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McCarron R, Moore A, Foreman I, Brewis E, Clarke O, Howes A, Parkin K, Luk D, Hirst MS, Sach E, Shipp A, Stahly L, Bhardwaj A. Remote consultations in community mental health: A qualitative study of clinical teams. J Psychiatr Ment Health Nurs 2024; 31:857-868. [PMID: 38462900 DOI: 10.1111/jpm.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/14/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental health care can be delivered remotely through video and telephone consultations. Remote consultations may be cheaper and more efficient than in person consultations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Accessing community mental health care through remote consultations is perceived as not possible or beneficial for all service users. Delivering remote consultations may not be practical or appropriate for all clinicians or community mental health teams. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Remote consultation cannot be a 'one-size-fits-all' model of community mental health care. A flexible approach is needed to offering remote consultation that considers its suitability for the service-user, service and clinician. ABSTRACT INTRODUCTION: Responding to COVID-19, community mental health teams in the UK NHS abruptly adopted remote consultations. Whilst they have demonstrable effectiveness, efficiency, and economic benefits, questions remain around the acceptability, feasibility and medicolegal implications of delivering community mental health care remotely. AIM To explore perceived advantages, challenges, and practice adaptations of delivering community mental health care remotely. METHODS Ten community mental health teams in an NHS trust participated in a service evaluation about remote consultation. Fifty team discussions about remote consultation were recorded April-December 2020. Data analysis used a framework approach with themes being coded within a matrix. RESULTS Three major horizontal themes of operations and team functioning, clinical pathways, and impact on staff were generated, with vertical themes of advantages, challenges, equity and adaptations. DISCUSSION Remote consultation is an attractive model of community mental healthcare. Clinical staff note benefits at individual (staff and service-user), team, and service levels. However, it is not perceived as a universally beneficial or practical approach, and there are concerns relating to access equality. IMPLICATIONS FOR PRACTICE The suitability of remote consultation needs to be considered for each service-user, clinical population and clinical role. This requires a flexible and hybrid approach, attuned to safeguarding equality.
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Affiliation(s)
- Robyn McCarron
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Anna Moore
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ilana Foreman
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Emily Brewis
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Olivia Clarke
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Abby Howes
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Katherine Parkin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diana Luk
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Emilie Sach
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Aimee Shipp
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Lorna Stahly
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Anupam Bhardwaj
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Doering JJ, Wichman CL, Laszewski A, Kuehn S, Ke W. Perinatal psychiatric practitioner consultation program delivers rapid response to OB/GYN practitioners. Birth 2023; 50:764-772. [PMID: 36939290 DOI: 10.1111/birt.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/15/2021] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Screening and treatment initiation for perinatal psychiatric conditions is a recommended competency in OB/GYN practitioners, yet perinatal psychiatry is rapidly evolving. Practitioner-to-psychiatrist consultation programs have the potential to improve the management of psychiatric conditions in perinatal women. This study describes utilization of a statewide perinatal psychiatric consultation service by OB/GYN practitioners through examination of the volume, responsivity, content and outcomes of clinical inquiries, and satisfaction. METHODS This quality improvement study describes the 460 telephone or e-mail consultations requested by OB/GYN practitioners over 2 years and housed within a REDCap database. Data include the characteristics of consult users, month-over-month and total utilization, the patient's perinatal status, the reason for contact, current symptoms and medications, and the consulting psychiatrist recommendations. Practitioner satisfaction with consultation is also described. RESULTS After completion of triage, the psychiatrist returned the practitioner's call ≤5 min in 59% of consultations. The most common inquiries were for pregnant (64%) women for depressive (51%) or anxiety (46%) symptoms with 47% of inquiries reporting the patient was currently taking a psychiatric medication. Had consultation not been available, referral to mental health (41%) or starting a medication (15%) were most often reported. CONCLUSIONS This perinatal psychiatric consultation service rapidly and effectively met the needs of practitioners practicing in OB/GYN settings across a state having a critical psychiatry shortage and varying urban and rural geography. Future recommendations include the assessment of direct patient outcomes, practitioner skill attainment, and long-term cost savings of this perinatal psychiatric consultation model.
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Affiliation(s)
- Jennifer J Doering
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Christina L Wichman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Audrey Laszewski
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelby Kuehn
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Weiming Ke
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Haun MW, Oeljeklaus L, Hoffmann M, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Primary care patients' experiences of video consultations for depression and anxiety: a qualitative interview study embedded in a randomized feasibility trial. BMC Health Serv Res 2023; 23:9. [PMID: 36600264 PMCID: PMC9811759 DOI: 10.1186/s12913-022-09012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/26/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Integrated mental health care models that provide rapid access to video consultations with mental health specialists for primary care patients are a promising short-term, low-threshold treatment option and may reduce waiting times for specialist care. This qualitative study, nested within a randomized feasibility trial, aimed to explore participants' views on this type of care model, its influence on the lived experience of patients, and barriers and facilitators for its delivery. METHODS In five primary care practices, 50 adults with depression and/or anxiety were randomly assigned to either an integrated care model (maximum of five video consultations with a mental health specialist) or usual care (primary care or another treatment option). Prior to obtaining the trial results, interviews were held with participants who had received video consultations. Interviews were transcribed and analysed thematically. RESULTS Twenty of the 23 patients who received video consultations participated in the interviews. Patients engaged well with the care model and reported positive effects on their most pressing needs, while denying safety concerns. Generally, they perceived the usability of video consultations as high, and temporary connectivity failures were not considered a substantial barrier. We identified two key mechanisms of impacts on the patients' lived experience: fast access to specialist mental healthcare and the emerging rapport with the specialist. In particular, patients with no prior mental healthcare experience indicated that familiarity with the primary practice and their physician as a gatekeeper were important facilitators of proactive treatment. CONCLUSIONS From the patients' perspective, mental health care models integrating video consultations with mental health specialists into primary care are linked to positive lived experiences. Our findings imply that primary care physicians should promote their role as gatekeepers to (1) actively engage patients, (2) apply integrated care models to provide a familiar and safe environment for conducting mental health care video consultations, and (3) be able to regularly assess whether certain patients need in-person services. Scaling up such models may be worthwhile in real-world service settings, where primary care physicians are faced with high workloads and limited specialist services. TRIAL REGISTRATION DRKS00015812.
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Affiliation(s)
- Markus W. Haun
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Lydia Oeljeklaus
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Mariell Hoffmann
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Justus Tönnies
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Michel Wensing
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Regina Krisam
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Dorothea Kronsteiner
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
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Jones LS, Russell A, Collis E, Brosnan M. To What Extent Can Digitally-Mediated Team Communication in Children's Physical Health and Mental Health Services Bring about Improved Outcomes? A Systematic Review. Child Psychiatry Hum Dev 2022; 53:1018-1035. [PMID: 33963964 PMCID: PMC8105145 DOI: 10.1007/s10578-021-01183-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/13/2022]
Abstract
Digital communication technologies can be used for team consultation, case management, and information sharing in health and mental health services for children and young people (CYP). The objective of the systematic review was to investigate the evidence as to whether digitally-mediated team communication for CYP improves outcomes. We searched PsycINFO, PubMed, Web of Science, and Cochrane Library for relevant studies. Results were synthesised narratively. Seven studies were identified from 439 initial records. Analysis highlighted that digitally-mediated team communication is generally valued by professionals for supporting practice and that there is overall satisfaction with the process. There was preliminary evidence (from one study) that clinical outcomes from digitally-mediated team communication are comparable to those achieved by a collaborative service model with direct specialist care to service users via digital communication technology. There is a need for further high-quality research into clinical outcomes and service user experience, as well as financial implications.
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Affiliation(s)
- Lauren Stephanie Jones
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Emma Collis
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Mark Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK
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La Valle C, Johnston E, Tager-Flusberg H. A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104269. [PMID: 35636261 PMCID: PMC10521149 DOI: 10.1016/j.ridd.2022.104269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments. AIM This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality. METHOD AND PROCEDURES Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools. OUTCOMES AND RESULTS Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality. CONCLUSIONS AND IMPLICATIONS Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.
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Affiliation(s)
- Chelsea La Valle
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Emily Johnston
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
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Harding S, Eyllon M, Twigden A, Hogan A, Barry D, Mirsky J, Barnes B, Nordberg S. Power on: The rapid transition of a large interdisciplinary behavioral health department to telemental health during the COVID-19 pandemic. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 27:100506. [PMID: 35229056 PMCID: PMC8866964 DOI: 10.1016/j.xjep.2022.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic necessitated a rapid transition to telemental health (TMH) for behavioral health services in the behavioral health department of a large integrated primary care organization. Although the COVID-19 pandemic was the initial trigger for rapid organizational change, systems were developed with a focus on longer term scalability and sustainability. Methods This paper discusses the process of organizational change within our healthcare delivery system using the Strengths, Opportunities, Aspirations, and Results (SOAR) framework. Within this framework a structured mixed methods survey of 38 clinicians representing 5 different disciplines was conducted. Internal and survey data were analyzed to evaluate and guide the iterative change process. Results The majority of BH clinicians reported that they were as or more effective with TMH. The transition to TMH in our organization resulted in increased access to care, with a 10.3% increase in BH visit completions. The transition to TMH may benefit clinician work-life balance, but requires resources to support clinical, technological, and communication/teamwork changes. Implications/conclusions TMH is a feasible treatment modality for integrated care settings. It is cost-effective and well-accepted by clinicians. The SOAR framework can be used to guide rapid organizational change and ongoing QI processes.
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Toh G, Pearce E, Vines J, Ikhtabi S, Birken M, Pitman A, Johnson S. Digital interventions for subjective and objective social isolation among individuals with mental health conditions: a scoping review. BMC Psychiatry 2022; 22:331. [PMID: 35549899 PMCID: PMC9098213 DOI: 10.1186/s12888-022-03889-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Social isolation encompasses subjective and objective concepts. Both are associated with negative health consequences and are more prevalent among people with mental health problems than among the general population. To alleviate social isolation, digital interventions have potential as accessible alternatives or adjuncts to face-to-face interventions. This scoping review aimed to describe the types of digital interventions evaluated for feasibility, acceptability and effectiveness in alleviating social isolation among individuals with mental health problems, and to present an overview of the quantitative evidence yielded to inform future intervention design. METHODS We searched five electronic databases for quantitative and mixed methods studies published between January 2000 and July 2020. Studies were included if they evaluated digital interventions for individuals with mental health conditions, had subjective and/or objective social isolation as their primary outcome, or as one of their outcomes if no primary outcome was specified. Feasibility studies were included if feasibility outcomes were the primary outcomes and social isolation was among their secondary outcomes. A narrative synthesis was conducted to present our findings. The protocol was registered on Open Science Framework (doi: https://doi.org/10.17605/OSF.IO/CNX8A ). RESULTS Thirty-two studies were included for our review: 16 feasibility studies, seven single-group studies and nine effectiveness trials. There was great variation in the interventions, study designs and sample populations. Interventions included web-based programmes, phone-based programmes, blended interventions, socially assistive robots and virtual reality interventions. Many were feasibility studies, or otherwise not fully powered to detect an effect if one were present, thus preventing clear conclusions about clinical effectiveness. Satisfactory feasibility outcomes indicated potential for future trials to assess these interventions. CONCLUSION Our scoping review identified a range of digital approaches utilized to alleviate social isolation among individuals with mental health disorders. Conclusions regarding clinical effectiveness cannot be reached due to variability of approaches and lack of large-scale randomized controlled trials. To make clear recommendations for digital social isolation interventions, future research needs to be based on rigorous methods and larger samples. Future studies should also focus on utilizing theory-driven approaches and improving existing approaches to advance the field.
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Affiliation(s)
- Gigi Toh
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK.
| | - Eiluned Pearce
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - John Vines
- School of Informatics, University of Edinburgh, Crichton St, Newington, Edinburgh, UK
| | - Sarah Ikhtabi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - Mary Birken
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
| | - Alexandra Pitman
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK
- Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK
| | - Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 149 Tottenham Court Road, London, W1W 7NF, UK.
- Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, St Pancras Way, London, NW1 0PE, UK.
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McDougal Ronconi J, Kim S, Hackel J, Kelly L, Zhang L. Implementing Telemental Health to Improve Access to Mental Health Care in Rural Vermont. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morgan AA, Landers AL, Simpson JE, Russon JM, Case Pease J, Dolbin‐MacNab ML, Bland KN, Jackson JB. The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us? JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:320-341. [PMID: 33742728 PMCID: PMC8250895 DOI: 10.1111/jmft.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.
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Affiliation(s)
- Amy A. Morgan
- Department of Family ScienceSchool of Public HealthUniversity of MarylandCollege ParkMDUSA
| | - Ashley L. Landers
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jessica E. Simpson
- Department of Family Social ScienceCollege of Education and Human DevelopmentUniversity of MinnesotaSt PaulMNUSA
| | - Jody M. Russon
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jenene Case Pease
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Megan L. Dolbin‐MacNab
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Krista N. Bland
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jeffrey B. Jackson
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
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Juarez-Reyes M, Mui HZ, Kling SMR, Brown-Johnson C. Accessing behavioral health care during COVID: rapid transition from in-person to teleconferencing medical group visits. Ther Adv Chronic Dis 2021; 12:2040622321990269. [PMID: 33633823 PMCID: PMC7887692 DOI: 10.1177/2040622321990269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND AIM Effective and safe behavioral health interventions in primary care are critical during pandemic and other disaster situations. California shelter-in-place orders necessitated rapid transition of an effective mindfulness-based medical group visit (MGV) program from in-person to videoconferenced sessions (VCSs). Aim: to Describe procedures, acceptability, and feasibility of converting from in-person to VCS. PATIENTS AND METHODS Methods: qualitative. Dataset: primary care. Intervention: a six-session 2-h MGV program with educational and mindfulness components was converted. Four in-person sessions and two VCSs were held. General Anxiety Disorder and Patient Health Questionnaire-9 were administered at first and last sessions. A semi-structured focus group was conducted after session six. Population studied: six primary care patients (42 ± 11 years) with stress, anxiety, or depression participated. RESULTS Procedural changes included remote material distribution, scheduling, hosting, and facilitation functions using the Zoom platform. The focus group revealed that patients preferred in-person sessions during initial visits, but appreciated transitioning to VCS, which provided continued support during a challenging time. Instruction on technical (e.g. logging on) and social (e.g. signaling next speaker) aspects of VCS was suggested. Building relationships through conversations was an important part before and after in-person sessions missing from VCS. Patients suggested combining in-person and VCS to allow relationship building while also improving access. CONCLUSION While many procedural changes were needed to facilitate conversion to VCS, primary care patients seeking stress, anxiety, and depression interventions found VCS acceptable during COVID-19. Future iterations of this program are proposed which incorporate procedural changes and facilitate relationship building between patients in VCS.
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Affiliation(s)
- Maria Juarez-Reyes
- School of Medicine, Stanford University, 3250 Alpine Rd, Portola Valley, CA 94028, USA
| | - Heather Z Mui
- Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Samantha M R Kling
- Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Cati Brown-Johnson
- Evaluation Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
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Johns G, Tan J, Burhouse A, Ogonovsky M, Rees C, Ahuja A. A visual step-by-step guide for clinicians to use video consultations in mental health services: NHS examples of real-time practice in times of normal and pandemic healthcare delivery. BJPsych Bull 2020; 44:277-284. [PMID: 33213560 PMCID: PMC7360952 DOI: 10.1192/bjb.2020.71] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Despite the increasingly widespread use of video consultations, there are very few documented descriptions of how to set up and implement video consultations in real-time practice. This step-by-step guide will describe the set-up process based on the authors' experience of two real-time National Health Service (NHS) examples: a single health board use (delivered in normal time), and an All-Wales National Video Consultation Service roll-out (delivered during an emergency pandemic as part of the COVID-19 response). This paper provides a simple visual step-by-step guide for using telepsychiatry via the remote use of video consultations in mental health services, and outlines the mandatory steps to achieving a safe, successful and sustainable use of video consultations in the NHS by ensuring that video consultations fit into existing and new NHS workflow systems and adhere to legal and ethical guidelines.
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Affiliation(s)
| | | | | | | | | | - Alka Ahuja
- Aneurin Bevan University Health Board, UK
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Spencer T, Noyes E, Biederman J. Telemedicine in the Management of ADHD: Literature Review of Telemedicine in ADHD. J Atten Disord 2020; 24:3-9. [PMID: 31257978 DOI: 10.1177/1087054719859081] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Telemedicine has been used successfully in several medical specialties with favorable patient outcomes, satisfaction, in a cost-effective manner. However, its use in the context of ADHD remains unclear. Our main aim was to investigate what is known about the use of telemedicine in ADHD. Method: We conducted a systematic search of the literature assessing telemedicine in ADHD in PubMed, PsycINFO, and Medline. Included were original articles published in English with the main aim to assess the use of telemedicine in ADHD. Results: Only 11 articles met our inclusion and exclusion criteria, coming from only three systematic trials of telemedicine in ADHD. The studies suggest that telemedicine is valued by its users, is well accepted, and is associated with improved outcomes. Conclusion: The limited research indicates that telemedicine has potential to expand the delivery of clinical services to patients with ADHD. More work is needed to further evaluate this finding.
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Affiliation(s)
- Thomas Spencer
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Joseph Biederman
- Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, MA, USA
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Abstract
INTRODUCTION Healthcare providers and systems increasingly utilize telehealth modalities to address barriers and challenges for healthcare delivery. Specialties, such as psychiatry, are testing asynchronous methods for telehealth delivery. The National Quality Forum (NQF) developed a framework with which to assess the quality of telemedicine according to measures and measure concepts within four domains. This review assesses existing asynchronous telepsychiatry (ATP) research according to the telehealth domains established by NQF, evaluates the prevalence and quality of ATP, and identifies the areas in which more research must be conducted. METHODS A systematic review of ATP methods was conducted according to PRISMA guidelines. Studies were categorized according to NQF telehealth domains and subdomains to further examine study outcomes. RESULTS The review initially identified 205 studies that were narrowed down to a final sample of 11 articles. Of the final articles, most studies addressed the effectiveness of ATP or users' experience with ATP. DISCUSSION The initial investigation of published ATP literature suggests promising results. ATP studies suggest that these services improve access to care, can be feasibly implemented by the clinical team, maintain patient/family satisfaction, and potentially reduce the cost of services. The limited sample of published literature necessitates further study of the practice in order to assess ATP according to the quality domains identified by NQF, especially access to care for patients and caregivers, the financial costs incurred by both providers and patients, and barriers to uptake.
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Affiliation(s)
- Molly O'Keefe
- Department of Health Management & Systems Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
| | - Kelsey White
- Department of Health Management & Systems Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
| | - J'Aime C Jennings
- Department of Health Management & Systems Sciences, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA
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Lynch S, Greeno C, Teich JL, Heekin J. Pediatric integrated behavioral health service delivery models: Using a federal framework to assess levels of integration. SOCIAL WORK IN HEALTH CARE 2019; 58:32-59. [PMID: 30321132 DOI: 10.1080/00981389.2018.1531104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/20/2018] [Accepted: 09/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the level of integration of pediatric integrated behavioral health service delivery models (IBHSDM) since it has not been well established. DATA SOURCES A systematic review of journal databases (e.g., PubMed) and Google searches was used to identify publications. STUDY SELECTION Studies were included if they examined children who were treated in an IBHSDM. DATA EXTRACTION The authors extracted data from studies and assessed them for level of integration using a federal conceptual framework. DATA SYNTHESIS Guided by PRISMA standards, the authors identified 40 journal articles that described 32 integrated delivery models. Five models (15.6%) were rated at integration level 1 or 2 (coordinated care), eight models (25%) were rated level 3 and five models (15.6%) were rated level 4 (co-located care), and fourteen models (43.8%) were rated level 5 or 6 (integrated care). CONCLUSIONS In general, it is assumed that more completely integrated care will result in higher quality care and reduced costs. Thirteen of the models described (40.6%) had levels of integration of 3 or lower that may be too low to produce desired effects on quality and cost. Future research should address potential barriers that impede the development of models with higher degrees of integration.
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Affiliation(s)
- Sean Lynch
- a U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration , Center for Behavioral Health Statistics & Quality , Rockville , MD
| | - Catherine Greeno
- a U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration , Center for Behavioral Health Statistics & Quality , Rockville , MD
| | - Judith L Teich
- a U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration , Center for Behavioral Health Statistics & Quality , Rockville , MD
| | - Janet Heekin
- a U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration , Center for Behavioral Health Statistics & Quality , Rockville , MD
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Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
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Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
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Hilty DM, Rabinowitz T, McCarron RM, Katzelnick DJ, Chang T, Bauer AM, Fortney J. An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care. PSYCHOSOMATICS 2017; 59:227-250. [PMID: 29544663 DOI: 10.1016/j.psym.2017.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance. METHOD This conceptual review article explores TP as applied to newer models of care (e.g., collaborative, stepped, and integrated care). RESULTS The field of psychosomatic medicine (PSM) has developed clinical care models, educates interdisciplinary team members, and provides leadership to clinical teams. PSM is uniquely positioned to steer TP and implement other telebehavioral health care options (e.g., e-mail/telephone, psych/mental health apps) in the future in primary care. Together, PSM and TP provide versatility to health systems by enabling more patient points-of-entry, matching patient needs with provider skills, and helping providers work at the top of their licenses. TP and other technologies make collaborative, stepped, and integrated care less costly and more accessible. CONCLUSION Effective health care delivery matches the intensity of the services to the needs of a patient population or clinic, standardizes interventions, and evaluates both process and clinical outcomes. More research is indicated on the application of TP and other technologies to these service delivery models.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California, Veterans Administration Health Care System, Mather, CA; Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC).
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine, Burlington, Vermont; Division of Consultation Psychiatry and Psychosomatic Medicine, University of Vermont College of Medicine, Burlington, Vermont; University of Vermont Medical Center, Burlington, Vermont
| | - Robert M McCarron
- Psychiatry & Behavioral Sciences and Department of Internal Medicine, University of California, Irvine Health System, Irvine, CA
| | - David J Katzelnick
- Department of Psychiatry and Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN
| | - Trina Chang
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amy M Bauer
- Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA; Behavioral Health Integration Program (BHIP) and Washington State's Mental Health Integration Program (MHIP), Seattle, WA
| | - John Fortney
- Division of Population Health, Seattle, WA; Department of Psychiatry & Behavioral Sciences, the University of Washington, Seattle, WA
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Yellowlees P, Burke Parish M, González Á, Chan S, Hilty D, Iosif AM, McCarron R, Odor A, Scher L, Sciolla A, Shore J, Xiong G. Asynchronous Telepsychiatry: A Component of Stepped Integrated Care. Telemed J E Health 2017; 24:375-378. [PMID: 29024612 DOI: 10.1089/tmj.2017.0103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Integrated behavioral healthcare models typically involve a range of consultation options for mental healthcare. Asynchronous telepsychiatry (ATP) consults may be an additional potential choice, so we are conducting a 5-year clinical trial comparing ATP with synchronous telepsychiatry (STP) consultations. METHODS Patients referred by primary care providers are randomly assigned to one of the two treatment groups, ATP or STP. Clinical outcome, satisfaction, and economic data are being collected from patients for 2 years at 6-month intervals. RESULTS Baseline characteristics for the first 158 patients and case examples of ATP are presented. CONCLUSION Implementing ATP in existing integrated behavioral healthcare models could make mental healthcare more efficient.
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Affiliation(s)
- Peter Yellowlees
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Michelle Burke Parish
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California.,2 The Betty Irene Moore School of Nursing, University of California, Davis , Sacramento, California
| | - Álvaro González
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Steven Chan
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Don Hilty
- 3 Department of Psychiatry, Keck School of Medicine, University of Southern California , Visalia, California
| | - Ana-Maria Iosif
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Robert McCarron
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Alberto Odor
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Lorin Scher
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Andrés Sciolla
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
| | - Jay Shore
- 4 Department of Psychiatry, University of Colorado Denver , Aurora, Colorado
| | - Glen Xiong
- 1 Department of Psychiatry, University of California, Davis , Sacramento, California
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18
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Young HM, Nesbitt TS. Increasing the Capacity of Primary Care Through Enabling Technology. J Gen Intern Med 2017; 32:398-403. [PMID: 28243871 PMCID: PMC5377889 DOI: 10.1007/s11606-016-3952-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/13/2016] [Accepted: 11/28/2016] [Indexed: 01/17/2023]
Abstract
Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, UC Davis Health System, Sacramento, CA, 95817, USA.
| | - Thomas S Nesbitt
- UC Davis Health System, Davis, CA, USA
- Family and Community Medicine, UC Davis, Davis, CA, USA
- Center for Information Technology Research in the Interest of Society, University of California, Davis, CA, USA
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19
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McMillan C, Lee J, Milligan J, Hillier LM, Bauman C. Physician perspectives on care of individuals with severe mobility impairments in primary care in Southwestern Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:463-472. [PMID: 25809600 DOI: 10.1111/hsc.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 06/04/2023]
Abstract
Despite the high health risks associated with severe mobility impairments, individuals with physical disabilities are less likely to receive the same level of primary care as able-bodied persons. This study explores family physicians' perspectives on primary care for individuals with mobility impairments to identify and better understand the challenges that prevent equitable service delivery to this group of patients. Semi-structured interviews were conducted in the autumn of 2012 with a purposeful sample of 20 family physicians practising in Southwestern Ontario to gather their perspectives of the personal and professional barriers to healthcare delivery for individuals with mobility impairments, including perceptions of challenges, contributing reasons and possible improvements. A thematic analysis was conducted on the transcripts generated from the interviews to identify perceptions of existing barriers and gaps in care, needs and existing opportunities for improving primary care for this patient population. Eight themes emerged from the interviews that contributed to understanding the perceived challenges of providing care to patients with mobility impairments: transportation barriers, knowledge gaps and practice constraints resulting in episodic care rather than preventive care, incongruence between perceived and actual accessibility to care, emergency departments used as centres for primary care, inattention to mobility issues among specialist and community services, lack of easily accessible practice tools, low patient volumes impact decision-making regarding building decreased motivation to expand clinical capacity due to low patient volume, and lastly, remuneration issues. Despite this patient population presenting with high healthcare needs and significant barriers and care gaps in primary care, low prevalence rates negatively impact the acquisition of necessary equipment and knowledge required to optimally care for these patients in typical primary care settings. Novel approaches to address inequitable healthcare practices for this vulnerable group are needed.
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Affiliation(s)
- Colleen McMillan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Renison College, University of Waterloo, Waterloo, Ontario, Canada
| | - Joseph Lee
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James Milligan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Loretta M Hillier
- Specialized Geriatric Services, St. Joseph's Health Care London, London, Ontario, Canada
- Aging, Rehabilitation & Geriatric Care Research Centre, London, Ontario, Canada
| | - Craig Bauman
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Hilty DM, Shoemaker EZ, Myers K, Snowdy CE, Yellowlees PM, Yager J. Need for and Steps Toward a Clinical Guideline for the Telemental Healthcare of Children and Adolescents. J Child Adolesc Psychopharmacol 2016; 26:283-95. [PMID: 26871510 DOI: 10.1089/cap.2015.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This article identifies and describes key considerations toward the development of a clinical guideline intended to optimize telemental healthcare (TMH) of children and adolescents. METHODS The literature was searched with key terms and title words. Of 2824 articles that met primary or secondary key word search criteria, 326 met both criteria, and 118 thematically related directly to child and adolescent TMH. Only 44 studies met levels of evidence I-III and expert recommendation criteria used in clinical guidelines; review of their references found 8 additional studies (52 total). Data from adult, child, and adolescent in-person psychiatric care and adult TMH were applied to provide context in developing the key considerations. RESULTS TMH guidelines for adults are well delineated, and TMH guidelines for children and adolescents are likely to closely overlap in terms of general clinical, technical, and administrative issues. However, for a child and adolescent focus, modifications of existing general guidelines appear necessary; for example, based on developmental status, family involvement, and patient-site modifications for space and sound. Additional clinical issues include specify who, exactly, is the "patient" (i.e., the patient, family, and /or other stakeholders), modalities of care (i.e., age-related psychotherapies such as play therapy or behavior management), and psychopharmacology. CONCLUSIONS Specific clinical, administrative, and technical issues are key considerations - based on the nuances of established child and adolescent mental healthcare - and must be considered in developing a clinical guideline for TMH of these patients. Developing such guidance should proceed from a careful review of the growing evidence base, and through expert consensus processes.
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Affiliation(s)
- Donald M Hilty
- 1 Kaweah Delta Medical Center, Visalia, California.,2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Erica Z Shoemaker
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California.,3 Child and Adolescent Services Los Angeles County and University of Southern California Medical Center , Los Angeles, California
| | - Kathleen Myers
- 4 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,5 Telemental Health Service, Seattle Children's Hospital , Seattle, Washington
| | - Christopher E Snowdy
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Peter M Yellowlees
- 6 Department of Psychiatry, UC Davis School of Medicine , Davis, California
| | - Joel Yager
- 7 Department of Psychiatry, University of Colorado at Denver School of Medicine , Denver, Colorado
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Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health 2014; 19:444-54. [PMID: 23697504 DOI: 10.1089/tmj.2013.0075] [Citation(s) in RCA: 550] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The effectiveness of any new technology is typically measured in order to determine whether it successfully achieves equal or superior objectives over what is currently offered. Research in telemental health-in this article mainly referring to telepsychiatry and psychological services-has advanced rapidly since 2003, and a new effectiveness review is needed. MATERIALS AND METHODS The authors reviewed the published literature to synthesize information on what is and what is not effective related to telemental health. Terms for the search included, but were not limited to, telepsychiatry, effectiveness, mental health, e-health, videoconferencing, telemedicine, cost, access, and international. RESULTS Telemental health is effective for diagnosis and assessment across many populations (adult, child, geriatric, and ethnic) and for disorders in many settings (emergency, home health) and appears to be comparable to in-person care. In addition, this review has identified new models of care (i.e., collaborative care, asynchronous, mobile) with equally positive outcomes. CONCLUSIONS Telemental health is effective and increases access to care. Future directions suggest the need for more research on service models, specific disorders, the issues relevant to culture and language, and cost.
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, Sacramento, California 95817, USA.
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22
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Liddy C, Rowan MS, Afkham A, Maranger J, Keely E. Building access to specialist care through e-consultation. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2013; 7:e1-8. [PMID: 23687533 PMCID: PMC3654501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Limited access to specialist care remains a major barrier to health care in Canada, affecting patients and primary care providers alike, in terms of both long wait times and inequitable availability. We developed an electronic consultation system, based on a secure web-based tool, as an alternative to face-to-face consultations, and ran a pilot study to evaluate its effectiveness and acceptability to practitioners. METHODS In a pilot program conducted over 15 months starting in January 2010, the e-consultation system was tested with primary care providers and specialists in a large health region in Eastern Ontario, Canada. We collected utilization data from the electronic system itself (including quantitative data from satisfaction surveys) and qualitative information from focus groups and interviews with providers. RESULTS Of 18 primary care providers in the pilot program, 13 participated in focus groups and 9 were interviewed; in addition, 10 of the 11 specialists in the program were interviewed. Results of our evaluation showed good uptake, high levels of satisfaction, improvement in the integration of referrals and consultations, and avoidance of unnecessary specialist visits. A total of 77 e-consultation requests were processed from 1 Jan. 2010 to 1 Apr. 2011. Less than 10% of the referrals required face-to-face follow-up. The most frequently noted benefits for patients (as perceived by providers) included improved access to specialist care and reduced wait times. Primary care providers valued the ability to assist with patient assessment and management by having access to a rapid response to clinical questions, clarifying the need for diagnostic tests or treatments, and confirming the need for a formal consultation. Specialists enjoyed the improved interaction with primary care providers, as well as having some control in the decision on which patients should be referred. INTERPRETATION This low-cost referral system has potential for broader implementation, once payment models for physicians are adapted to cover e-consultation.
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Butler TN, Yellowlees P. Cost analysis of store-and-forward telepsychiatry as a consultation model for primary care. Telemed J E Health 2011; 18:74-7. [PMID: 22085113 DOI: 10.1089/tmj.2011.0086] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Store-and-forward telepsychiatry, or asynchronous telepsychiatry (ATP), which allows clinical data, including video to be collected to be reviewed at a later time by a specialist, has been described as a feasible alternative to real-time telepsychiatry, or synchronous telepsychiatry (STP), as a consultation model for primary care. In theory, ATP should be economically more cost-effective than STP due to the increased flexibility of patient data collection and the substitution of the time of specialists with that of lower-cost providers. The aim of this study was to conduct a retrospective cost-analysis comparing ATP with STP and traditional in-person psychiatric consultations in the primary care setting. One hundred and twenty five ATP consultations were performed and fixed and marginal costs were calculated for each model using inputs such as equipment costs, time spent by providers and support staff, and hourly salaries. The fixed costs were $7,000 and $20,000 for ATP and STP and marginal costs were $68.18, $107.50, and $96.36, respectively, for the three groups. STP was the most expensive of the three types of consultations. ATP became the most cost-effective of the three models beyond 249 consultations. The marginal cost savings of ATP were due to substitution of low-cost providers for specialists. ATP represents a potential disruptive healthcare process that could allow more affordable care to be delivered to a larger population of patients. A full accounting of ATP's efficiency will require further studies, including prospective cost-benefit analyses from the perspectives of the patient, provider, and society.
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Affiliation(s)
- Thomas N Butler
- Department of Psychiatry, University of California Davis, Sacramento, California, USA
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Innovations in the Utilization of Health Information Technology in Psychiatric Services. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x0000138x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThere is ever-increasing activity in applying information technology to various areas of healthcare, including mental health. Examples of innovations include applications in screening, treatment, clinical decision support, communication and coordination, telemedicine, Internet-based education and services, public health research, training and education, and bioinformatics. Issues and challenges include protection of privacy, managing narrative free text, assessing the reliability of information found online, and mitigating impact on clinical workflow. While many of the innovations described will not be fully realized until national information systems reach a larger scale, many are having a positive impact on mental healthcare today.
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Abstract
In this article we review practice models for treating common mental disorders in primary care. Novel treatment approaches by primary care providers and specialty providers, including collaborative care and telepsychiatric models, show considerable promise. An understanding of remaining barriers to improved care suggests several possible solutions and future directions for outpatient psychosomatic medicine.
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Abstract
The core doctor-patient relationship is changing and becoming more fluid. Many factors are causing the changes, but they are being underpinned by the current technological revolution, which has spawned terms such as e-patients, health 2.0, participatory medicine, and virtual medicine in cyberspace. The Internet is being used so creatively and commonly by both patients and doctors that it has become literally a "part" of the doctor-patient relationship. To explore how the psychiatrist-patient relationship is changing, five simple questions are examined: How are patient expectations and behaviors changing? Who is using the Internet for mental health care? What online mental health services are currently being offered? How are current and past models of the psychiatrist-patient relationship being affected by these changes? And what is the psychiatrist-patient relationship of the future likely to be? Psychiatrists working in this environment will need to make changes to their practices over time. It is likely that their relationships with patients will continuously change, gradually becoming more participatory and ubiquitous, as care is provided both face-to-face and online-and literally anytime, anywhere.
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Affiliation(s)
- Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, 95864, USA
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:323-338. [PMID: 20161010 PMCID: PMC2758653 DOI: 10.1111/j.1468-2850.2009.01170.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Affiliation(s)
| | | | - Anouk L. Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY : A PUBLICATION OF THE DIVISION OF CLINICAL PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2009. [PMID: 20161010 DOI: 10.1111/j.1468‐2850.2009.01170.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Kelleher KJ, Stevens J. Evolution of child mental health services in primary care. Acad Pediatr 2009; 9:7-14. [PMID: 19329085 PMCID: PMC2699251 DOI: 10.1016/j.acap.2008.11.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 11/20/2008] [Accepted: 11/24/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although the importance of mental health assessment and treatment in primary care is increasingly recognized, the research that underlies current practices largely stems from a considerable body of non-mental health primary care studies. Our purpose was to describe trends in research over the past 2 decades and to suggest further key items for the research agenda. METHODS We reviewed the literature broadly on health services research in pediatrics, especially studies of changes in primary care practice, and examined recent articles in primary care mental health services. RESULTS The evolution of primary care mental health services for children has been slow, but the focus of research has changed with the development of clinical improvements. Proposals to deliver more effective services have evolved over the past 40 years in a series of approaches that paralleled initiatives in the broader fields of medicine and pediatrics. Current trends in electronic technology, practice consolidation and coordination, and personalized medicine are likely to increase the pace of change in mental health services for primary care. CONCLUSIONS The evolution of pediatric mental health services in primary care suggests a continuing expansion from a focus initially on provider behavior and quality to a growing attention to patient and systems' behavior over time and within communities.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Cleary M, Walter G, Matheson S. What Is the Role of e-Technology in Mental Health Services and Psychiatric Research? J Psychosoc Nurs Ment Health Serv 2008; 46:42-8. [DOI: 10.3928/02793695-20080401-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hilty DM, Cobb HC, Neufeld JD, Bourgeois JA, Yellowlees PM. Telepsychiatry reduces geographic physician disparity in rural settings, but is it financially feasible because of reimbursement? Psychiatr Clin North Am 2008; 31:85-94. [PMID: 18295040 DOI: 10.1016/j.psc.2007.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Telemedicine has been shown to improve rural patient outcomes in two randomized controlled trials, to increase access to many patients, to serve underserved minorities, and to train primary care providers. Yet, programs are dwindling even after successful grants due to inadequate reimbursement. Studies have been thoroughly done to gauge the payor status of potential rural telemedicine patients, as the "floodgates" are not generally open to all-including those who cannot pay-in typical grants. Or the population of one community may not be representative of others. This study is part of a grant that explored the use of telemedicine for rural service delivery, attempted to get a clear snapshot of whom would be served if all were invited (paying or not), and to understand issues with the reimbursement systems. This article (1) examines the receipts of reimbursement and insurance coverage during the 1-year grant period by determining actual versus projected reimbursements, (2) identifies what payor(s) typical patients use, and (3) identifies problems and barriers for future study. Other administrative issues pertinent to telemedicine and costs are briefly discussed (eg, no-show rates, staffing, scheduling).
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Affiliation(s)
- Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.
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Antonacci DJ, Bloch RM, Saeed SA, Yildirim Y, Talley J. Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: implications for forensic and correctional psychiatry. BEHAVIORAL SCIENCES & THE LAW 2008; 26:253-69. [PMID: 18548519 DOI: 10.1002/bsl.812] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A growing body of literature now suggests that use of telepsychiatry to provide mental health services has the potential to solve the workforce shortage problem that directly affects access to care, especially in remote and underserved areas. Live interactive two-way audio-video communication-videoconferencing-is the modality most applicable to psychiatry and has become synonymous with telepsychiatry involving patient care, distance education, and administration. This article reviews empirical evidence on the use and effectiveness of videoconferencing in providing diagnostic and treatment services in mental health settings that serve child, adolescent, and adult populations. Descriptive reports, case studies, research articles, and randomized controlled trials related to clinical outcomes were identified and reviewed independently by two authors. Articles related to cost-effectiveness, technological issues, or legal or ethical aspects of telepsychiatry were excluded. The review of the evidence broadly covers mental health service provision in all settings, including forensic settings. Given the sparse literature on telepsychiatry in forensic settings, we discuss implications for mental health care across settings and populations and comment on future directions and potential uses in forensic or correctional psychiatry.
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Affiliation(s)
- Diana J Antonacci
- Department of Psychiatric Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
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Abstract
OBJECTIVE New models of psychiatric intervention are needed to improve the accessibility of mental health care in the primary care setting, particularly in rural areas of the United States and especially for children and adolescents. The aim of this study was to examine the diagnostic characteristics and outcomes for children referred for eMental Health consultations at UC Davis (videoconferencing, telephone, and secure e-mail) from 10 primary care clinics in rural northern California. METHOD : A retrospective analysis was conducted on the diagnostic and clinical outcomes of 139 referred children who received a full psychiatric diagnostic evaluation via videoconferencing. Within the group, a convenience sample of 58 initial and 41 three-month follow-up Child Behavior Checklists (CBCLs) was collected. RESULTS Comprehensive eMental Health programs appear to be effective for psychiatric diagnosis and assessment of children. Attention deficit (36.2%) and mood (28.1%) disorders were the most common diagnostic groupings overall. Most children were seen only once, but a statistically significant improvement between initial evaluation and 3-month follow-up in the convenience sample was seen in the Affect and Oppositional domains of the CBCL for girls and boys, respectively. CONCLUSIONS Versatile eMental Health programs, incorporating standardized checklists, may assist in diagnosis and treatment of rural children.
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Abstract
Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. A multidisciplinary treatment approach, group care, and case management are common features of mental health treatment settings only rarely used in primary care practices. Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.
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Affiliation(s)
- Stephen Thielke
- Geriatric Mental Health Services, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195, USA.
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Shore JH, Hilty DM, Yellowlees P. Emergency management guidelines for telepsychiatry. Gen Hosp Psychiatry 2007; 29:199-206. [PMID: 17484936 PMCID: PMC1986661 DOI: 10.1016/j.genhosppsych.2007.01.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 01/24/2007] [Accepted: 01/24/2007] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Telepsychiatry, in the form of live interactive videoconferencing, is an emerging application for emergency psychiatric assessment and treatment and can improve the quality and quantity of mental health services, particularly for rural, remote and isolated populations. Despite the potential of emergency telepsychiatry, the literature has been fairly limited in this area. METHOD Drawing on the combined clinical and administrative experiences of its authors, this article reviews the common administrative, legal/ethical and clinical issues that arise in emergency telepsychiatry. RESULTS An initial set of guidelines for emergency telepsychiatry is presented to generate further discussion to assist those who are considering establishing general telepsychiatry and/or emergency telepsychiatry services. CONCLUSION The practices and techniques of emergency telepsychiatry are relatively new and require further examination, modification and refinement so that they may be fully utilized within comprehensive mental health service systems.
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Affiliation(s)
- Jay H Shore
- American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, Aurora, CO 80045-0508, USA.
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