealth during or after the COVID-19 pandemic?” Respondents were asked to answer on behalf of their organizations. The 391 responses to this question were analyzed for emergent themes using a conventional approach to content analysis. Results Three major themes emerged: COVID-specific experiences with telehealth, general experiences with telehealth, and recommendations to continue telehealth delivery. Convenience, access to new populations, and lack of commute were frequently cited advantages of telehealth, while perceived ineffectiveness of and limited access to technology were frequently cited disadvantages. Also commonly mentioned was the relaxation of reimbursement regulations. Respondents supported continuation of relaxed regulations, increased institutional support, and using a combination of telehealth and in-person care in their practices. Conclusions This study advanced our knowledge of how the behavioral health workforce experiences telehealth delivery. Further longitudinal research comparing treatment outcomes of those receiving in-person and virtual services will be necessary to undergird organizations’ financial support, and perhaps also legislative support, for virtual SUD and MH services.
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Affiliation(s)
- Abby Kisicki
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, 1513 University Ave., WI, 53706, Madison, USA.
| | - Sara Becker
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Michael Chaple
- Division On Substance Use Disorders, New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - David H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, 1513 University Ave., WI, 53706, Madison, USA
| | - Bryan J Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105, USA
| | - Nora Jacobson
- Institute for Clinical and Translational Research, Community Academic Partnerships Program, University of Wisconsin-Madison School of Nursing, 701 Highland Ave, Madison, WI, 53705, USA
| | - Ann A Murphy
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, 675 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Stephanie Tapscott
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| | - Todd Molfenter
- Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, 1513 University Ave., WI, 53706, Madison, USA
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25
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Implementation of telemedicine consultations for people with mental health conditions in the community: a protocol for a systematic review. HRB Open Res 2022; 4:125. [DOI: 10.12688/hrbopenres.13435.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 01/14/2023] Open
Abstract
Background: The COVID-19 pandemic response has led to an exponential increase in the use and spread of telemedicine internationally. In community mental health care settings, telemedicine services were implemented within a few weeks, with little time for rigorous planning. Despite the reported acceptability of telemedicine by patients and clinicians, barriers to its implementation have come to light. There is now a need to investigate these barriers, and facilitators, as telemedicine begins to show potential promise beyond the pandemic. We propose a review that aims to identify the factors affecting the implementation of telemedicine consultations for patients with mental health conditions in the community. Methods: A systematic review will be conducted and reported according to the PRISMA guidelines. Five electronic databases will be searched using a pre-defined search strategy from 2016 to 2021. Only studies of synchronous, interactive telemedicine consultations conducted via video, phone or live messaging between patients and providers will be included. Quantitative, qualitative and mixed methods studies will be eligible for inclusion. Only studies published in the English language will be included. Titles and abstracts will be screened by two reviewers. Full text articles will be screened by two reviewers. The methodological quality of studies will be assessed using the Mixed Method Appraisal Tool (MMAT) by two reviewers. Data will be extracted and tabulated to address the aims of the review. A narrative synthesis will be conducted and reported factors will be mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Conclusion: By identifying the factors that influence the implementation of telemedicine consultations for patients with mental conditions in the community, consideration can be given to both barriers and facilitators that could be addressed in future mental health services planning. PROSPERO registration: CRD42021273422 (04/10/2021)
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26
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Adams L, Adamo N, Hollocks MJ, Valmaggia L, Brewster A, Watson J, Krisson M, Simonoff E. Examining clinicians' concerns delivering telemental health interventions directly to autistic individuals during COVID-19. RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 94:101956. [PMID: 35369648 PMCID: PMC8963796 DOI: 10.1016/j.rasd.2022.101956] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic necessitated the adoption of telemental health (TMH). Pre-pandemic, clinicians had voiced many TMH concerns, but these had not been investigated with respect to autism spectrum disorder (ASD) even with it being known that there are distinct ASD-associated challenges for in-person mental health interventions. METHOD A convenience sample of (n = 55) clinicians completed an online survey regarding their perspectives of adopting TMH interventions in ASD, with closed- and open-answered questions. Quantitative and qualitative data were analysed descriptively/inferentially and via Content Analysis, respectively. RESULTS Multiple clinicians endorsed each TMH challenges/barrier previously identified as concerns in the non-ASD literature. However, overall levels of concern over challenges/barriers were low, and challenges were more likely to be predicted than experienced and considered to be case/presentation specific. Challenges that were considered ASD-specific included the exacerbation of those associated with in-person delivery in ASD, alongside difficulties with trust and appropriate remote social behaviour. On average, clinicians indicated a preference for 50% TMH interventions post-pandemic. Clinicians' perceived technological competence and extent of professional experience with ASD were not significantly associated with levels of concern, nor number of experienced challenges, with TMH interventions in ASD. CONCLUSION In support of the existing TMH literature, challenges/barriers were more likely to be predicted than experienced and were considered to be case/presentation-specific, though this may be more variable in ASD owing to the well-established marked heterogeneity in this population. Remote provision of interventions exacerbated in-person ASD-associated challenges, as predicted, but clinician-level factors appeared not to impact TMH perceptions.
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Affiliation(s)
- Lucy Adams
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Nicoletta Adamo
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Matthew J Hollocks
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Aylana Brewster
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Jennifer Watson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Maisie Krisson
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Emily Simonoff
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
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27
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Frye WS, Gardner L, Campbell JM, Katzenstein JM. Implementation of telehealth during COVID-19: Implications for
providing behavioral health services to pediatric patients. J Child Health Care 2022; 26:172-184. [PMID: 33779352 PMCID: PMC9194499 DOI: 10.1177/13674935211007329] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The coronavirus pandemic and in-person contact restrictions necessitated rapid implementation of telehealth, specifically videoconferencing, to provide essential care to patients. This study surveyed 25 pediatric behavioral health providers at a single center during their first month of utilizing telehealth during coronavirus disease 2019 (COVID-19). Twenty-one participants completed a pre-questionnaire distributed prior to telehealth service delivery, and 23 providers completed a post-questionnaire approximately three weeks later. Results indicate the majority of behavioral health providers had no experience providing telehealth services prior to COVID-19. The majority of participating behavioral health providers utilized telehealth to provide pediatric patient care within the first month of access to telehealth. Participants' confidence in their ability to provide telehealth services significantly increased within the first month of implementation, regardless of previous training in telehealth. This study identified differences between anticipated and actual barriers to treatment, with technological issues identified as the largest actual barrier to service delivery. Participants indicated a preference for in-person service delivery, which they reported allows for better rapport-building, behavioral observations, reduced technological barriers, and fewer distractions. However, most participants reported they intend to continue utilizing telehealth for certain types of behavioral health services (e.g., diagnostic interviews and outpatient therapy) after the pandemic has subsided.
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Affiliation(s)
- William S Frye
- Department of Psychology, Johns Hopkins All Children’s
Hospital, Saint Petersburg, FL, USA,William S Frye, Department of Psychology,
Johns Hopkins All Children’s Hospital, 880 6th St S, Saint Petersburg, Florida
33701-4634, USA.
| | - Lauren Gardner
- Department of Psychology, Johns Hopkins All Children’s
Hospital, Saint Petersburg, FL, USA
| | | | - Jennifer M Katzenstein
- Department of Psychology, Johns Hopkins All Children’s
Hospital, Saint Petersburg, FL, USA
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28
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Putteeraj M, Bhungee N, Somanah J, Moty N. Assessing E-Health adoption readiness using diffusion of innovation theory and the role mediated by each adopter's category in a Mauritian context. Int Health 2022; 14:236-249. [PMID: 34114007 PMCID: PMC9070468 DOI: 10.1093/inthealth/ihab035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The preparedness of healthcare institutes for the foreseen changes expected to arise through the implementation of E-Health is a significant turning point in determining its success. This should be evaluated through the awareness and readiness of healthcare workers to adopt E-Health technology to reduce health information technology failures. METHODS This study investigated the relationship between the perceived attributes of innovation and E-Health adoption decisions of healthcare workers as part of a preimplementation process. Using a cross-sectional quantitative approach, the dimensions of the diffusion of innovation (DOI) theory were used to assess the E-Health readiness of 110 healthcare workers in a Mauritian specialized hospital. RESULTS A strong inclination towards E-Health adoption was observed, where the prime stimulators were perceived as modernization of healthcare management (84.1%, ẋ=4.19), increased work efficiency through reduction of duplication (77.6%, ẋ=4.10) and faster generation of results (71.1%, ẋ=4.07). The findings of this study also validated the use of five DOI dimensions (i.e. relative advantage, compatibility, complexity, trialability and observability) in a predictability model (F(5, 101)=17.067, p<0.001) towards E-Health adoption. A significant association between 'adopter category' and 'willingness to recommend E-Health adoption' (χ2(8)=74.89, p<0.001) endorsed the fact that physicians and nursing managers have central roles within a social ecosystem to facilitate the diffusion of technology and influence the adoption of innovation. CONCLUSION This is the first study of its kind in Mauritius to successfully characterize each adopter's profile and demonstrate the applicability of the DOI framework to predict the diffusion rate of E-Health platforms, while also highlighting the importance of identifying key opinion leaders who can be primed by innovators regarding the benefits of E-Health platforms, thus ensuring non-disruptive evolutionary innovation in the Mauritian healthcare sector.
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Affiliation(s)
- Manish Putteeraj
- School of Health Sciences, University of Technology Mauritius , 11134, Port Louis, Mauritius
| | - Nandhini Bhungee
- Cardiac Center, Sir Seewoosagur Ramgoolam National (SSRN) Hospital, 21017, Pamplemousses, Mauritius
| | - Jhoti Somanah
- School of Health Sciences, University of Technology Mauritius , 11134, Port Louis, Mauritius
| | - Numrata Moty
- Faculty of Law, University of Mauritius, 80837, Reduit, Mauritius
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29
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Butt Z, Kirsten L, Beatty L, Kelly B, Dhillon H, Shaw JM. Barriers and enablers to implementing telehealth consultations in psycho-oncology. Psychooncology 2022; 31:1365-1373. [PMID: 35460322 PMCID: PMC9545227 DOI: 10.1002/pon.5939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/21/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
Objective In response to the COVID‐19 pandemic, use of telehealth to deliver care was recommended across the Australian health system. This study aims to explore the barriers and enablers to delivery of psycho‐oncology services via telehealth and attitudes to use of telehealth in psycho‐oncology. Methods Twenty‐one psycho‐oncology clinicians participated in semi‐structured telephone interviews. Transcribed interviews were thematically analysed using the framework method. Results Three key themes were identified which described the overall experience of delivering psycho‐oncology services via telehealth: (1) Context Matters‐for whom is telehealth effective, when is it less effective; (2) Therapy content and telehealth implementation; (3) Recommendations for Sustainability. Conclusions These insights into the barriers and enablers to delivering psycho‐oncology services via telehealth inform future research and clinical practice. While there is support for the continued use of telehealth in psycho‐oncology, there are significant improvements needed to ensure effective implementation and continued benefit.
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Affiliation(s)
- Zoe Butt
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, New South Wales, Australia
| | - Laura Kirsten
- Nepean Cancer Care Centre, Penrith, New South Wales, Australia
| | - Lisa Beatty
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Brian Kelly
- University of Newcastle, School of Medicine and Public Health, Newcastle, New South Wales, Australia
| | - Haryana Dhillon
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, New South Wales, Australia
| | - Joanne M Shaw
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, New South Wales, Australia
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VanderWerf M, Bernard J, Barta DT, Berg J, Collins T, Dowdy M, Feiler K, Moore DL, Sifri C, Spargo G, Taylor CW, Towle CB, Wibberly KH. Pandemic Action Plan Policy and Regulatory Summary Telehealth Policy and Regulatory Considerations During a Pandemic. Telemed J E Health 2022; 28:457-466. [PMID: 34265216 PMCID: PMC9058868 DOI: 10.1089/tmj.2021.0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Reports, studies, and surveys have demonstrated telehealth provides opportunities to make health care more efficient, better coordinated, convenient, and affordable. Telehealth can also help address health income and access disparities in underserved communities by removing location and transportation barriers, unproductive time away from work, childcare expenses, and so on. Despite evidence showing high-quality outcomes, satisfaction, and success rates (e.g., 95% patient satisfaction rate and 84% success rate in which patients were able to completely resolve their medical concerns during a telehealth visit), nationwide adoption of telehealth has been quite low due to policy and regulatory barriers, constraints, and complexities.
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Affiliation(s)
| | | | - Doris T. Barta
- National Telehealth Technology Assessment Center, Anchorage, Alaska, USA
| | - Jordan Berg
- National Telehealth Technology Assessment Center, Anchorage, Alaska, USA
| | - Tim Collins
- Alaska Native Epidemiology Center, Anchorage, Alaska, USA
| | | | | | | | - Costi Sifri
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Garret Spargo
- Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
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Kamath J, Leon Barriera R, Jain N, Keisari E, Wang B. Digital phenotyping in depression diagnostics: Integrating psychiatric and engineering perspectives. World J Psychiatry 2022; 12:393-409. [PMID: 35433319 PMCID: PMC8968499 DOI: 10.5498/wjp.v12.i3.393] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/23/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Depression is a serious medical condition and is a leading cause of disability worldwide. Current depression diagnostics and assessment has significant limitations due to heterogeneity of clinical presentations, lack of objective assessments, and assessments that rely on patients' perceptions, memory, and recall. Digital phenotyping (DP), especially assessments conducted using mobile health technologies, has the potential to greatly improve accuracy of depression diagnostics by generating objectively measurable endophenotypes. DP includes two primary sources of digital data generated using ecological momentary assessments (EMA), assessments conducted in real-time, in subjects' natural environment. This includes active EMA, data that require active input by the subject, and passive EMA or passive sensing, data passively and automatically collected from subjects' personal digital devices. The raw data is then analyzed using machine learning algorithms to identify behavioral patterns that correlate with patients' clinical status. Preliminary investigations have also shown that linguistic and behavioral clues from social media data and data extracted from the electronic medical records can be used to predict depression status. These other sources of data and recent advances in telepsychiatry can further enhance DP of the depressed patients. Success of DP endeavors depends on critical contributions from both psychiatric and engineering disciplines. The current review integrates important perspectives from both disciplines and discusses parameters for successful interdisciplinary collaborations. A clinically-relevant model for incorporating DP in clinical setting is presented. This model, based on investigations conducted by our group, delineates development of a depression prediction system and its integration in clinical setting to enhance depression diagnostics and inform the clinical decision making process. Benefits, challenges, and opportunities pertaining to clinical integration of DP of depression diagnostics are discussed from interdisciplinary perspectives.
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Affiliation(s)
- Jayesh Kamath
- Department of Psychiatry and Immunology, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Roberto Leon Barriera
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Neha Jain
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Efraim Keisari
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut Health Center, Farmington, CT 06032, United States
| | - Bing Wang
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT 06269, United States
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Greenwood H, Krzyzaniak N, Peiris R, Clark J, Scott AM, Cardona M, Griffith R, Glasziou P. Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Ment Health 2022; 9:e31780. [PMID: 35275081 PMCID: PMC8956990 DOI: 10.2196/31780] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. OBJECTIVE This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. METHODS In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. RESULTS A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI -0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI -0.40 to 0.39), function (SMD 0.13, 95% CI -0.16 to 0.42), working alliance client (SMD 0.11, 95% CI -0.34 to 0.57), working alliance therapist (SMD -0.16, 95% CI -0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI -0.30 to 0.53), or at any other time point (3, 6, and 12 months). CONCLUSIONS With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions.
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Affiliation(s)
- Hannah Greenwood
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Natalia Krzyzaniak
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia.,School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Ruwani Peiris
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia.,Gold Coast University Hospital Evidence-Based Practice Professorial Unit, Southport, Australia
| | | | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
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Machluf R, Abba Daleski M, Shahar B, Kula O, Bar‐Kalifa E. Couples Therapists' Attitudes Toward Online Therapy During the COVID-19 Crisis. FAMILY PROCESS 2022; 61:146-154. [PMID: 33861867 PMCID: PMC8251182 DOI: 10.1111/famp.12647] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The measures adopted by governments around the world to control the spread of the COVID-19 virus (e.g., social distancing) have propelled a rapid transition from face-to-face to online therapy. Studies on online individual therapy indicate that therapists often have favorable attitudes toward this modality. To date, there is scant work on couples therapists' attitudes, despite the fact that the provision of online couples' therapy poses unique challenges (e.g., dealing with escalating conflict remotely). To provide a snapshot, in real time, as to how therapists experience the transition to online therapy, we surveyed 166 Israeli couples' therapists during April 2020, when lockdown orders prevented therapists from seeing couples face-to-face. A few weeks later, when the stay-at-home policy was lifted, a subsample (N = 60) of these therapists completed a follow-up assessment. The results suggest that couples therapists had limited experience using the online modality prior to COVID. The therapists reported experiencing online couples' therapy as somewhat successful and that their experience of providing therapy during the COVID-19 crisis had an overall positive impact on their attitudes toward online work. Establishing a strong therapeutic bond with both partners, dealing with escalating conflict, and treatment dropout were identified as the issues of most concern when conducting online couples therapy. The perceived difficulties with online therapy prospectively predicted lower usage of online couples' therapy, as well as less intention to continue online treatment once the crisis is over.
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Affiliation(s)
| | | | | | - Ofra Kula
- Ben‐Gurion UniversityBeer‐ShevaIsrael
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Kang E, Song N, Ju H. Contents and sentiment analysis of newspaper articles and comments on telemedicine in Korea: Before and after of COVID-19 outbreak. Health Informatics J 2022; 28:14604582221075549. [PMID: 35212233 PMCID: PMC8883126 DOI: 10.1177/14604582221075549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Telemedicine is rapidly growing to meet the increased needs for high-quality health care during the COVID-19 pandemic. However, telemedicine is still a sensitive issue as it is related to medical privatization. The use of telemedicine after the COVID-19 outbreak might be influenced by public opinion, and this may be an important key in implementing telemedicine. In this study, we aimed to assess if telemedicine-related newspaper articles and comments changed positively during the COVID-19 pandemic. From January 1, 2019, to March 1, 2020 (before COVID-19), a total of 1073 telemedicine-related articles were found in the Korean news network. Although the post-COVID-19 article collection period (from March 2, 2020, to September 30, 2020) was about half that of the pre-COVID-19, about twice the number (1934) of telemedicine-related articles were collected. And telemedicine-related news articles had a more positive tone post-COVID-19 than pre-COVID-19 (52.9% after vs 40.4% before). In conclusion, this study presented the association between the COVID-19 outbreak and changes in the media's perception of telemedicine in Korea. This study presented that, as telemedicine begins to be utilized due to COVID-19, news media and readers who embrace it are beginning to view telemedicine positively, suggesting that COVID-19 has a positive foundation for the spread of telemedicine.
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Affiliation(s)
- EunKyo Kang
- National Cancer Control Institute, 70317National Cancer Center, Goyang-si, Korea.,Department of Family Medicine, 105922National Cancer Center, Goyang-si, Korea
| | - Narae Song
- Ministry of Environment, 58927Government of South Korea, Sejong, Korea
| | - HyoRim Ju
- Department of Family Medicine, 58927Seoul National University Hospital, Korea
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Orsolini L, Bellagamba S, Marchetti V, Menculini G, Tempia Valenta S, Salvi V, Volpe U. A Preliminary Italian Cross-Sectional Study on the Level of Digital Psychiatry Training, Knowledge, Beliefs and Experiences among Medical Students, Psychiatry Trainees and Professionals. Healthcare (Basel) 2022; 10:healthcare10020390. [PMID: 35207004 PMCID: PMC8871870 DOI: 10.3390/healthcare10020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic led to the implementation of digital psychiatry (DP), resulting in the need for a new skilled healthcare workforce. The purpose of this study was to investigate the level of training, knowledge, beliefs, and experiences of young mental health professionals and medical students in DP. An ad hoc cross-sectional survey was administered and descriptive analyses, Student’s t and ANOVA tests were conducted, together with an exploratory factor analysis, bivariate correlations and linear regression. Most of the sample (N = 239) declared that DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on the issue. Nevertheless, subjects mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that their training should include this topic (54.4%). Moreover, most subjects declared that digital interventions are less effective than face-to-face ones (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p ≤ 0.05). Strong positive correlations were found between the knowledge score (KS) and perceived significance index (PSI) (r = 0.148, p < 0.001), and KS and Digital Psychiatry Opinion (DPO) index (r = 0.193, p < 0.001). PSI scores statistically significantly predicted KS total scores (F(1, 237) = 5.283, R2 = 0.022, p = 0.022). KS scores statistically significantly predicted DPO total scores (F(1, 237) = 9.136, R2 = 0.037, p = 0.003). During the current pandemic, DP represented an ideal response to the forced physical distancing by ensuring the advantage of greater access to care. However, this kind of intervention is still uncommon, and mental health professionals still prove to be skeptical. The lack of formal training on DP during the academic years could be a limiting factor.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, 60126 Ancona, Italy; (L.O.); (S.B.); (S.T.V.); (V.S.)
| | - Silvia Bellagamba
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, 60126 Ancona, Italy; (L.O.); (S.B.); (S.T.V.); (V.S.)
| | - Virginia Marchetti
- School of Medicine and Surgery, Polytechnic University of Marche, 60126 Ancona, Italy;
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, 06100 Perugia, Italy;
| | - Silvia Tempia Valenta
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, 60126 Ancona, Italy; (L.O.); (S.B.); (S.T.V.); (V.S.)
| | - Virginio Salvi
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, 60126 Ancona, Italy; (L.O.); (S.B.); (S.T.V.); (V.S.)
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, 60126 Ancona, Italy; (L.O.); (S.B.); (S.T.V.); (V.S.)
- Correspondence:
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DeHart D, King LB, Iachini AL, Browne T, Reitmeier M. Benefits and Challenges of Implementing Telehealth in Rural Settings: A Mixed-Methods Study of Behavioral Medicine Providers. HEALTH & SOCIAL WORK 2022; 47:7-18. [PMID: 34910158 DOI: 10.1093/hsw/hlab036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 06/14/2023]
Abstract
Social workers and other healthcare professionals face increasing pressure to expand access, efficiency, and quality of healthcare to rural patients. Telehealth has become a viable and necessary tool to address gaps in healthcare for rural areas. Unfortunately, little is known about the benefits and challenges of using these services to meet the needs of rural communities. This mixed-methods study examines telehealth implementation among healthcare organizations in a predominantly rural state. Seventeen providers from 11 organizations were interviewed. Most had used live video conferencing, and about a third used mobile technologies, but fewer providers had experience with store-and-forward or remote patient monitoring. Analyses of qualitative data collected via interviews revealed two main themes among benefits of telehealth implementation: (1) increased inter- and intra-agency coordination and (2) savings in time, travel, and efficiency. Three main themes emerged among barriers to telehealth: (1) organizational capacity, (2) patient skills and comfort, and (3) provider knowledge and skills. Recommendations are provided for social workers and other healthcare professionals related to expanding utilization of telehealth services to improve access to healthcare for rural populations.
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Kaphzan H, Sarfati Noiman M, Negev M. The Attitudes and Perceptions of Israeli Psychiatrists Toward Telepsychiatry and Their Behavioral Intention to Use Telepsychiatry. Front Psychiatry 2022; 13:829965. [PMID: 35386519 PMCID: PMC8977602 DOI: 10.3389/fpsyt.2022.829965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although telemedicine care has grown in recent years, telepsychiatry is growing at a slower pace than expected, because service providers often hamper the assimilation and expansion of telepsychiatry due their attitudes and perceptions. The unified theory of acceptance and use of technology (UTAUT) is a model that was developed to assess the factors influencing the assimilation of a new technology. We used the UTAUT model to examine the associations between the attitudes and perceptions of psychiatrists in Israel toward telepsychiatry and their intention to use it. METHODS An online, close-ended questionnaire based on a modified UTAUT model was distributed among psychiatrists in Israel. Seventy-six questionnaires were completed and statistically analyzed. RESULTS The behavioral intention of Israeli psychiatrists to use telepsychiatry was relatively low, despite their perceptions of themselves as capable of high performance with low effort. Nonetheless, they were interested in using telepsychiatry voluntarily. Experience in telepsychiatry, and to a lesser extent, facilitating conditions, were found to be positively correlated with the intention to use telepsychiatry. Psychiatrists have a positive attitude toward treating patients by telepsychiatry and perceive its risk as moderate. DISCUSSION Despite high performance expectancy, low effort expectancy, low perceived risk, largely positive attitudes, high voluntariness, and the expectancy for facilitating conditions, the intention to use telepsychiatry was rather low. This result is explained by the low level of experience, which plays a pivotal role. We recommend promoting the facilitating conditions that affect the continued use of telepsychiatry when initiating its implementation, and conclude that it is critical to create a sense of success during the initial stages of experience.
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Affiliation(s)
- Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | | | - Maya Negev
- Division of Health Systems Policy and Administration, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Hurtubise K. Telehealth: Moving It Forward as an Option to Enhance Family-Centered Pediatric Rehabilitation Services. A Commentary on "'Another Tool in Your Toolkit': Pediatric Occupational and Physical Therapists' Perspectives of Initiating Telehealth during the COVID-19 Pandemic". Phys Occup Ther Pediatr 2022; 42:482-489. [PMID: 35949140 DOI: 10.1080/01942638.2022.2106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Karen Hurtubise
- CanChild Center for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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Kubota T, Kuroda N, Horinouchi T, Ikegaya N, Kitazawa Y, Kodama S, Kuramochi I, Matsubara T, Nagino N, Neshige S, Soga T, Takayama Y, Sone D. Barriers to telemedicine among physicians in epilepsy care during the COVID-19 pandemic: A national-level cross-sectional survey in Japan. Epilepsy Behav 2022; 126:108487. [PMID: 34922326 PMCID: PMC9759923 DOI: 10.1016/j.yebeh.2021.108487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to investigate the factors affecting the unwillingness of physicians involved in epilepsy care to continue telemedicine during the coronavirus disease 2019 (COVID-19) pandemic in Japan. METHOD This was a national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan) which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES). We asked physicians who conducted telemedicine in patients with epilepsy (PWE) during the COVID-19 pandemic at four clinics and 21 hospitals specializing in epilepsy care in Japan from March 1 to April 30, 2021. The following data were collected: (1) participant profile, (2) characteristics of PWE treated by telemedicine, and (3) contents and environmental factors of telemedicine. Statistically significant variables (p < 0.05) in the univariate analysis were analyzed in a multivariate binary logistic regression model to detect the independently associated factors with the unwillingness to continue telemedicine. RESULT Among the 115 respondents (response rate: 64%), 89 were included in the final analysis. Of them, 60 (67.4%) were willing to continue telemedicine, and 29 (32.6%) were unwilling. In the univariate binary logistic regression analysis, age (Odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.10-3.09, p = 0.02), psychiatrist (OR = 5.88, 95% CI 2.15-16.08, p = 0.001), hospital (OR = 0.10, 95% CI 0.01-0.94, p = 0.04), the number of COVID-19 risk factors in the participant (OR = 2.88, 95% CI 1.46-5.69, p = 0.002), the number of COVID-19 risk factors in the cohabitants (OR = 2.52, 95% CI 1.05-6.01, p = 0.04), COVID-19 epidemic area (OR = 4.37, 95% CI 1.18-16.20, p = 0.03), consultation time during telemedicine (OR = 2.51, 95% CI 1.32-4.76, p = 0.005), workload due to telemedicine (OR = 4.17, 95% CI 2.11-8.24, p < 0.001) were statistically significant. In the multivariate binary logistic regression analysis, workload due to telemedicine (OR = 4.93, 95% CI 1.96-12.35) was independently associated with the unwillingness to continue telemedicine. CONCLUSION This national-level cross-sectional survey found that workload due to telemedicine among physicians involved in epilepsy care was independently associated with the unwillingness to continue telemedicine.
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Affiliation(s)
- Takafumi Kubota
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurology, University Hospitals of Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA; Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Naoto Kuroda
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan,Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Toru Horinouchi
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Psychiatry and Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoki Ikegaya
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan; Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Yu Kitazawa
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurology and Stroke Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Satoshi Kodama
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Izumi Kuramochi
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Teppei Matsubara
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Naoto Nagino
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan
| | - Shuichiro Neshige
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Hiroshima, Hiroshima, Japan
| | - Temma Soga
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan,Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yutaro Takayama
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Daichi Sone
- Japan Young Epilepsy Section, Kodaira, Tokyo, Japan,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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Békés V, Aafjes-van Doorn K, McCollum J, Prout TR, Hoffman L. The development of a self-report scale to assess therapists' acceptance of telepsychotherapy. J Clin Psychol 2021; 78:1240-1260. [PMID: 34897674 DOI: 10.1002/jclp.23289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to develop a self-report measure of therapist acceptance of telepsychotherapy based on the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. METHODS Using a cross-sectional survey design, 1265 therapists completed the UTAUT-T, as well as additional questions. RESULTS Confirmatory analysis indicated that the original UTAUT model did not fit the therapist context well. Exploratory factor analysis specified a better-fitting five-factor model, which showed good internal validity fit (χ2 = 17,753.36, RMSEA = 0.063, TLI = 0.886, SRMSR = 0.04). The five UTAUT-T subscales showed high internal consistency (Cronbach's α = 0.86) and together predicted the intention to use online therapy in the future (R2 = 0.42, F(5, 1259) = 181.9, p < 0.001). CONCLUSION The 21-item UTAUT-T offers a promising self-report measure of therapist acceptance of telepsychotherapy and intention towards using it in the future. Future studies on the convergent and predictive validity of the UTAUT-T are warranted.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, United States, USA
| | | | - James McCollum
- San Francisco Psychotherapy Research Group, San Francisco, California, USA
| | - Tracy R Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, United States, USA
| | - Leon Hoffman
- New York Psychoanalytic Society and Institute, New York, New York, USA
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Implementation of telemedicine consultations for people with mental health conditions in the community: a protocol for a systematic review. HRB Open Res 2021; 4:125. [DOI: 10.12688/hrbopenres.13435.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The COVID-19 pandemic response has led to an exponential increase in the use and spread of telemedicine internationally. In community mental health care settings, telemedicine services were implemented within a few weeks, with little time for rigorous planning. Despite the reported acceptability of telemedicine by patients and clinicians, barriers to its implementation have come to light. There is now a need to investigate these barriers, and facilitators, as telemedicine begins to show potential promise beyond the pandemic. We propose a review that aims to identify the factors affecting the implementation of telemedicine consultations for patients with mental health conditions in the community. Methods: A systematic review will be conducted and reported according to the PRISMA guidelines. Five electronic databases will be searched using a pre-defined search strategy from 2016 to 2021. Only studies of synchronous, interactive telemedicine consultations conducted via video, phone or live messaging between patients and providers will be included. Quantitative, qualitative and mixed methods studies will be eligible for inclusion. Only studies published in the English language will be included. Titles and abstracts will be screened by two reviewers. Full text articles will be screened by a single reviewer, with a random 20% sample screened by a second reviewer. The methodological quality of studies will be assessed using the Mixed Method Appraisal Tool (MMAT) by two reviewers. Data will be extracted and tabulated to address the aims of the review. A narrative synthesis will be conducted and reported factors will be mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Conclusion: By identifying the factors that influence the implementation of telemedicine consultations for patients with mental conditions in the community, consideration can be given to both barriers and facilitators that could be addressed in future mental health services planning. PROSPERO registration: CRD42021273422 (04/10/2021)
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Gentry MT, Puspitasari AJ, McKean AJ, Williams MD, Breitinger S, Geske JR, Clark MM, Moore KM, Frye MA, Hilty DM. Clinician Satisfaction with Rapid Adoption and Implementation of Telehealth Services During the COVID-19 Pandemic. Telemed J E Health 2021. [DOI: 10.1089/tmj.2020.0575 10.1089/tmj.2020.0575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alastair J. McKean
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D. Williams
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Breitinger
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer R. Geske
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew M. Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine M. Moore
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald M. Hilty
- VA Northern California Health Care System, Mather, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, Sacramento, California, USA
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Harris L, Gilmore D, Hanks C, Coury D, Moffatt-Bruce S, Garvin JH, Hand BN. "It was surprisingly equivalent to the appointment I had in person": Advantages and disadvantages of synchronous telehealth for delivering primary care for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1573-1580. [PMID: 34847744 DOI: 10.1177/13623613211060589] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Autistic adults face many barriers to receiving quality primary health care like clinics that are far away and sensory sensitivities. Real-time telehealth visits, called "virtual visits," are live video chats between the patient and provider. Virtual visits may minimize barriers to care for autistic adults. We wanted to describe advantages and disadvantages of using virtual visits for delivering primary health care for autistic adults. We interviewed 7 autistic adults and 12 caregivers of autistic adults who receive primary care through one clinic. Autistic adults and caregivers said advantages to virtual visits were that (1) patients were more comfortable at home, (2) patients could get health care while avoiding physical contact with other people during the pandemic, and (3) virtual visits were similar to or better than in-person visits. The disadvantages included that (1) there could be technology problems like grainy video, (2) the doctor could not physically examine the patient (e.g. look in ears), and (3) patients sometimes participated less in the virtual visit than they would in person. Virtual visits may be beneficial for autistic adults by eliminating travel to the clinic and avoiding stressful sensory stimuli. We recognize that virtual visits may not work for all patients or in all situations. However, our study shows that primary care virtual visits may be beneficial for autistic adults during and beyond the pandemic.
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Silvestrini M, Indresano J, Zeliadt SB, Chen JA. "There's a huge benefit just to know that someone cares:" a qualitative examination of rural veterans' experiences with TelePain. BMC Health Serv Res 2021; 21:1111. [PMID: 34656133 PMCID: PMC8520618 DOI: 10.1186/s12913-021-07133-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Veterans in the United States are at an increased risk of chronic pain and have higher reported pain prevalence and severity than nonveterans. This qualitative study aims to examine veterans' perspectives on the acceptability of receiving pain care through TelePain, a telehealth program implemented by the Veterans Health Administration (VA) that offers specialty pain care to rural veterans in their homes or in a video conferencing room at a nearby outpatient clinic. METHODS The VA electronic health record was used to identify patients who were referred to TelePain from rural clinics located in Washington, Oregon, and Alaska between 12/01/2019 and 03/31/2020. The study team completed 16 semi-structured interviews with rural veterans about their experiences with TelePain. After interview transcripts were recorded digitally and transcribed, Atlas.ti was used to organize data and facilitate qualitative coding. Interview transcripts were analyzed using thematic analysis. RESULTS Veterans reported general satisfaction with receiving pain care through telehealth and valued having supportive, knowledgeable providers who provided useful information and resources. In addition, veterans appreciated the convenience of telehealth. Barriers to care included problems with program follow-up, negative perceptions of mental health care for pain, and preference for in-person care. Although some patients suggested that telehealth audio and video could be improved, most patients did not have any significant problems with telehealth technology. CONCLUSIONS In this sample of rural veterans who used TelePain, many reported satisfaction with the program and positive experiences with providers. Targets for quality improvement include streamlining the program's referral and scheduling process and improving patient motivation to engage in psychological pain treatments. Results indicate that delivering pain services over telehealth is an acceptable modality for this patient population.
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Affiliation(s)
- Molly Silvestrini
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, USA.
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA.
| | - Jess Indresano
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, USA
| | - Steven B Zeliadt
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, USA
- Department of Health Services, University of Washington, Seattle, USA
| | - Jessica A Chen
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, USA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
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Abstract
The present study was designed to assess mental health provider attitudes and perceptions of telemental health (TMH) prior to and during the COVID-19 Pandemic, as well as the nature of their TMH utilization. The study aimed to gather information about positive and negative attitudes towards TMH, perceptions and correlates based on the modality of care, and beliefs about the overall effectiveness of TMH as compared to face-to-face care. The current study is part of a larger mixed methods project utilizing a repeated cross-sectional design. An online survey was administered to a sample of 1448 mental health providers and included demographic and professional information, experiences with and perceptions of TMH prior to and during the COVID-19 Pandemic, as well as a brief measure of pandemic-related stress. The COVID-19 Pandemic resulted in an increased use of TMH in the study sample. During COVID-19, providers reported increased agreement with TMH being necessary, important, and effective for care delivery. Providers who primarily used video, compared with telephone, reported that TMH was more useful, satisfying, and effective. While negative attitude towards TMH was predicted only by prior attitudes and belief in TMH effectiveness, positive attitude towards TMH was also predicted by female sex and current level of pandemic related stress. TMH use during the pandemic was predicted by primary use of video platform and previous TMH use. The 2020 COVID-19 Pandemic resulted in increased use of TMH and significantly increased positive perceptions about TMH among mental health providers.
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Affiliation(s)
- Jennifer M. Doran
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
| | - Jessica L. Lawson
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
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Nies S, Patel S, Shafer M, Longman L, Sharif I, Pina P. Understanding Physicians' Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study. JMIR Form Res 2021; 5:e26565. [PMID: 34227993 PMCID: PMC8366754 DOI: 10.2196/26565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/30/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. OBJECTIVE We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. METHODS We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. RESULTS Of 272 health care providers who were sent the electronic survey, 157 (58%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91%] vs 65/90 [72%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95% CI 1.7-16.2; younger age: odds ratio 1.05, 95% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. CONCLUSIONS The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over.
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Affiliation(s)
- Sarah Nies
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Shae Patel
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Melissa Shafer
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Laura Longman
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Iman Sharif
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
| | - Paulo Pina
- Family Health Centers at New York University Langone, Brooklyn, NY, United States
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Einstellungen und Hinderungsgründe bezüglich Telemedizin bei Epilepsien: Eine Umfrage in neurologischen Praxen. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2021. [PMCID: PMC8243621 DOI: 10.1007/s10309-021-00417-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Zusammenfassung
Hintergrund
In Anbetracht ihres bedeutenden Potenzials zur Verbesserung der medizinischen Versorgung wird Telemedizin weiterhin zu wenig genutzt. Trotz einiger erfolgreicher Pilotprojekte in den vergangenen Jahren ist insbesondere über die Hindernisse der Etablierung und Verstetigung von Telemedizin wenig bekannt. Diese Studie hatte das Ziel, die Einstellung niedergelassener Neurologen hinsichtlich der Nutzung von Telemedizin in der Epileptologie und resultierende Hinderungsgründe zu verstehen. Gleichzeitig werden mögliche Lösungsansätze präsentiert.
Methoden
Mithilfe eines individuell erstellten 14-Item-Fragebogens befragten wir prospektiv alle Neurologen, die zuvor die Teilnahme an einem transregionalen Telemedizinpilotprojekt im Bereich der Epileptologie abgelehnt oder keine Rückmeldung gegeben hatten, zu Gründen für und gegen den generellen Einsatz von bzw. die Teilnahme an Telemedizin.
Ergebnisse
Von 58 kontaktierten Neurologen antworteten 33 (57 %). Die häufigsten Gründe für die fehlende Nutzung der Telemedizin waren ein vermuteter Zeitmangel oder ein vermuteter zu großer organisatorischer Aufwand (49 %). Zudem wurden Bedenken bezüglich der technischen Ausstattung (30 %) und eine Präferenz für alternative Wege der intersektoralen Kommunikation (30 %) angegeben. Befürchtete Probleme in Bezug auf die Kostenerstattung für telemedizinische Leistungen waren für 27 % ein Hindernis. Neurologen in ländlichen Gebieten waren signifikant häufiger bereit, zunächst eine telemedizinische Konsultation anzufordern, bevor sie eine Überweisung ausstellen (p = 0,006).
Schlussfolgerungen
Die flächendeckende Etablierung von Telemedizinstrukturen ist immer noch durch Hindernisse erschwert, die meist im organisatorischen Bereich liegen. Die bestehenden Herausforderungen im Gesundheitswesen in ländlichen Gebieten sind eine besondere Chance für die Implementierung von Telemedizin. Die meisten Probleme der Telemedizin können gelöst werden, sollten aber bereits bei der Konzeptionierung von Projekten mitbedacht werden, um ihre Verstetigung zu erleichtern.
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Yellowlees PM, Parish MB, Gonzalez AD, Chan SR, Hilty DM, Yoo BK, Leigh JP, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Soltero KM, Fisher A, Fine JR, Bannister J, Iosif AM. Clinical Outcomes of Asynchronous Versus Synchronous Telepsychiatry in Primary Care: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24047. [PMID: 33993104 PMCID: PMC8335606 DOI: 10.2196/24047] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/26/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asynchronous telepsychiatry (ATP; delayed-time) consultations are a novel form of psychiatric consultation in primary care settings. Longitudinal studies comparing clinical outcomes for ATP with synchronous telepsychiatry (STP) are lacking. OBJECTIVE This study aims to determine the effectiveness of ATP in improving clinical outcomes in English- and Spanish-speaking primary care patients compared with STP, the telepsychiatry usual care method. METHODS Overall, 36 primary care physicians from 3 primary care clinics referred a heterogeneous sample of 401 treatment-seeking adult patients with nonurgent psychiatric disorders. A total of 184 (94 ATP and 90 STP) English- and Spanish-speaking participants (36/184, 19.6% Hispanic) were enrolled and randomized, and 160 (80 ATP and 80 STP) of them completed baseline evaluations. Patients were treated by their primary care physicians using a collaborative care model in consultation with the University of California Davis Health telepsychiatrists, who consulted with patients every 6 months for up to 2 years using ATP or STP. Primary outcomes (the clinician-rated Clinical Global Impressions [CGI] scale and the Global Assessment of Functioning [GAF]) and secondary outcomes (patients' self-reported physical and mental health and depression) outcomes were assessed every 6 months. RESULTS For clinician-rated primary outcomes, ATP did not promote greater improvement than STP at 6-month follow-up (ATP vs STP, adjusted difference in follow-up at 6 months vs baseline differences for CGI: 0.2, 95% CI -0.2 to 0.6; P=.28; and GAF: -0.6, 95% CI -3.1 to 1.9; P=.66) or 12-month follow-up (ATP vs STP, adjusted difference in follow-up at 12 months vs baseline differences for CGI: 0.4, 95% CI -0.04 to 0.8; P=.07; and GAF: -0.5, 95% CI -3.3 to 2.2; P=.70), but patients in both arms had statistically and clinically significant improvements in both outcomes. There were no significant differences in improvement from baseline between ATP and STP on any patient self-reported ratings at any follow-up (all P values were between .17 and .96). Dropout rates were higher than predicted but similar between the 2 arms. Of those with baseline visits, 46.8% (75/160) did not have a follow-up at 1 year, and 72.7% (107/147) did not have a follow-up at 2 years. No serious adverse events were associated with the intervention. CONCLUSIONS This is the first longitudinal study to demonstrate that ATP can improve clinical outcomes in English- and Spanish-speaking primary care patients. Although we did not find evidence that ATP is superior to STP in improving clinical outcomes, it is potentially a key part of stepped mental health interventions available in primary care. ATP presents a possible solution to the workforce shortage of psychiatrists and a strategy for improving existing systems of care. TRIAL REGISTRATION ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Michelle Burke Parish
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Alvaro D Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Steven R Chan
- Stanford University School of Medicine, Stanford, CA, United States
- Veterans Administration Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Donald M Hilty
- Northern California Veterans Administration, Mather, CA, United States
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - J Paul Leigh
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | | | - Lorin M Scher
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Andres F Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Jay Shore
- University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | | | - Alice Fisher
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jeffrey R Fine
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, United States
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California Davis, Davis, CA, United States
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Puspitasari AJ, Heredia D, Gentry M, Sawchuk C, Theobald B, Moore W, Tiede M, Galardy C, Schak K, Clinic M. Rapid Adoption and Implementation of Telehealth Group Psychotherapy During COVID 19: Practical Strategies and Recommendations. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:492-506. [PMID: 34188434 PMCID: PMC8223010 DOI: 10.1016/j.cbpra.2021.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
Behavioral health services have been tasked with rapidly adopting and implementing teletherapy during the SARS-CoV-2/COVID-19 pandemic to assure patient and staff safety. Existing teletherapy guidelines were developed prior to the pandemic and do not capture the nuances of rapidly transitioning in-person individual and group-based treatments to a teletherapy format. In this paper, we describe our approach to quickly adapting to a teletherapy technology platform for an intensive outpatient program (IOP) guided by cognitive and behavioral modular principles for adults with serious mental illness. A review of existing guidelines was conducted and the staged approach for teletherapy implementation (Muir et al., 2020) was selected as the most appropriate model for our organizational context. We describe the most pertinent implementation strategies and report our preliminary findings detailing the feasibility of IOPs delivered via telehealth. This model of rapid teletherapy implementation offers practical clinical guidelines for administrators and clinicians seeking to transition traditional in-person behavioral health services to a teletherapy format.
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Client, clinician, and administrator factors associated with the successful acceptance of a telehealth comprehensive recovery service: A mixed methods study. Psychiatry Res 2021; 300:113871. [PMID: 33887517 PMCID: PMC8141021 DOI: 10.1016/j.psychres.2021.113871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/12/2021] [Indexed: 11/21/2022]
Abstract
The coronavirus disease 2019 SARS-CoV-2 (COVID-19) crisis and subsequent social distancing recommendations resulted in increased use of telehealth within recovery-oriented behavioral health services (RS). Populations with serious mental illness (SMI) rely on psychosocial treatment, care coordination, and pharmacotherapy to achieve recovery goals and increase community engagement. This program evaluation of a group-based RS used mixed methods to better understand the multiple factors that contributed to successful telehealth conversion. Clients' service utilization over an 18-week period was collected to determine acceptance and the client characteristics associated with utilization (n = 72). Clients completed a treatment satisfaction questionnaire that was distributed ten weeks following telehealth conversion. Qualitative interviews explored staff perspectives on factors that impacted conversion, acceptance, and utilization. Initial staff skepticism gave way to acceptance, while the demands of resourcefulness, flexibility, and competency were emphasized. Clients' treatment utilization remained stable, while the number of missed/cancelled sessions were less frequent over time, especially for clients with a history of psychosis. Clients reported high overall satisfaction, but a preference for in-person treatment. Within this clinic serving middle to high socioeconomic status (SES) clients, clinicians and clients alike found the virtual group-based RS to be feasible and acceptable while in-person treatment was not an option.
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