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Bell J, Gottlieb LM, Lyles CR, Nguyen OK, Ackerman SL, De Marchis EH. Provision of digital devices and internet connectivity to improve synchronous telemedicine access in the U.S.: a systematic scoping review. Front Digit Health 2024; 6:1408170. [PMID: 39135634 PMCID: PMC11317370 DOI: 10.3389/fdgth.2024.1408170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction The COVID-19 pandemic led to a dramatic increase in telemedicine use for direct patient care. Inequities in device/internet access can limit the extent to which patients can engage with telemedicine care and exacerbate health disparities. In this review, we examined existing literature on interventions designed to improve patient telemedicine access by providing digital devices including tablets, smartphones, and computers and/or internet connectivity. Methods In this systematic scoping review, we searched four databases for peer-reviewed studies published 1/1/2000-10/19/2021 that described healthcare interventions that provided patients with devices and/or internet connectivity and reported outcomes related to telemedicine access and/or usage. Data extraction elements included: study population, setting, intervention design, details on device/connectivity provision, and outcomes evaluated. Results Twelve articles reflecting seven unique interventions met inclusion criteria. Ten articles examined telemedicine utilization (83%) and reported improved patient show rates/utilization. Seven articles examined patient satisfaction with the interventions (58%) and reported positive experiences. Fewer articles examined health outcomes (17%; 2/12) though these also demonstrated positive results. Across included studies, study quality was low. There were no controlled trials, and the most rigorously designed studies (n = 4) involved pre/post-intervention assessments. Discussion Findings from this review indicate that providing material technology supports to patients can facilitate telemedicine access, is acceptable to patients and clinicians, and can contribute to improved health outcomes. The low number and quality of existing studies limits the strength of this evidence. Future research should explore interventions that can increase equitable access to telemedicine services. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=183442, identifier, PROSPERO: CRD42020183442.
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Affiliation(s)
- Joshua Bell
- Department of Pediatrics, University of California, San Francisco, CA, United States
| | - Laura M. Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
- Social Interventions Research and Evaluation Network (SIREN), Center for Health and Community, University of California, San Francisco, CA, United States
| | - Courtney R. Lyles
- Center for Healthcare Policy and Research, University of California, Sacramento, CA, United States
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA, United States
| | - Oanh Kieu Nguyen
- UCSF Center for Vulnerable Populations, University of California, San Francisco, CA, United States
- Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Sara L. Ackerman
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, CA, United States
| | - Emilia H. De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, CA, United States
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Jaske E, Wheat CL, Rubenstein LV, Leung L, Curtis I, Wahlberg L, Felker B. Understanding How Contingency Staffing Programs Can Support Mental Health Services in the Veterans Health Administration. Telemed J E Health 2024; 30:1857-1865. [PMID: 38563753 DOI: 10.1089/tmj.2023.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Introduction: Beginning in 2019, the Department of Veterans Affairs (VA) prioritized improving access to care nationally to deliver virtual care and implemented 18 regionally based Clinical Resource Hubs (CRHs) to meet this priority. This observational study describes the quantity and types of care delivered by CRH Mental Health teams, and the professions of those hired to deliver it. Methods: A retrospective cohort study, based on national VA CRH mental health care utilization data and CRH staffing data for CRH's first 3 years, was conducted. Results: CRH Mental Health teams primarily used Telemental Health (TMH) to provide care (98.1% of all CRH MH encounters). The most common disorders treated included depression, post-traumatic stress disorder, and anxiety disorders. The amount of care delivered overtime steadily increased as did the racial and ethnic diversity of Veterans served. Psychologists accounted for the largest share of CRH staffing, followed by psychiatrists. Conclusions: CRH TMH delivered from a regional hub appears to be a feasible and acceptable visit modality, based on the continuously increasing CRH TMH visit rates. Our results showed that CRH TMH was predominantly used to address common mental health diagnoses, rather than serious mental illnesses. Traditionally marginalized patient populations increased over the 3-year window, suggesting that CRH TMH resources were accessible to many of these patients. Future research should assess barriers and facilitators for accessing CRH TMH, especially for difficult-to-service patient populations, and should consider whether similar results to ours occur when regional TMH is delivered to non-VA patient populations.
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Affiliation(s)
- Erin Jaske
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA
| | - Chelle L Wheat
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA
| | - Lisa V Rubenstein
- Center for the Study of Health care Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Health Care System, Department of Veterans Affairs, Los Angeles, California, USA
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA
| | - Lucinda Leung
- Center for the Study of Health care Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Health Care System, Department of Veterans Affairs, Los Angeles, California, USA
- Division of General Internal Medicine-Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Idamay Curtis
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA
| | - Lawrence Wahlberg
- Department of Veterans Affairs, National Clinical Resource Hub, VA Central Office, Washington, District of Columbia, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Bradford Felker
- VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Washington, USA
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Rowe Ferrara M, Chapman SA. Rural Patients' Experiences with Synchronous Video Telehealth in the United States: A Scoping Review. Telemed J E Health 2024; 30:1357-1377. [PMID: 38265694 DOI: 10.1089/tmj.2023.0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Background: Telehealth can help increase rural health care access. To ensure this modality is accessible for rural patients, it is necessary to understand rural patients' experiences with telehealth. Objectives of this scoping review were to explore how rural patients' telehealth experiences have been measured, assess relevant research, and describe rural telehealth patient experiences. Methods: We searched five databases for articles published from 2016 through 2022. Primary research reports assessing rural adult patient experiences with synchronous video telehealth in the United States in any clinical area were included. Data collected pertained to study characteristics and patient experience assessment characteristics and outcomes. Quality of included studies was assessed using the Quality Assessment with Diverse Studies tool. Review findings were presented in a narrative synthesis. Results: There were 740 articles identified for screening, and 24 met review inclusion criteria. Most studies (70%, n = 16) assessed rural telehealth patient experience using questionnaires; studies employed interviews (n = 11) alone or in combination with surveys. The majority of surveys were study developed and not validated. Quantitative patient experience outcomes fell under categories of patient satisfaction, telehealth care characteristics, patient-provider rapport, technology elements, and access. Qualitative themes were most often presented as telehealth benefits or facilitators, and drawbacks or barriers. Conclusions: Available research indicates positive patient experiences with rural telehealth services. However, study weaknesses limit generalizability of findings. Future research should apply established definitions for participant rurality and clearly group samples by rurality. Efforts should be made to use validated telehealth patient experience measures.
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Affiliation(s)
- Meghan Rowe Ferrara
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Kornblith E, Schweizer S, Abrams G, Gardner R, Barnes D, Yaffe K, Novakovic-Agopian T. Telehealth delivery of group-format cognitive rehabilitation to older veterans with TBI: a mixed-methods pilot study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-13. [PMID: 37044120 DOI: 10.1080/23279095.2023.2199160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Traumatic brain injury (TBI) is common among Veterans and may interact with aging, increasing risk for negative cognitive, emotional, and functional outcomes. However, no accessible (i.e., in-home) group interventions for TBI targeted to older adults exist. Goal Oriented Attentional Self-Regulation (GOALS) is a manualized, group cognitive rehabilitation training that improves executive function and emotional regulation among Veterans with TBI and healthy older adults. Our objectives were to adapt GOALS for delivery to older Veterans via in-home video telehealth (IVT) and evaluate feasibility and participant-rated acceptability of the telehealth GOALS intervention (TeleGOALS). Six Veterans 69+, with multiple TBIs completed the 10-session intervention in groups of 2. One participant withdrew, and another completed the remaining sessions alone (total n enrolled = 8). Required adaptations were noted; questionnaire responses were quantified; and feedback was analyzed and coded to identify themes. Quantitative and qualitative methods were used to examine feasibility (i.e., recruitment and retention) and participant-rated acceptability. Minimal adaptations were required for IVT delivery. Key themes emerged: (a) the importance of telehealth logistics, (b) facilitators' roles in prioritizing interpersonal connection, and (c) telehealth's capability to create opportunities for community reintegration. Thematic saturation (the point at which feedback from respondents is consistent and no further adaptations are required) was achieved. Participants stated they would likely recommend TeleGOALS to other Veterans. Although further study with a larger, more diverse sample is required, the adapted TeleGOALS intervention appears highly feasible and acceptable for older Veterans with TBI able and willing to participate in a group-format IVT intervention.
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Affiliation(s)
- Erica Kornblith
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sara Schweizer
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Gary Abrams
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Raquel Gardner
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
| | - Deborah Barnes
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Kristine Yaffe
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
- Department of Neurology, UCSF, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | - Tatjana Novakovic-Agopian
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco (UCSF), San Francisco, CA, USA
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5
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Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
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Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
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Chen PV, Helm A, Caloudas SG, Ecker A, Day G, Hogan J, Lindsay J. Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature. Curr Psychiatry Rep 2022; 24:529-539. [PMID: 36053400 PMCID: PMC9437398 DOI: 10.1007/s11920-022-01359-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper is to provide a comparative review of using phone (audio-only) or video for mental health treatments. Our review includes evidence of phone and video's effectiveness in terms of reduced symptomology, retention, satisfaction, therapeutic alliance, and other outcomes of interest. This review also discusses how patients and providers' experiences and attitudes differ between these two modalities. Finally, we present information on different usage rates of phone and video across patient populations and mental health provider types, and different implementation strategies. RECENT FINDINGS Treatments through phone and video are both able to reduce symptoms related to mental health conditions and have both been found to be non-inferior to in-person care. Both phone and video are more convenient to patients. Video offers important visual information that can be important to diagnosing mental health conditions. Phone, however, is more broadly accessible and may come with fewer technological issues. In the context of mental health care, where non-verbal cues are tied to symptomology and diagnosing, and a strong relationship between patient and provider can enhance treatment, we encourage the use of video, especially for psychotherapeutic services. However, as phone is more accessible, we ultimately recommend an accommodating approach, one that flexibly makes use of both phone and video. Future studies on telehealth should focus on direct, head-to-head comparisons between phone and video and conduct more rigorous testing on whether clinical differences exist.
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Affiliation(s)
- Patricia V Chen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
- Margaret M. and Albert B Alkek Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Ashley Helm
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Steve G Caloudas
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Anthony Ecker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Giselle Day
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Julianna Hogan
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
| | - Jan Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Houston, TX, USA
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Maher M, Reilly K, Smith E, Coyne E, Murphy S, Wilson C. Receiving teletherapy in Ireland: The experiences of service users in the public mental health system. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Maher
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| | - Katie Reilly
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| | - Elaine Smith
- HSE Adult Mental Health Service Dublin South Kildare West Wicklow Community Healthcare Kildare Ireland
| | - Elaine Coyne
- HSE Adult Mental Health Service, Co. Kildare Ireland
| | - Síle Murphy
- HSE Adult Mental Health Service, Co. Kildare Ireland
| | - Charlotte Wilson
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
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Dune T, Chimoriya R, Caputi P, MacPhail C, Olcon K, Ogbeide A. White and non-White Australian mental health care practitioners' desirable responding, cultural competence, and racial/ethnic attitudes. BMC Psychol 2022; 10:119. [PMID: 35526020 PMCID: PMC9080170 DOI: 10.1186/s40359-022-00818-4] [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: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Racial, ethnic, religious, and cultural diversity in Australia is rapidly increasing. Although Indigenous Australians account for only approximately 3.5% of the country’s population, over 50% of Australians were born overseas or have at least one migrant parent. Migration accounts for over 60% of Australia’s population growth, with migration from Asia, Sub-Saharan African and the Americas increasing by 500% in the last decade. Little is known about Australian mental health care practitioners’ attitudes toward this diversity and their level of cultural competence. Aim Given the relationship between practitioner cultural competence and the mental health outcomes of non-White clients, this study aimed to identify factors that influence non-White and White practitioners’ cultural competence. Methods An online questionnaire was completed by 139 Australian mental health practitioners. The measures included: the Balanced Inventory of Desirable Responding (BIDR); the Multicultural Counselling Inventory (MCI); and the Color-blind Racial Attitudes Scale (CoBRAS). Descriptive statistics were used to summarise participants’ demographic characteristics. One-way ANOVA and Kruskal–Wallis tests were conducted to identify between-group differences (non-White compared to White practitioners) in cultural competence and racial and ethnic blindness. Correlation analyses were conducted to determine the association between participants’ gender or age and cultural competence. Hierarchical multiple regression analysis was conducted to predict cultural competence. Results The study demonstrates that non-White mental health practitioners are more culturally aware and have better multicultural counselling relationships with non-White people than their White counterparts. Higher MCI total scores (measuring cultural competence) were associated with older age, greater attendance of cultural competence-related trainings and increased awareness of general and pervasive racial and/or ethnic discrimination. Practitioners with higher MCI total scores were also likely to think more highly of themselves (e.g., have higher self-deceptive positive enhancement scores on the BIDR) than those with lower MCI total scores. Conclusion The findings highlight that the current one-size-fits-all and skills-development approach to cultural competence training ignores the significant role that practitioner diversity and differences play. The recommendations from this study can inform clinical educators and supervisors about the importance of continuing professional development relevant to practitioners’ age, racial/ethnic background and practitioner engagement with prior cultural competence training.
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Affiliation(s)
- Tinashe Dune
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia. .,School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia.,Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Peter Caputi
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Katarzyna Olcon
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Anita Ogbeide
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia
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Saunders GH, Oliver F. Impact of Hearing Loss on Communication During Remote Health Care Encounters. Telemed J E Health 2022; 28:1350-1358. [PMID: 35020484 DOI: 10.1089/tmj.2021.0490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Satisfaction with telemedicine is generally high; however, it can lead to communication problems for people with hearing loss (HL), especially when encounters are conducted by telephone, because of the inability to see the face and lips on which many people with HL rely. Despite acknowledgement that HL might affect telemedicine outcomes, no studies have directly examined this. The primary aims of this study were to determine whether and how HL impacts patient satisfaction and willingness to use telemedicine. Methods: Opinions about telemedicine were assessed in a survey of 383 members of the general public. Data regarding reported hearing ability, use of hearing assistive technology, and preferred form of communication (oral/aural vs. sign language) were also collected; people with HL were intentionally oversampled. Survey items included closed set and open-ended responses. Results: People with HL declined the offer of telemedicine appointments, rated telemedicine outcomes significantly less positively, and had stronger preferences for in person care than did people without HL. Explanations provided for this were directly associated with hearing-related difficulties or the indirect consequences of those difficulties. HL resulted in concerns about communication during the appointment, a lack of privacy when an intermediary helped with communication during the appointment, worries that critical information has been misheard/missed, and anxiety/stress. Conclusions: The needs of people with HL during telemedicine encounters must be addressed to ensure equitable access. Health care providers should take responsibility to communicate clearly with people with HL and individuals with HL should be willing to advocate for their needs and use special access tools during telemedicine appointments.
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Affiliation(s)
- Gabrielle H Saunders
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
| | - Francesca Oliver
- The Royal National Institute for Deaf People, Peterborough, United Kingdom
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Moghimi E, Knyahnytska Y, Omrani M, Nikjoo N, Stephenson C, Layzell G, Frederic Simpson AI, Alavi N. Benefits of Digital Mental Health Care Interventions for Correctional Workers and Other Public Safety Personnel: A Narrative Review. Front Psychiatry 2022; 13:921527. [PMID: 35873240 PMCID: PMC9304966 DOI: 10.3389/fpsyt.2022.921527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/07/2022] [Indexed: 01/12/2023] Open
Abstract
Chronic exposure to stressors and potentially psychologically traumatic events contributes to the high prevalence of mental health disorders in correctional workers (CWs) and other public safety personnel (PSP). Digital mental health interventions are an accessible and scalable method of improving and maintaining the mental health of this population. The current review explores the benefits of digital mental health interventions for PSP-with a focus on CWs-and how these innovations can address the limitations in in-person mental health care. A systematic literature search of five databases (Medline, PsycInfo, Embase, CINAHL, Google Scholar) was conducted until March 2022. The search yielded 16 publications that focused on digital mental health interventions or care available to CWs and other PSP. The benefits of digital innovations were summarized into five categories which discussed (1) their ability to enhance accessibility and reduce stigma; (2) the provision of evidence-based and structured psychotherapy programs; (3) variability in the degree of therapist engagement; (4) the integration of proactive interventions; and (5) enhancing engagement by acknowledging unique experiences and interpersonal relationships. Although digital mental health technologies for CWs are still in their infancy, there is strong evidence to support their effectiveness in ameliorating symptoms of mental distress. Future research should consider how ethnicity, gender, culture, sexual orientation, and socioeconomic status can be integrated into these therapies and how the interplay between different stakeholders and organizations can impact the effectiveness of online therapies and programs.
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Affiliation(s)
- Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,OPTT Inc., Toronto, ON, Canada
| | - Niloofar Nikjoo
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Gina Layzell
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
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11
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Parmar B, Beukes E, Rajasingam S. The impact of COVID-19 on provision of UK audiology services & on attitudes towards delivery of telehealth services. Int J Audiol 2021; 61:228-238. [PMID: 34010078 DOI: 10.1080/14992027.2021.1921292] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To (i) identify the impact of COVID-19 on provision of UK audiology services across sectors (ii) compare teleaudiology service provision between private and public sectors before and after the introduction of restrictions and (iii) identify barriers to teleaudiology delivery amongst UK hearing care professionals in both sectors. DESIGN A mixed-methods cross-sectional survey study design. Responses to the structured questionnaire were analysed using descriptive and non-parametric statistics. STUDY SAMPLE UK based hearing care professionals (HCP) (n = 323) completed the survey (218 public sector; 89 private sector). RESULTS Changes in working patterns varied greatly between different sectors, with 61% of national employed and 26% of independent HCPs being furloughed, compared with 1% in the public sector. Use of telehealth was under-utilised across all sectors and groups in UK hearing healthcare, despite 92% of public and 75% of private HCPs reporting feeling comfortable conducting remote consultations. CONCLUSION This study highlights a variation in teleaudiology adoption and key barriers across sector in the UK. A collaborative approach between hearing device manufacturers, research centres, HCPs and professional bodies is required for the creation of targeted guidance and training materials according to sector, to support clinicians in effective teleaudiology provision.
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Affiliation(s)
- Bhavisha Parmar
- UCL Ear Institute, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Eldre Beukes
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Saima Rajasingam
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom of Great Britain and Northern Ireland
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12
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Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 258] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
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Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
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13
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Mishkind MC. How telemental health delivered to non-traditional locations helped prepare for responses to COVID-19. Mhealth 2021; 7:17. [PMID: 33898586 PMCID: PMC8063003 DOI: 10.21037/mhealth-2020-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matthew C Mishkind
- Departments of Psychiatry and Family Medicine, Helen and Arthur E Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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14
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Mishkind MC, Shore JH, Bishop K, D'Amato K, Brame A, Thomas M, Schneck CD. Rapid Conversion to Telemental Health Services in Response to COVID-19: Experiences of Two Outpatient Mental Health Clinics. Telemed J E Health 2020; 27:778-784. [PMID: 33393857 DOI: 10.1089/tmj.2020.0304] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: The COVID-19 pandemic triggered changes across health care systems, with many sectors seeing significant drops in patient visits. Rapid transition to telemental health (TMH) allowed for the continued delivery of mental health care. Although several guidelines and best practices are available for the methodical development of a TMH service, there are few documented procedures on rapidly converting to fully virtualized services. We discuss how two outpatient mental health clinics at the University of Colorado Anschutz Medical Campus rapidly virtualized clinical services during the COVID-19 pandemic. Methods: All current clinical appointments were converted to virtual, and all new clinical intakes were scheduled as virtual visits starting March 16, 2020. Virtualization included a modified needs assessment, updated clinic procedures, focused patient and staff training on TMH, and increased frequency of team meetings. We conducted a retrospective evaluation of clinic log and electronic health record data to examine the number of appointments and no-shows before and after COVID-19 virtualization. Results: Virtualization was operational within two business days. Scheduled appointments decreased 10.6% immediately postvirtualization, followed by an increase of 17.8% across the 6 months postvirtualization. No-show rates dropped from 11.9% pre- to 6.8% postvirtualization, leading to a 26.2% increase in completed visits. Discussion: Rapid virtualization of mental health services can occur effectively. Wider use and acceptance of TMH, especially to patient-homes, is likely in the foreseeable future as health care providers and systems reconceptualize service delivery. Future research must include analyzing the impact such changes make on clinical outcomes and patient visit volumes.
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Affiliation(s)
- Matthew C Mishkind
- Departments of Psychiatry and Family Medicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Departments of Psychiatry and Family Medicine, Steven A Cohen Military Family Clinic at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay H Shore
- Departments of Psychiatry and Family Medicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Departments of Psychiatry and Family Medicine, Steven A Cohen Military Family Clinic at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Departments of Psychiatry and Family Medicine, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Kammy Bishop
- Departments of Psychiatry and Family Medicine, Steven A Cohen Military Family Clinic at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kaitlin D'Amato
- Departments of Psychiatry and Family Medicine, Steven A Cohen Military Family Clinic at the University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Azure Brame
- Departments of Psychiatry and Family Medicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marshall Thomas
- Departments of Psychiatry and Family Medicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher D Schneck
- Departments of Psychiatry and Family Medicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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15
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Steidtmann D, McBride S, Mishkind MC. Experiences of Mental Health Clinicians and Staff in Rapidly Converting to Full-Time Telemental Health and Work from Home During the COVID-19 Pandemic. Telemed J E Health 2020; 27:785-791. [PMID: 33301354 DOI: 10.1089/tmj.2020.0305] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: The mitigation strategies for the COVID-19 pandemic pushed much of the mental health workforce to rapidly convert to full-time telemental health (TMH). For many people, this occurred in the context of working from makeshift home offices with novel distractions. We describe the results of an online survey of mental health clinicians and staff regarding their experiences in rapidly converting to full-time TMH and work from home (WFH) during COVID-19. Methods: Fourteen clinicians and 11 administrative staff from two outpatient mental health clinics in a large academic medical center completed the survey in May 2020. Results: More than 85% of participants rated the experience of providing or supporting full-time TMH care as "somewhat better" or "much better than expected." Clinicians and administrative staff reported perceptions that most clients were satisfied with TMH services. Identified TMH challenges included difficulty providing clinical forms and difficulties with technology. Identified benefits of WFH included lack of commute, time with loved ones, opportunities for self-care, and increased flexibility. Maintaining team cohesion and communication while working remotely, and setting boundaries between work and nonwork hours were identified as challenges. Nearly all respondents indicated a preference to continue some TMH from home in the future. Conclusions: Findings suggest that rapidly adopting TMH and WFH during a pandemic were well accepted. Should the progression of the pandemic require agile movement in and out of TMH and WFH, overcommunication and extra attention to supporting employee connection and morale are especially important.
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Affiliation(s)
- Dana Steidtmann
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Family Medicine, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samantha McBride
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Family Medicine, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew C Mishkind
- Department of Psychiatry, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Family Medicine, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Steven A. Cohen Military Family Clinic, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Jones C, Miguel-Cruz A, Smith-MacDonald L, Cruikshank E, Baghoori D, Kaur Chohan A, Laidlaw A, White A, Cao B, Agyapong V, Burback L, Winkler O, Sevigny PR, Dennett L, Ferguson-Pell M, Greenshaw A, Brémault-Phillips S. Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review. JMIR Mhealth Uhealth 2020; 8:e22079. [PMID: 32955456 PMCID: PMC7536597 DOI: 10.2196/22079] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. OBJECTIVE This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. METHODS Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. RESULTS A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. CONCLUSIONS Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted.
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Affiliation(s)
- Chelsea Jones
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- 1 Field Ambulance Physical Rehabilitation Department, Canadian Armed Forces Health Services, Department of National Defense, Edmonton, AB, Canada
| | - Antonio Miguel-Cruz
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital Research Innovation and Technology (GRRIT), Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emily Cruikshank
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Delaram Baghoori
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Avneet Kaur Chohan
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexa Laidlaw
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Allison White
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bo Cao
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent Agyapong
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phillip R Sevigny
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Martin Ferguson-Pell
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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17
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Saunders GH, Roughley A. Audiology in the time of COVID-19: practices and opinions of audiologists in the UK. Int J Audiol 2020; 60:255-262. [PMID: 32909474 DOI: 10.1080/14992027.2020.1814432] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To document changes in audiology practice resulting from COVID-19 restrictions and to assess audiologists' opinions about teleaudiology. DESIGN A survey consisting of closed-set and open-ended questions that assessed working practices during the COVID-19 restrictions and audiologists' attitudes towards teleaudiology. SAMPLE About 120 audiologists in the UK recruited via snowball sampling through social media and emails. RESULTS About 30% of respondents said they had used teleaudiology prior to COVID-19 restrictions; 98% had done at the time of survey completion, and 86% said they would continue to do so even when restrictions are lifted. Reasons for prior non-use of teleaudiology were associated with clinical limitations/needs, available infrastructure and patient preferences. Respondents believe teleaudiology will improve travel, convenience, flexibility and scheduling, that it will have little/no impact on satisfaction and quality of care, but that it will negatively impact personal interactions. Concerns about teleaudiology focussed on communication, inability to conduct some clinical procedures and technology. CONCLUSIONS Respondents' experience with teleaudiology has generally been positive however improvements to infrastructure and training are necessary, and because many procedures must be conducted in-person, it will always be necessary to have hybrid-care pathways available.
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Affiliation(s)
- Gabrielle H Saunders
- Faculty of Biology, Medicine and Health, Manchester Centre for Audiology and Deafness (ManCAD), University of Manchester, Manchester, UK
| | - Amber Roughley
- Faculty of Biology, Medicine and Health, Manchester Centre for Audiology and Deafness (ManCAD), University of Manchester, Manchester, UK.,Mid Cheshire Hospitals NHS Foundation Trust, Cheshire, UK
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18
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Morland LA, Wells SY, Glassman LH, Greene CJ, Hoffman JE, Rosen CS. Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD. ACTA ACUST UNITED AC 2020; 7:221-241. [PMID: 32837831 PMCID: PMC7261035 DOI: 10.1007/s40501-020-00215-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of review Effective treatments for posttraumatic stress disorder (PTSD) remain underutilized and individuals with PTSD often have difficulty accessing care. Telehealth, particularly clinical videoconferencing (CVT), can overcome barriers to treatment and increase access to care for individuals with PTSD. The purpose of this review is to summarize the literature on the delivery of PTSD treatments through office-based and home-based videoconferencing, and outline areas for future research. Recent findings Evidence-based PTSD treatments delivered through office-based and home-based CVT have been studied in pilot studies, non-randomized trials, and randomized clinical trials. The studies have consistently demonstrated feasibility and acceptability of these modalities as well as significant reduction in PTSD symptoms, non-inferior outcomes, and comparable dropout rates when compared with traditional face-to-face office-based care. Finally, it has been shown that using CVT does not compromise the therapeutic process. Summary Office-based and home-based CVT can be used to deliver PTSD treatments while retaining efficacy and therapeutic process. The use of these modalities can increase the number of individuals that can access efficacious PTSD care.
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Affiliation(s)
- Leslie A Morland
- VA San Diego Healthcare System, 3375 La Jolla Village Drive, San Diego, CA USA.,University of California, San Diego, San Diego, USA.,Pacific Island Division, National Center for PTSD, Honolulu, HI USA
| | - Stephanie Y Wells
- Durham VA Health Care System, Durham, NC USA.,VISN 6 Mid-Atlantic MIRECC, Durham, NC USA
| | - Lisa H Glassman
- VA San Diego Healthcare System, 3375 La Jolla Village Drive, San Diego, CA USA
| | - Carolyn J Greene
- Department of Veterans Affairs Healthcare System, Little Rock, AR USA.,University of Arkansas for Medical Sciences (UAMS), Little Rock, AR USA
| | - Julia E Hoffman
- Behavioral Health Strategy, Livongo Health, Inc, Silicon Valley, CA USA
| | - Craig S Rosen
- Dissemination & Training Division, National Center for PTSD, Palo Alto, CA USA.,Stanford University School of Medicine, Palo Alto, CA USA
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19
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Slightam C, Gregory AJ, Hu J, Jacobs J, Gurmessa T, Kimerling R, Blonigen D, Zulman DM. Patient Perceptions of Video Visits Using Veterans Affairs Telehealth Tablets: Survey Study. J Med Internet Res 2020; 22:e15682. [PMID: 32293573 PMCID: PMC7191342 DOI: 10.2196/15682] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/05/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Video-based health care can help address access gaps for patients and is rapidly being offered by health care organizations. However, patients who lack access to technology may be left behind in these initiatives. In 2016, the US Department of Veterans Affairs (VA) began distributing video-enabled tablets to provide video visits to veterans with health care access barriers. OBJECTIVE This study aimed to evaluate veterans' experiences with VA-issued tablets and identify patient characteristics associated with preferences for video visits vs in-person care. METHODS A baseline survey was sent to the tablet recipients, and a follow-up survey was sent to the respondents 3 to 6 months later. Multivariate logistic regression was used to identify patient characteristics associated with preferences for care, and we examined qualitative themes around care preferences using standard content analysis methods for coding the data collected in the open-ended questions. RESULTS Patient-reported access barriers centered around transportation and health-related challenges, outside commitments, and feeling uncomfortable or uneasy at the VA. Satisfaction with the tablet program was high, and in the follow-up survey, approximately two-thirds of tablet recipients preferred care via a tablet (194/604, 32.1%) or expressed that video-based and in-person care were "about the same" (216/604, 35.7%), whereas one-third (192/604, 31.7%) indicated a preference for in-person care. Patients were significantly more likely to report a preference for video visits (vs a preference for in-person visits or rating them "about the same") if they felt uncomfortable in a VA setting, reported a collaborative communication style with their doctor, had a substance use disorder diagnosis, or lived in a place with better broadband coverage. Patients were less likely to report a preference for video visits if they had more chronic conditions. Qualitative analyses identified four themes related to preferences for video-based care: perceived improvements in access to care, perceived differential quality of care, feasibility of obtaining necessary care, and technology-related challenges. CONCLUSIONS Many recipients of VA-issued tablets report that video care is equivalent to or preferred to in-person care. Results may inform efforts to identify good candidates for virtual care and interventions to support individuals who experience technical challenges.
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Affiliation(s)
- Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Amy J Gregory
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jiaqi Hu
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Josephine Jacobs
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Tolessa Gurmessa
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Program Evaluation and Resource Center, Veterans Health Administration, Menlo Park, CA, United States
| | - Rachel Kimerling
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- National Center for Post-Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Daniel Blonigen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
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20
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Morland LA, Macdonald A, Grubbs KM, Mackintosh MA, Monson CM, Glassman LH, Becker J, Sautter F, Buzzella B, Wrape E, Wells SY, Rooney BM, Glynn S. Design of a randomized superiority trial of a brief couple treatment for PTSD. Contemp Clin Trials Commun 2019; 15:100369. [PMID: 31193184 PMCID: PMC6520635 DOI: 10.1016/j.conctc.2019.100369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/30/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022] Open
Abstract
Interpersonal difficulties are common among veterans with posttraumatic stress disorder (PTSD) and are associated with poorer treatment response. Treatment outcomes for PTSD, including relationship functioning, improve when partners are included and engaged in the therapy process. Cognitive-behavioral conjoint therapy for PTSD (CBCT) is a manualized 15-session intervention designed for couples in which one partner has PTSD. CBCT was developed specifically to treat PTSD, engage a partner in treatment, and improve interpersonal functioning. However, recent research suggests that an abbreviated CBCT protocol may lead to sufficient gains in PTSD and relationship functioning, and yield lower dropout rates. Likewise, many veterans report a preference for receiving psychological treatments through clinical videoteleconferencing (CVT) rather than traditional face-to-face modalities that require travel to VA clinics. This manuscript describes the development and implementation of a novel randomized controlled trial (RCT) that examines the efficacy of an abbreviated 8-session version of CBCT ("brief CBCT," or B-CBCT), and compares the efficacy of this intervention delivered via CVT to traditional in-person platforms. Veterans and their partners were randomized to receive B-CBCT in a traditional Veterans Affairs office-based setting (B-CBCT-Office), CBCT through CVT with the veteran and partner at home (B-CBCT-Home), or an in office-delivered, couple-based psychoeducation control condition (PTSD Family Education). This study is the first RCT designed to investigate the delivery of B-CBCT specifically to veterans with PTSD and their partners, as well as to examine the delivery of B-CBCT over a CVT modality; findings could increase access to care to veterans with PTSD and their partners.
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Affiliation(s)
- Leslie A. Morland
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Alexandra Macdonald
- The Citadel, Military College of South Carolina, 171 Moultrie St, Charleston, SC, 29409, USA
| | - Kathleen M. Grubbs
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Margaret-Anne Mackintosh
- National Center for PTSD – Dissemination & Training Division, VA Palo Alto Healthcare System, 795 Willow Rd, Building 334 (NCPTSD) Room C-130, Menlo Park, CA, 94025, USA
| | | | - Lisa H. Glassman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Julia Becker
- Tulane University School of Medicine, 6823 St Charles Ave, New Orleans, LA, 70118, USA
- Southeast Louisiana Healthcare System, 2400 Canal Street, New Orleans, LA, 70119, USA
| | - Frederic Sautter
- Southeast Louisiana Healthcare System, 2400 Canal Street, New Orleans, LA, 70119, USA
| | - Brian Buzzella
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Elizabeth Wrape
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Stephanie Y. Wells
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - Benjamin M. Rooney
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Shirley Glynn
- VA Greater Los Angeles Healthcare System, 11301, Wilshire Blvd, Los Angeles, CA, 90073, USA
- University of California Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095, USA
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Valentine LM, Donofry SD, Sexton MB. Demographic and psychiatric predictors of engagement in psychotherapy services conducted via clinical video telehealth. J Telemed Telecare 2018; 26:113-118. [PMID: 30261806 DOI: 10.1177/1357633x18801713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Military veterans are at high risk for developing mental health problems. Unfortunately, veterans have relatively low rates of engagement in mental health services compared with non-veterans. In order to address barriers to mental health care services, the Veteran’s Health Administration (VHA) has implemented clinical video telehealth (CVT). Although the effectiveness of this technology appears promising, there is limited research evaluating rates of engagement in CVT mental health services or what factors may predict premature attrition from mental health care delivered via this format. Methods The present study aimed to investigate treatment engagement among veterans enrolled in psychotherapy delivered via CVT, as well as to explore the effects of various demographic and clinical characteristics on these outcomes. Participants were 250 veterans with consults placed to the CVT clinic at a large Midwestern VHA. To evaluate characteristics related to therapy retention, demographic and symptom profile information was gathered from a subset of 93 participants who attended at least one CVT psychotherapy appointment. Results Results indicated there were no significant demographic differences between veterans who attended at least one CVT appointment and those who did not attend at least one session. Demographic variables were not related to the number of CVT visits attended. Regarding psychological characteristics, veterans with anxiety disorders attended fewer CVT appointments overall than veterans with mood disorders and attendance at CVT was negatively correlated with anxiety severity. Discussion These findings have potential implications for providers working in CVT clinics as well as for future research in this area.
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Affiliation(s)
- Lisa M Valentine
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shannon D Donofry
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Minden B Sexton
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Ann Arbor, Michigan, USA
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Abstract
PURPOSE OF REVIEW Telemental health has rapidly evolved as technology and policy advances have allowed new and innovative approaches, including the remote delivery of services directly to patients' homes. This review examined the literature on video to home (VTH) delivery of mental health services to synthesize information regarding (1) the comparative clinical effectiveness of VTH to in-person mental health treatment, (2) impact of VTH on treatment adherence, (3) patient and provider satisfaction with VTH, (4) cost effectiveness of VTH, and (5) clinical considerations for VTH use. RECENT FINDINGS Clinical effectiveness, treatment adherence, and patient satisfaction outcomes are comparable for VTH and in-person delivery of psychotherapy and psychiatric consultation services. Clinical applications for VTH have expanded in an effort to provide mental health care to difficult to reach, underserved populations. VTH is less costly than in-person care when assuming that patients could employ existing personal technologies. VTH delivery offers a safe and effective option for increasing access to mental health care for patients who face logistical and stigma-related barriers to receiving in-person treatment. VTH should be routinely offered to patients as an option for receiving care, maximizing patient choice, and coordination of care.
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Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, Yano EM, Haskell SG, Hamilton AB. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Womens Health Issues 2018; 28:181-187. [DOI: 10.1016/j.whi.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
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