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Bass E, Garabrant J, Salyers MP, Patterson S, Iwamasa GY, McGuire AB. eHealth Use on Acute Inpatient Mental Health Units: Implementation Processes, Common Practices, and Barriers to Use. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01262-1. [PMID: 36943598 PMCID: PMC10028324 DOI: 10.1007/s10488-023-01262-1] [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] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
Information technology to promote health (eHealth) is an important and growing area of mental healthcare, yet little is known about the use of patient-facing eHealth in psychiatric inpatient settings. This quality improvement project examined the current practices, barriers, implementation processes, and contextual factors affecting eHealth use across multiple Veteran Health Administration (VHA) acute mental health inpatient units. Staff from units serving both voluntary and involuntary patients (n = 49 from 37 unique sites) completed surveys regarding current, desired, and barriers to use of Veteran-facing eHealth technologies. Two subsets of respondents were then interviewed (high success sites in eHealth use, n = 6; low success sites, n = 4) to better understand the context of their eHealth use. Survey responses indicated that 20% or less of Veterans were using any type of eHealth technology while inpatient. Tablets and video chat were the most desired overall and most successfully used eHealth technologies. However, many sites noted difficulty implementing these technologies (e.g., limited Wi-Fi access). Qualitative analysis of interviews revealed differences in risk/benefit analysis and implementation support between high and low success eHealth sites. Despite desired use, patient-facing eHealth technology is not regularly implemented on inpatient units due to multiple barriers (e.g., limited staffing, infrastructure needs). Successful implementation of patient-facing eHealth may require an internal champion, guidance from external supports with experience in successful eHealth use, workload balance for staff, and an overall perspective shift in the benefits to eHealth technology versus the risks.
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Affiliation(s)
- Emily Bass
- Health Services Research & Development, Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis, USA.
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St., IN, 46202, Indianapolis, USA.
| | - Jennifer Garabrant
- Health Services Research & Development, Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St., IN, 46202, Indianapolis, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St., IN, 46202, Indianapolis, USA
| | - Scott Patterson
- Health Services Research & Development, Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
| | - Gayle Y Iwamasa
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, VA Central Office, Washington, DC, USA
| | - Alan B McGuire
- Health Services Research & Development, Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, 402 N. Blackford St., IN, 46202, Indianapolis, USA
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Schmutte T, Olfson M, Xie M, Marcus SC. Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm. Am J Geriatr Psychiatry 2022; 30:478-491. [PMID: 34563430 PMCID: PMC10563141 DOI: 10.1016/j.jagp.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. RESULTS Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. CONCLUSION Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
| | - Mark Olfson
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University, New York, New York
| | - Ming Xie
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania
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Payvandi L, Parsons C, Bourgeois FC, Hron JD. Inpatient telehealth experience of limited English proficient patients: a cross-sectional survey and semi-structured interview (Preprint). JMIR Form Res 2021; 6:e34354. [PMID: 35438641 PMCID: PMC9066319 DOI: 10.2196/34354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 12/20/2022] Open
Abstract
Background Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. Objective This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. Methods We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. Results A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. Conclusions Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP.
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Affiliation(s)
- Lily Payvandi
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
| | - Chase Parsons
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Fabienne C Bourgeois
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jonathan D Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Harkey K, Connor CD, Wang H, Kaiser N, Matthews BD, Kelz R, Reinke CE. View from the Patient Perspective: Mixed-Methods Analysis of Post-Discharge Virtual Visits in a Randomized Controlled Trial. J Am Coll Surg 2021; 233:593-605.e4. [PMID: 34509613 DOI: 10.1016/j.jamcollsurg.2021.07.688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Virtual visits (VVs) are being used increasingly to provide patient-centered care and have undergone rapid uptake during the COVID-19 pandemic. Our aim was to compare satisfaction and convenience of virtual post-discharge follow-up for surgical patients and qualitatively analyze free-text survey responses in a randomized controlled noninferiority trial. Patient satisfaction with VVs has not been evaluated previously in a randomized controlled trial and few mixed-methods analyses have been done to understand barriers and facilitators to post-discharge visits. STUDY DESIGN Patients undergoing laparoscopic appendectomy or cholecystectomy were randomized to VV or in-person visit (2:1). Surveys with 11 multiple-choice and 2 open-ended questions evaluated patient satisfaction and convenience. Univariate analysis compared responses to the multiple-choice questions and qualitative content analysis evaluated open-ended responses. RESULTS Of 442 enrolled patients, 289 completed their postoperative visit and were sent surveys (55% response rate). Patients were categorized as VV (n = 135), crossover (randomized to virtual but completed in-person; n = 53), and in-person visits (n = 101). Patient-reported satisfaction was similar, but convenience was higher for VV patients. Open-ended responses (72 VVs, 14 crossovers, and 41 in-person visits) were qualitatively analyzed. In all groups, patient experience was influenced by quality of care, efficiency, and convenience. Barriers were different for virtual and in-person appointments. CONCLUSIONS We found that quality of, and access to, care-whether in person or virtual-remained critical components of patient satisfaction. VVs address many barriers associated with in-person visits and were more convenient, but can present additional technological barriers.
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Affiliation(s)
| | - C Danielle Connor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC
| | | | | | | | - Rachel Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
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Brahmbhatt K, Mournet AM, Malas N, DeSouza C, Greenblatt J, Afzal KI, Giles LL, Charoensook J, Feuer V, Raza H, Mooneyham GC, Pergjika A, Schlesinger A, Chapman A, Strain A, Gandhi B, Johnson K, Mroczkowski MM, Ibeziako P, Graham R, Yoon Y, Plioplys S, Fuchs C, Shaw RJ, Pao M. Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey. J Acad Consult Liaison Psychiatry 2021; 62:511-521. [PMID: 34033972 PMCID: PMC8141785 DOI: 10.1016/j.jaclp.2021.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.
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Affiliation(s)
- Khyati Brahmbhatt
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA.
| | - Annabelle M Mournet
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | - Nasuh Malas
- University of Michigan Medical School, Department of Psychiatry and Department of Pediatrics, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Claire DeSouza
- University of Toronto, Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Jeanne Greenblatt
- NYU Grossman School of Medicine, Departments of Child Psychiatry and Pediatrics, NYU Hassenfeld Children's Hospital and Bellevue Hospital Center, New York, NY
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Lisa L Giles
- University of Utah School of Medicine, Departments of Pediatrics and Psychiatry, Primary Children's Hospital, Salt Lake City, UT 84113
| | - Janet Charoensook
- Children's Hospital Los Angeles, Division of Psychiatry, Los Angeles, CA
| | - Vera Feuer
- Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | - Haniya Raza
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | | | - Alba Pergjika
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Amanda Schlesinger
- University of Minnesota Medical School. F262 West Building, Minneapolis, MN
| | - Andrea Chapman
- University of British Columbia, Department of Psychiatry, British Columbia Children's Hospital, Vancouver, BC
| | - Angela Strain
- The University of North Carolina at Chapel Hill, Department of Emergency Medicine, Chapel Hill, NC
| | - Bela Gandhi
- Nationwide Children's Hospital, Department of Psychiatry. 444 Butterfly Gardens Drive, Columbus, OH
| | - Kyle Johnson
- Oregon Health & Science University. Division of Child & Adolescent Psychiatry, Portland, OR
| | - Megan M Mroczkowski
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston MA
| | - Regina Graham
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA
| | - Yesie Yoon
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL
| | - Sigita Plioplys
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Catherine Fuchs
- Vanderbilt University, Department of Psychiatry and Behavioral Sciences and Pediatrics, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Richard J Shaw
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences. 401 Quarry Road, Palo Alto, CA
| | - Maryland Pao
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
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Gopalan P, Auster L, Brockman I, Shenai N. Telemedicine Psychiatric Consultation on an Inpatient Obstetrical Labor and Delivery Unit. J Acad Consult Liaison Psychiatry 2021; 62:577-581. [PMID: 33972195 DOI: 10.1016/j.jaclp.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/22/2021] [Accepted: 04/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited access to mental health resources has challenged clinicians in delivering early behavioral health interventions to perinatal populations. We describe telepsychiatry consultations to a rural hospital's labor and delivery unit. OBJECTIVE To demonstrate how consultation-liaison services during peripartum hospitalization could meet this need. METHODS One-year data from electronic medical records of women who were at risk of postpartum syndromes and offered a telepsychiatry consult was extracted and reviewed. RESULTS A total of 85 consults were conducted via telepsychiatry primarily for depression, anxiety, and medication management. Bedside psychotherapeutic interventions and education were provided to 63 patients, medications were initiated for 32 patients, and outpatient referrals were made for 47 patients. CONCLUSIONS Our results indicate that consultation-liaison telehealth can successfully engage at-risk mothers in psychiatric treatment. Given accelerated telemedicine efforts due to the COVID-19 pandemic, improving access to telepsychiatry for rural, peripartum populations is an important area of development.
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Affiliation(s)
- Priya Gopalan
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA.
| | - Lauren Auster
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA
| | - Ida Brockman
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA
| | - Neeta Shenai
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA
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Yoon MS, Martin KB, Marraccini RL, Norris ER. Provider Satisfaction from a New Telepsychiatry Inpatient Consultation Service. Telemed J E Health 2021; 27:1129-1135. [DOI: 10.1089/tmj.2020.0317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Michael S. Yoon
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Katherine B. Martin
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Rory L. Marraccini
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Edward R. Norris
- Department of Psychiatry, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Abstract
Calls for social distancing amid the COVID-19 pandemic have renewed attention on the utility of telepsychiatry. Although considerable evidence supports use of telepsychiatry in outpatient settings, telepsychiatry in hospitals is less studied and less developed. The COVID-19 pandemic may lead to rapid adoption of telepsychiatry by hospitals, and this column explores opportunities hospital-based telepsychiatry offers for staffing, patient and staff safety, social connection, and real-time responsiveness. Because hospital-based telepsychiatry brings unique challenges compared with outpatient telepsychiatry, this column also proposes a research agenda for studying and supporting adoption of these technologies in hospital settings.
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Affiliation(s)
- Nathaniel P Morris
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Morris, Hirschtritt); Division of Research, Kaiser Permanente Northern California, and The Permanente Medical Group, Oakland (Hirschtritt). Dror Ben-Zeev, Ph.D., is the editor of this column
| | - Matthew E Hirschtritt
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Morris, Hirschtritt); Division of Research, Kaiser Permanente Northern California, and The Permanente Medical Group, Oakland (Hirschtritt). Dror Ben-Zeev, Ph.D., is the editor of this column
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Beran C, Sowa NA. Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision. J Acad Consult Liaison Psychiatry 2020; 62:186-192. [PMID: 33288272 PMCID: PMC7667404 DOI: 10.1016/j.psym.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has led to drastic changes in how psychiatric consultation-liaison (C-L) services conduct business and required rapid transition to telepsychiatry. We describe the practice changes implemented to rapid transition to virtual care in a large, academic psychiatry C-L service in response to the pandemic. OBJECTIVE To describe clinical service structural changes, timelines and impacts on consultation volume as well as present quantitative and qualitative data regarding the experience of this transition from the standpoints of both psychiatric trainees and attending physicians. METHODS We present the narrative descriptions of transition details based on focused interviews with inpatient C-L leadership. Inpatient consult volume and charge data were gathered using analysis of health system data. Attending and trainee experience of the transition to virtual care were assessed using anonymous, online surveys. RESULTS During the pandemic, the average weekly consultation volume and average weekly charges were significantly lower compared with prepandemic. Both volume and charges were affected by addition of video consultation capability. Both attendings and trainees had moderate or high comfort and moderate satisfaction with telephone and video consultations. Overall, the trainee satisfaction with supervision, learning, and their consult psychiatry experience did not seem to be affected by the pandemic. CONCLUSIONS Our results support the feasibility of the rapid implementation of virtual care in a psychiatric academic C-L service without negatively impacting the learner's consult psychiatry experience. This should provide comfort to academic C-L services that required rapid implementation of virtual care.
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Affiliation(s)
- Christine Beran
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Nathaniel A Sowa
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
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Implementation of a Centralized Telepsychiatry Consult Service in a Multi-Hospital Metropolitan Health Care System: Challenges and Opportunities. J Acad Consult Liaison Psychiatry 2020; 62:193-200. [PMID: 33046267 PMCID: PMC7483289 DOI: 10.1016/j.psym.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Providing adequate psychiatry consultation capacity on a 24/7 basis is an intrinsic challenge throughout many multihospital health care systems. At present, implementation research has not adequately defined the effectiveness and feasibility of a centralized telepsychiatry consultation service within a multihospital health care system. OBJECTIVE To demonstrate feasibility of a hub and spoke model for provision of inpatient consult telepsychiatry service from an academic medical center to 2 affiliated regional hospital sites, to reduce patient wait time, and to develop best practice guidelines for telepsychiatry consultations to the acutely medically ill. METHODS The implementation, interprofessional workflow, process of triage, and provider satisfaction were described from the first 13 months of the service. RESULTS This pilot study resulted in 557 completed telepsychiatry consults over the course of 13 months from 2018 to 2019. A range of psychiatric conditions commonly encountered by consultation-liaison services were diagnosed and treated through the teleconferencing modality. The most common barriers to successful use of telepsychiatry were defined for the 20% of consult requests that were retriaged to face-to-face evaluation. The average patient wait time from consult request to initial consultation was reduced from >24 hours to 92 minutes. CONCLUSIONS This study demonstrated the feasibility of a centralized telepsychiatry hub to improve delivery of psychiatry consultation within a multihospital system with an overall reduction in patient wait time. This work may serve as a model for further design innovation across many health care settings and new patient subpopulations.
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Ghosh A, Verma M, Lal S. A Review of Models and Efficacy of Telepsychiatry for Inpatient Service Delivery: Proposing a Model for Indian Settings. Indian J Psychol Med 2020; 42:34S-40S. [PMID: 33354061 PMCID: PMC7736746 DOI: 10.1177/0253717620958168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The use of telepsychiatry (TP) for inpatient service delivery is still an emerging field and there is limited literature on its practice and evidence. This review was conducted with the objectives of (a) exploring the models of TP for inpatient service delivery, (b) qualitative synthesis of the efficacy of TP in inpatient settings, and (c) proposing a best-fit model of TP-based inpatient care for Indian settings. METHODS An electronic database search was conducted on July 22, 2020, in PubMed, Directory of Open Access Journals, and Google Scholar for relevant articles. Seventeen articles were included in the review. RESULTS The review revealed three models for TP-based inpatient care; direct care model, teleconsultation model, and the collaborative care model. Preliminary evidence suggests that TP is cost-effective and reliable, and that patients and service providers are highly satisfied with this approach. Evidence gaps were seen for some diagnostic categories such as psychosis and for extremes of age groups. Based on the existing models, we propose an Indian model for implementing TP in inpatient settings. CONCLUSION Promising initial results and the evidence gaps highlight the need for further research in this area.
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Affiliation(s)
- Abhishek Ghosh
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meha Verma
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Lal
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada.,Youth Mental Health and Technology Lab, University of Montreal Hospital Research Centre, Montreal, QC, Canada.,PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada
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Kohan L, Sobey C, Wahezi S, Brancolini S, Przkora R, Shaparin N, Spektor B, Moeschler S, Anitescu M. Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part II: Innovations in Clinical Care Workflow, Clinical Supervision, Job Satisfaction, and Postgraduation Mentorship for Pain Fellows During the COVID-19 Pandemic. PAIN MEDICINE 2020; 21:1718-1728. [PMID: 32379882 PMCID: PMC7239119 DOI: 10.1093/pm/pnaa176] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Pain fellowship programs are facing unique challenges during the COVID-19 pandemic. Restrictions by state governments and the Centers for Disease Control and Prevention have resulted in a rapidly changing and evolving learning environment for today’s fellows. Innovative solutions must be sought to maintain proper education and ensure the well-being of our trainees. Methods : We assembled a panel of pain program directors who serve as officers/board members of the Association of Pain Program Directors, offering guidance and recommendations to pain fellowship directors nationwide. Panel members evaluate best available evidence and expert opinion on use of remote and virtual platforms in clinical care, adaptability to alterations in clinic and referral management, and provide guidance on post-graduate impact. Conclusions The country is in the midst of an unprecedented pandemic. The impact on pain management fellowships has been significant and will likely last for months, resulting in extraordinary challenges to the administration of pain fellowship programs and the education of our fellows. Several strategies will help address these challenges, including employing telehealth capabilities to continue clinical experiences, and providing trainees with opportunities to continue their professional growth beyond fellowship completion. Together, we can implement innovative solutions to overcome these challenges.
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Affiliation(s)
- Lynn Kohan
- Division of Pain Medicine, Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Christopher Sobey
- Clinical Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sayed Wahezi
- Physical Medicine and Rehabilitation, Anesthesiology, and Orthopedic, Montefiore Medical Center, New York, New York
| | - Scott Brancolini
- Department of Anesthesia, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rene Przkora
- Pain Medicine Division, Department of Anesthesiology, College of Medicine, University of Florida, Miami, Florida
| | - Naum Shaparin
- Anesthesiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Boris Spektor
- Department of Anesthesiology, Emory School of Medicine, Atlanta, Georgia
| | - Susan Moeschler
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Minneapolis, Minnesota
| | - Magdalena Anitescu
- Pain Management, Department of Anesthesia and Critical Care Medicine, University of Chicago, Chicago, IL, USA
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13
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Caravella RA, Deutch AB, Noulas P, Ying P, Liaw KRL, Greenblatt J, Collins K, Eastburn HK, Fries E, Khan S, Kozikowski A, Sidelnik SA, Yee M, Ginsberg D. Development of a Virtual Consultation-Liaison Psychiatry Service: A Multifaceted Transformation. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200610-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Hron JD, Parsons CR, Williams LA, Harper MB, Bourgeois FC. Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic. Appl Clin Inform 2020; 11:452-459. [PMID: 32610350 DOI: 10.1055/s-0040-1713635] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing. OBJECTIVE This article evaluates the use of a rapidly implemented, secure inpatient telehealth program. METHODS We assembled a multidisciplinary team to rapidly design, implement, and iteratively improve an inpatient telehealth quality improvement initiative using an existing videoconferencing system at our academic medical center. We assigned each hospital bed space a unique meeting link and updated the meeting password for each new patient. Patients and families were encouraged to use their own mobile devices to join meetings when possible. RESULTS Within 7 weeks of go-live, we hosted 1,820 inpatient telehealth sessions (13.3 sessions per 100 bedded days). We logged 104,647 minutes of inpatient telehealth time with a median session duration of 22 minutes (range 1-1,961). There were 5,288 participant devices used with a mean of 3 devices per telehealth session (range 2-22). Clinicians found they were able to build rapport and perform a reasonable physical exam. CONCLUSION We successfully implemented and scaled a secure inpatient telehealth program using an existing videoconferencing system in less than 1 week. Our implementation provided an intuitive naming convention for providers and capitalized on the broad availability of smartphones and tablets. Initial comments from clinicians suggest the system was useful; however, further work is needed to streamline initial setup for patients and families as well as care coordination to support clinician communication and workflows. Numerous use cases identified suggest a role for inpatient telehealth will remain after the COVID-19 crisis underscoring the importance of lasting regulatory reform.
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Affiliation(s)
- Jonathan D Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Chase R Parsons
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
| | - Lee Ann Williams
- Patient Care Operations, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Marvin B Harper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States.,Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Fabienne C Bourgeois
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
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15
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Becker JE, Smith JR, Hazen EP. Pediatric Consultation-Liaison Psychiatry: An Update and Review. PSYCHOSOMATICS 2020; 61:467-480. [PMID: 32482345 PMCID: PMC7194908 DOI: 10.1016/j.psym.2020.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
Background In recent years, there has been an increasing burden of child and adolescent mental illness recognized in the United States, and the need for pediatric mental health care is growing. Pediatric consultation-liaison (C-L) psychiatrists are increasingly playing a role in the management of medical and psychiatric disease for pediatric patients. The field is a fast-moving one, with understanding of new neuropsychiatric disease entities; reformulation of prior disease entities; and new interdisciplinary treatments and models of care. Methods In this study, we aim to review recent advances in the field of pediatric C-L psychiatry, including new diagnostic entities, updated management of frequently encountered clinical presentations, and developments in systems of care. Conclusion The advances in pediatric C-L psychiatry are broad and serve to promote more streamlined, evidence-based care for the vulnerable population of psychiatrically ill pediatric medical patients. More work remains to determine the most effective interventions for the wide array of presentations seen by pediatric C-L psychiatrists.
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Affiliation(s)
- Jessica E Becker
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Eric P Hazen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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16
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Johnson DS. Thinking Outside the Box: Are We Ready for Teleprecepting to Expand Training and Practice Venues? Issues Ment Health Nurs 2019; 40:215-222. [PMID: 30376390 DOI: 10.1080/01612840.2018.1488903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A significant challenge related to nurse practitioner (NP) training is the shortage of clinical sites with qualified faculty to precept NP interns. The problem is compounded in rural communities with provider shortages, restricting their opportunities to train (and potentially recruit) new APRNs. Consequently, these underserved communities have difficulty accessing specialty providers, such as Psychiatric Mental Health Nurse Practitioners (PMHNPs). Combined with geographic distance from urban communities and generally lower pay, many rural and/or remote communities struggle with the disparity in contrast to more populated regions. A needs assessment of an underserved county with poor access to psychiatric services suggests that contracted telepsychiatry was costly and failed to address the long-term dearth of local psychiatric providers. Stakeholders reported that local RNs (and possibly FNPs) were employed by the local hospital and that a subgroup may have aptitude and interest in psychiatry if a university program and preceptors were available. Collaborating with an urban PMHNP program, televideo technology for clinical training and preceptor development offers a solution to the dearth of preceptors. A pilot intervention will use teleprecepting aimed at establishing best practice guidelines for implementation of this novel approach to expanding the clinical training and capacity in rural and under-served communities.
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Affiliation(s)
- Deborah S Johnson
- a Community Health Systems , University of California San Francisco School of Nursing , San Francisco, California , USA
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17
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Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. Am J Geriatr Psychiatry 2019; 27:109-127. [PMID: 30416025 DOI: 10.1016/j.jagp.2018.10.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 01/02/2023]
Abstract
Telemental health (TMH) for older patients has the potential to increase access to geriatric specialists, reduce travel times for patients and providers, and reduce ever growing healthcare costs. This systematic review article examines the literature regarding psychiatric assessment and treatment via telemedicine for geriatric patients. English language literature was searched using Ovid Medline, PubMed, and PsycINFO with search terms including telemedicine, telemental health, aging, and dementia. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open label, qualitative and randomized controlled trial study designs. Data was compiled regarding participants, study intervention, and outcomes. 76 articles were included. TMH was shown to be feasible and well accepted in the areas of inpatient and nursing home consultation, cognitive testing, dementia diagnosis and treatment, depression in integrated and collaborative care models, and psychotherapy. There is limited data on cost-effectiveness of TMH in the elderly. This article will discuss the current barriers to broader implementation of telemedicine for geriatric patients including reimbursement from the Medicare program. Medicare reimbursement for telemedicine is limited to rural areas, which does not allow for the widespread development of telemedicine programs. All Medicare beneficiaries would benefit from increased access to telemedicine services, not only those living in rural areas. As many elderly and disabled individuals have mobility problems, home-based telemedicine services should also be made available. There are efforts in Congress to expand the coverage of these services under Medicare, but strong advocacy will be needed to ensure these efforts are successful.
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Affiliation(s)
- Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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18
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Kimmel RJ, Toor R. Telepsychiatry by a Public, Academic Medical Center for Inpatient Consults at an Unaffiliated, Community Hospital. PSYCHOSOMATICS 2018; 60:468-473. [PMID: 30626492 DOI: 10.1016/j.psym.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Telepsychiatry has the potential to help address the uneven distribution of psychiatrists between urban and rural areas. While telepsychiatry has been used for several decades, employing video conferencing technologies to conduct psychiatry consults to the medical wards of rural hospitals is a more recent application. OBJECTIVE To develop the first US program wherein psychiatrists covering the consult service at a public, academic medical center also delivered same-day consults to patients on the medical wards of unaffiliated, rural hospitals. METHODS We describe the rationale, workflow, technology, case distribution, benefits, and lessons learned from the first 24 months of the service. RESULTS The program resulted in 156 initial and follow-up consults wherein patient interviews were conducted via live videoconference. An additional 19 "curbside" consults were done via hospitalist-to-psychiatrist phone calls. Though the initial impetus for the development of the program was to manage involuntarily-detained patients awaiting the availability of a psychiatric bed, the availability of the psychiatrists resulted in the service being used for a wide range of situations and diagnoses. CONCLUSION Given the benefits noted by consultants, patients, and community hospital medical staff, the program could be replicated by other institutions.
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Affiliation(s)
- Ryan J Kimmel
- University of Washington, School of Medicine, Seattle, WA.
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19
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Abstract
PURPOSE OF REVIEW Mental health clinicians should understand how technologies augment, enhance, and provide alternate means for the delivery of mental healthcare. These technologies can be used asynchronously, in which the patient and the clinician need not be communicating at the same time. This contrasts with synchronous technologies, in which patient and clinician must communicate at the same time. RECENT FINDINGS The review is based on research literature and the authors' clinical and healthcare administration experiences. Asynchronous technologies can exist between a single clinician and a single patient, such as patient portal e-mail and messaging, in-app messaging, asynchronous telepsychiatry via store-and-forward video, and specialty patient-to-provider mobile apps. Asynchronous technologies have already been used in different countries with success, and can alleviate the psychiatric workforce shortage and improve barriers to access. Multiple studies referred to in this review demonstrate good retention and acceptability of asynchronous psychotherapy interventions by patients. Asynchronous technologies can alleviate access barriers, such as geographical, scheduling, administrative, and financial issues. It is important for clinicians to understand the efficacy, assess the ethics, and manage privacy and legal concerns that may arise from using asynchronous technologies.
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20
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Valdes-Stauber J, Bachthaler S. Clinical and care intensity differences among patients suffering from somatic diseases electively referred to a consultation and liaison service. Int J Psychiatry Med 2018; 53:141-158. [PMID: 29264939 DOI: 10.1177/0091217417749794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Background This investigation mainly explores possible care differences among patients hospitalized because of medical conditions being electively referred to a psychiatric-psychosomatic consultation and liaison service. Methods A four-year survey ( N = 2518 individuals) based on clinical and care variables selected from the basic documentation. STATISTICS Chi-square tests, analysis of variance, logistic and multivariate regression analyses, considering statistical modeling assumptions. Results A current psychiatric comorbidity has been found in 75% (less in cancer patients), mainly adjustment and anxiety (45%), mood (22%), and organic mental disorders (12%). The functioning score (Global Assessment of Functioning) was 59.4 and was especially low in patients suffering from unclear medical conditions. The performance status (Eastern Cooperative Oncology Group) amounted to 1.63 and was especially high in patients suffering from orthopedic conditions, infections, and cancer. Each patient received on average of 2.26 (SD = 2.81) contacts and 111 minutes (SD = 160) of total treatment time. In multivariate models, care differences among medical conditions are reduced. Men and older people have received less than the average amount of treatment, but psychiatrically comorbid patients and those with lower functionality and performance status have received more intensive psychological support. Conclusions As a quality feature of consultation and liaison service, patients suffering from psychiatric comorbidity, lower functionality, and lower performance status receive more intensive care and more post-discharge recommendations. Cancer patients and patients with pain as a leading diagnosis as well as strained mothers of hospitalized children have received more intensive treatment by consultation and liaison service despite lower psychiatric comorbidity levels. More attention has to be paid to men and older people independently of their physical condition.
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21
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Parish MB, Fazio S, Chan S, Yellowlees PM. Managing Psychiatrist-Patient Relationships in the Digital Age: a Summary Review of the Impact of Technology-enabled Care on Clinical Processes and Rapport. Curr Psychiatry Rep 2017; 19:90. [PMID: 29075951 DOI: 10.1007/s11920-017-0839-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Participatory medicine and the availability of commercial technologies have given patients more options to view and track their health information and to communicate with their providers. This shift in the clinical process may be of particular importance in mental healthcare where rapport plays a significant role in the therapeutic process. RECENT FINDINGS In this review, we examined literature related to the impact of technology on the clinical workflow and patient-provider rapport in the mental health field between January 2014 and June 2017. Thirty three relevant articles, of 226 identified articles, were summarized. The use of technology clinically has evolved from making care more accessible and efficient to leveraging technology to improve care, communication, and patient-provider rapport. Evidence exists demonstrating that information and communication technologies may improve care by better connecting patients and providers and by improving patient-provider rapport, although further research is needed.
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Affiliation(s)
- Michelle Burke Parish
- Department of Psychiatry, University of California Davis, Sacramento, CA, USA.
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48th St, Sacramento, CA, 95817, USA.
| | - Sarina Fazio
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48th St, Sacramento, CA, 95817, USA
| | - Steven Chan
- Department of Psychiatry, University of California Davis, Sacramento, CA, USA
- Division of Hospital Medicine, Clinical Informatics, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Peter M Yellowlees
- Department of Psychiatry, University of California Davis, Sacramento, CA, USA
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22
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Graziane JA, Gopalan P, Cahalane J. Telepsychiatry Consultation for Medical and Surgical Inpatient Units. PSYCHOSOMATICS 2017; 59:62-66. [PMID: 28918164 DOI: 10.1016/j.psym.2017.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Telepsychiatry is becoming more commonplace in the provision of psychiatric care. Most commonly used in the outpatient setting, there is little information available in the literature as to the use of telepsychiatry for inpatient medical/surgical consultation. OBJECTIVE We review the University of Pittsburgh Medical Center's telepsychiatry consultation program that provides consultation to an outlying community-based rural hospital. METHODS This article examines the 69 telepsychiatry consultations that were performed from November 2014 through February 2016, looking at the patients served, common consultation questions, and patterns of diagnoses and recommendations. RESULTS The median age of individuals undergoing telepsychiatry evaluations was 67 years, and the most common reason for consultation was for delirium. Over half of the patients consulted had a primary diagnosis of delirium, dementia, or a cognitive disorder not otherwise specified, using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses. In most patients, additional laboratory studies or imaging or both were requested and medication changes recommended (initiation, dose changes, and discontinuation). CONCLUSION This report provides one of the first detailed views of the use of telepsychiatry in a remote inpatient medical setting. Findings will guide education to primary teams and will shape the development of future telepsychiatry interventions.
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Affiliation(s)
- Julie A Graziane
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA; Department of Psychiatry, Penn State College of Medicine, Pennsylvania Psychiatric Institute, Harrisburg, PA.
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Jack Cahalane
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA
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Abstract
BACKGROUND The investigation of the real density of care by a consultation-liaison service (CLS) as a function of patient groups, settings and diagnoses makes sense with respect to a better allocation of resources. OBJECTIVE Are there differences concerning the density of care by a CLS in a general hospital depending on patient groups and on the psychiatric diagnosis? METHOD A retrospective (2012-2015) survey of all consultations (n = 7081 corresponding to 4080 patients) was carried out based on the CLS documentation for quality assurance. Bivariate tests (i.e. χ2-test and ANOVA) and multivariate linear and logistic models were used to investigate group differences and associations. RESULTS The number of consultations achieved corresponded to 3.2 % of the total admissions to hospital, especially internal medicine (22.3 %), surgery (26.1 %) as well as gynecology and obstetrics (21.1 %). A suicide attempt was the reason for treatment in 3.3 %. Each patient received on average 1.7 consultations lasting 75 min but only 25 % received 2 or more consultations. Patients with psychiatric comorbidities, non-oncology patients as well as female and young patients received a more intensive care by CLS. Patients with depressive and somatoform disorders received a higher density of treatment. DISCUSSION The psychotherapeutic interventions performed did not follow the expected diagnostic patterns in other settings. Systemic interventions with indirect treatment should be given priority in older patients and especially in patients with organic mental disorders.
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Bensamoun D, Gros A, Manera V, König A, Guérin O, Robert P, David R. [Neuropsychiatric disorders and technological solutions]. SOINS. GERONTOLOGIE 2016; 21:18-20. [PMID: 27664358 DOI: 10.1016/j.sger.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Innovative new tools today allow better clinical evaluation. Indeed, new information and communication technology is particularly interesting for the screening, monitoring and management of neuropsychiatric disorders of the elderly. A personalised approach to patients can further enhance their adherence and involvement.
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Affiliation(s)
- David Bensamoun
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Centre mémoire de ressources et de recherche, CHU de Nice, 10 rue Molière, 06100 Nice, France
| | - Auriane Gros
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Centre mémoire de ressources et de recherche, CHU de Nice, 10 rue Molière, 06100 Nice, France
| | - Valeria Manera
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Centre mémoire de ressources et de recherche, CHU de Nice, 10 rue Molière, 06100 Nice, France
| | - Alexandra König
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Centre mémoire de ressources et de recherche, CHU de Nice, 10 rue Molière, 06100 Nice, France
| | - Olivier Guérin
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Pôle Réhabilitation autonomie vieillissement, CHU de Nice, 4 avenue de la Reine-Victoria, 06003 Nice, France
| | - Philippe Robert
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Centre mémoire de ressources et de recherche, CHU de Nice, 10 rue Molière, 06100 Nice, France
| | - Renaud David
- EA Cobtek, université de Nice Sophia Antipolis, 98 boulevard Édouard-Herriot, 06000 Nice, France; Centre mémoire de ressources et de recherche, CHU de Nice, 10 rue Molière, 06100 Nice, France.
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