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Zimmermann J, Heilmann ML, Fisch-Jessen M, Hauch H, Kruempelmann S, Moeller H, Nagel L, Nathrath M, Vaillant V, Voelker T, Deckers MJ. Telehealth Needs and Concerns of Stakeholders in Pediatric Palliative Home Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1315. [PMID: 37628315 PMCID: PMC10453074 DOI: 10.3390/children10081315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Pediatric palliative home care (PPHC) provides care for children, adolescents, and young adults with life-limiting illnesses in their own homes. Home care often requires long travel times for the PPHC team, which is available to the families 24/7 during crises. The complementary use of telehealth may improve the quality of care. In this pilot study we identify the needs and concerns of patients, teams, and other stakeholders regarding the introduction of telehealth. As a first step, focus groups were conducted in three teams. For the second step, semi-structured interviews were conducted with patients and their families (n = 15). Both steps were accompanied by quantitative surveys (mixed methods approach). The qualitative data were analyzed using content analysis. A total of 11 needs were identified, which were prioritized differently. Highest priority was given to: data transmission, video consultation, access to patient records, symptom questionnaires, and communication support. The concerns identified were related to the assumption of deterioration of the status quo. Potential causes of deterioration were thought to be the negative impact on patient care, inappropriate user behavior, or a high level of technical requirements. As a conclusion, we define six recommendations for telehealth in PPHC.
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Affiliation(s)
- Jannik Zimmermann
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Marie Luise Heilmann
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Manuel Fisch-Jessen
- Palliative Care Team for Children Frankfurt, 60599 Frankfurt, Hesse, Germany
| | - Holger Hauch
- Palliative Care Team for Children Giessen, 35392 Giessen, Hesse, Germany
| | | | - Heidi Moeller
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Laura Nagel
- Department of Psychology—Theory and Methodology of Counseling, University of Kassel, 34127 Kassel, Hesse, Germany; (J.Z.)
| | - Michaela Nathrath
- Palliative Care Team for Children Kassel, 34125 Kassel, Hesse, Germany
| | - Vera Vaillant
- Palliative Care Team for Children Giessen, 35392 Giessen, Hesse, Germany
| | - Thomas Voelker
- Palliative Care Team for Children Kassel, 34125 Kassel, Hesse, Germany
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2
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Chapman KA, MacEachern D, Cox GF, Waller M, Fogarty J, Granger S, Stepanians M, Waisbren S. Neuropsychological endpoints for clinical trials in methylmalonic acidemia and propionic acidemia: A pilot study. Mol Genet Metab Rep 2023; 34:100953. [PMID: 36659999 PMCID: PMC9842695 DOI: 10.1016/j.ymgmr.2022.100953] [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: 10/02/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction This pilot study assessed instruments measuring relatively discrete neuropsychological domains to inform the selection of clinical outcome assessments that may be considered for interventional trials in methylmalonic acidemia (MMA) and propionic acidemia (PA). Methods Tests and questionnaires were selected for their possible relevance to MMA and PA and potential sensitivity to modest changes in functioning and behavior. Results Twenty-one patients (<18 years, n = 10;>18 years, n = 11) and/or their caregivers responded to video interviews and paper tests. Language deficits and significant motor deficits in some participants impacted scoring, especially in the verbal and processing speed sections of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) and the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV). However, all participants ≥12 years of age were able to complete the Cookie Theft Picture Task. Thus, verbal discourse remains a potentially useful endpoint for participants in this age group. The Vineland Adaptive Behavior Scales (VABS-3) Adaptive Behavior Composite and Communication Scores confirmed delayed or immature functioning in day-to-day activities in these participants. Significant motor deficits prevented completion of some tests. Computerized processing speed tasks, which require pressing a button or tapping a computer screen, may be easier than writing or checking off boxes on paper in this cohort. Sleep characteristics among MMA participants were within normative ranges of the Child and Adolescent Sleep Checklist (CASC), indicating that this measurement would not provide valuable data in a clinical trial. Despite their challenges, responses to the Metabolic Quality of Life Questionnaire indicated these patients and their caregivers perceive an overall high quality of life. Conclusion Overall, test and questionnaire results were notably different between participants with MMA and participants with PA. The study demonstrates that pilot studies can detect instruments that may not be appropriate for individuals with language or motor deficits and that may not provide a broad range of scores reflecting disease severity. It also provides a rationale for focusing on discrete neuropsychological domains since some aspects of functioning were less affected than others and some were more closely related to disease severity. When global measures are used, overall scores may mask specific deficits. A pilot study like this one cannot ensure that scores will change over time in response to a specific treatment in a clinical trial. However, it can avert the selection of instruments that do not show associations with severity or biomedical parameters likely to be the target of a clinical trial. A pilot study can also identify when differences in diagnoses and baseline functioning need to be addressed prior to developing the analytical plan for the trial.
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Affiliation(s)
- Kimberly A. Chapman
- Children's National Rare Disease Institute, 7125 13th Pl NW, Washington DC 20012, USA,Corresponding author at: 7125 13th Place NW, Washington DC 20012, USA.
| | - Devon MacEachern
- PROMETRIKA, LLC, 100 CambridgePark Drive, Cambridge, MA 02140, USA
| | - Gerald F. Cox
- HemoShear Therapeutics Inc., 501 Locust Ave #301, Charlottesville, VA 22902, USA,Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA
| | - Mavis Waller
- HemoShear Therapeutics Inc., 501 Locust Ave #301, Charlottesville, VA 22902, USA
| | - Jeanine Fogarty
- HemoShear Therapeutics Inc., 501 Locust Ave #301, Charlottesville, VA 22902, USA
| | - Suzanne Granger
- PROMETRIKA, LLC, 100 CambridgePark Drive, Cambridge, MA 02140, USA
| | | | - Susan Waisbren
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA
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Dörttepe ZÜ, Duman ZÇ. Examination of Telemental Health Practices in Caregivers of Children and Adolescents with Mental Illnesses: A Systematic Review. Issues Ment Health Nurs 2022; 43:625-637. [PMID: 35021018 DOI: 10.1080/01612840.2021.2013366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this systematic review, effects of telemental health (TMH) practices' on caregivers of children/adolescents with mental illnesses were investigated. The literature review included databases, and reference lists of published studies. All studies published until September 2021 were reviewed. Eleven studies were included. Several services were provided via TMH: education, cognitive behavioral therapy (CBT), parent training, caregiver behavior training, family CBT. The effectiveness of TMH interventions on caregivers varied from low to high. Most reproducible findings were on caregivers' satisfaction, stress, therapeutic alliance and caregiver burden. Studies had a low to high bias risk. Most studies had small samples. Results built on the small but growing literature support TMH interventions' promising role in caregivers of children with mental illness. Future studies should estimate outcomes with medium to low effect size. Other caregiver groups, rarely considered in previous studies, should be included. Bias risk should be minimized. Larger, more methodologically rigorous studies should be conducted.
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Affiliation(s)
- Zümra Ülker Dörttepe
- Medical Services and Techniques Department, Vocational School of Health Sciences, Uşak University, Uşak, Turkey
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4
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Stavropoulos KK, Heyman M, Salinas G, Baker E, Blacher J. Exploring telehealth during COVID for assessing autism spectrum disorder in a diverse sample. PSYCHOLOGY IN THE SCHOOLS 2022; 59:1319-1334. [PMID: 35572181 PMCID: PMC9088649 DOI: 10.1002/pits.22672] [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] [Received: 05/02/2021] [Revised: 10/27/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Abstract
Due to the coronavirus disease 2019 (COVID-19) pandemic, the importance of telehealth has rapidly increased, in particular as many in-person clinics have closed. Early intervention is crucial for improving outcomes in children with autism spectrum disorder (ASD). As such, the need for timely assessments and diagnoses remains despite COVID-19-related closures. This study offers preliminary data collected from 23 children assessed through a no-cost autism clinic in Southern California using a novel telehealth model. This includes an overview of an adapted, telehealth version of in-person observational assessment techniques for diagnosing autism. In addition, preliminary data on social validity assessed at two points are presented. Findings suggest that caregivers found the telehealth assessment procedures acceptable and convenient, and overall were satisfied with both the assessment and the written report/verbal feedback. Implications for future uses of telehealth are discussed, including how telehealth can assist with decision-making around school-based services and/or placement.
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Affiliation(s)
| | - Michelle Heyman
- Graduate School of EducationUniversity of California, RiversideRiversideCAUSA
| | - Giselle Salinas
- Graduate School of EducationUniversity of California, RiversideRiversideCAUSA
| | - Elizabeth Baker
- Graduate School of EducationUniversity of California, RiversideRiversideCAUSA
| | - Jan Blacher
- Graduate School of EducationUniversity of California, RiversideRiversideCAUSA
- Department of PsychologyUniversity of CaliforniaLos AngelesUSA
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Russell MR, Rogers RL, Rosenthal SM, Lee JY. Increasing Access to Care for Transgender/Gender Diverse Youth Using Telehealth: A Quality Improvement Project. Telemed J E Health 2022; 28:847-857. [PMID: 34637658 PMCID: PMC9231660 DOI: 10.1089/tmj.2021.0268] [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] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose:We sought to expand telehealth at an academic multidisciplinary pediatric gender center to increase access to gender-affirming care without compromising communication, privacy, or patient satisfaction.Materials and Methods:Patient needs assessments were performed from January 2019 to March 2020. The severe acute respiratory syndrome coronavirus 2 pandemic accelerated implementation of the quality improvement project, and clinically appropriate patients were scheduled for video visits starting March 16, 2020. From September 8, 2020 to October 2, 2020, caregivers of transgender and gender diverse (TGD) minors or TGD young adults pursuing gender-affirming medications completed 9-item surveys evaluating communication quality and privacy, access to care, and quality of services for video and clinic visits. Answers were rated via Likert scales (1 = strongly agree, 5 = strongly disagree; 1 = less travel time, 4 = more travel time).Results:Needs assessment (n = 69) showed that 63.8% felt that video visits would improve follow-up. Survey participants (n = 91) reported statistically significant differences (p < 0.05) in several areas. Compared with clinic visits, video visits were more convenient, 1.21 ± 0.435 versus 2.36 ± 1.207, took less time from other activities, 4.55 ± 0.522 versus 2.93 ± 1.281, required less travel time, 1.03 ± 0.180 versus 2.63 ± 0.901, and were more acceptable, 1.35 ± 0.545 versus 1.65 ± 0.736. Participants were more likely to choose video visits in the future, 1.32 ± 0.555 versus 1.57 ± 0.732. There were no statistically significant differences in communication quality, privacy, or overall satisfaction.Conclusion:An integrated clinic-video visit model increases access to gender-affirming care for TGD youth while maintaining excellent communication, privacy, and patient satisfaction.
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Affiliation(s)
- Meredith R. Russell
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca L. Rogers
- School of Nursing, Samuel Merritt University, Oakland, California, USA
| | - Stephen M. Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Janet Y. Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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6
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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7
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Davidson SK, Sanci L, de Nicolás Izquierdo C, Watson CJ, Baltag V, Sawyer SM. Best Practice During Teleconsultations With Adolescents: A Scoping Review. J Adolesc Health 2022; 70:714-728. [PMID: 35082052 DOI: 10.1016/j.jadohealth.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Teleconsultations are increasingly used to deliver health care, yet guidance on how to maximize health outcomes and ensure the quality and rights-based principles of adolescent health care during teleconsultations is lacking. This scoping review synthesized the literature on teleconsultations with adolescents, with the objective of informing a practical guidance for healthcare professionals. METHODS Eight databases were searched to identify articles published between 2010 and 2020 in English, French, or Spanish that provided evidence or guidance on synchronous teleconsultations with 10- to 19-year-olds. Web sites in six high-income countries and six low- to middle-income countries were also searched and a Google search was conducted. Data were analyzed using narrative synthesis. RESULTS Of 59 total references, 51 were from high-income countries. References included primary research (n = 21), reviews (n = 13), clinical guidance (n = 9), case reports (n = 9), commentaries (n = 6), and a website (n = 1). Just under half (46%) were descriptive, qualitative, or expert opinion. The main focus was mental health and behavioral disorders. DISCUSSION Good evidence on the complexities of conducting teleconsultations with adolescents is lacking. Questions remain regarding the scope and acuity of health issues for which teleconsultations are appropriate, their role in overcoming or contributing to inequalities, and the practicalities of conducting consultations.
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Affiliation(s)
- Sandra K Davidson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Cathy J Watson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA), World Health Organization (WHO), Geneva, Switzerland
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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8
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Stavropoulos KKM, Bolourian Y, Blacher J. A scoping review of telehealth diagnosis of autism spectrum disorder. PLoS One 2022; 17:e0263062. [PMID: 35143494 PMCID: PMC8830614 DOI: 10.1371/journal.pone.0263062] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Considering the COVID-19 pandemic, understanding the reliability, validity, social validity, and feasibility of using telehealth to diagnose ASD is a critical public health issue. This paper examines evidence supporting the use of telehealth methods to diagnose ASD and outlines the necessary modifications and adaptations to support telehealth diagnosis. Methods and procedures Studies were identified by searching PubMed and PsychInfo electronic databases and references lists of relevant articles. Only peer reviewed articles published in English with a focus on using telehealth for the purposes of diagnosing ASD were included. Searches were conducted through June 3rd, 2021. Outcomes and results A total of 10 studies were identified as meeting inclusion criteria. Of the eight papers that reported on reliability (e.g., accuracy), telehealth methods to diagnose ASD were between 80–91% accurate when compared with traditional in-person diagnosis. Six studies reported on validity (i.e., sensitivity and/or specificity). All six studies calculated sensitivity, with values ranging from 75% and 100%. Five of the six studies calculated specificity, with values ranging from 68.75% and 100%. The seven papers that reported social validity indicated that caregivers, as well as adult participants and clinicians, were mostly satisfied with telehealth. Feasibility was reported by seven studies and suggests that telehealth methods appear largely viable, though some challenges were reported. Conclusions and implications Although findings reviewed here are promising, more research is needed to verify the accuracy, validity, and feasibility of utilizing telehealth to diagnose ASD. Studies with larger sample sizes and samples across sites will be critical, as these will allow clinicians to identify subjects most likely to benefit from telehealth as well as those more likely to require an in-person assessment. This research is important not only due to the current pandemic, but also due to increased prevalence rates of ASD and an insufficient number of diagnostic providers—particularly in rural and/or otherwise under-served communities.
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Affiliation(s)
| | - Yasamin Bolourian
- School of Education, University of California, Riverside, CA, United States of America
| | - Jan Blacher
- School of Education, University of California, Riverside, CA, United States of America
- Department of Psychology, University of California, Los Angeles, CA, United States of America
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Abstract
Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted. RESULTS: Four USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.
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Azarang A, Pakyurek M, Giroux C, Nordahl TE, Yellowlees P. Information Technologies: An Augmentation to Post-Traumatic Stress Disorder Treatment Among Trauma Survivors. Telemed J E Health 2019; 25:263-271. [DOI: 10.1089/tmj.2018.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Atoosa Azarang
- MIND Institute, University of California-Davis Medical Center, Sacramento, California
| | - Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Caroline Giroux
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Thomas E. Nordahl
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
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