Telepsychiatry and Outpatient Department Services

Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings: A Systematic Review

Background: Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at health care facilities. However, its adoption in health care is not entirely realized due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian health care system, observed at the infrastructural, sociocultural, regulatory, and financial levels, from the perspectives of health care providers, patients, patient caregivers, society, health organizations, and the government. Methods: This review complies with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015. A total of 2,706 peer-reviewed studies published from December 2016 to September 2023 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE, and PsycInfo databases were considered for the title and abstract screening, after which 334 articles were chosen for the full-text review. In the end, 46 studies were selected for data synthesis. Results: Analysis of the literature revealed key barriers such as data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), infrastructure issues, and ICT training gaps. Facilitators included reduced health care delivery costs, enhanced patient access to health care in remote areas, and shorter patient wait times. The real-world experiences of Indian telemedicine practitioners and pioneers are also explored to complement literature-based perspectives on telemedicine implementation. Both stress the need for reliable internet connectivity, technological adoption, comprehensive ICT training, positive sociocultural attitudes, stringent data privacy measures, and viable business models as crucial for effective telemedicine adoption, with experts emphasizing practical adaptability alongside the literature-recognized facilitators.

Quality of asynchronous webchats vs in-person consultations for postpartum depression in China: a cross-sectional, mixed methods study using standardized patients

Background

Prompt professional care for postpartum depression (PPD) is difficult to obtain in China. Though online consultations improve accessibility and reduce stigma, the quality of services compared to in-person consultations is unclear.

Methods

Five trained, undisclosed "standardized patients" (SPs) made "asynchronous webchats" visits and in-person visits with psychiatrists. Visits were made to 85 psychiatrists who were based in 69 hospitals in ten provincial capital cities. The care between online and in-person consultations with the same psychiatrist was compared, including diagnosis, guideline adherence, and patient-centeredness. False discovery rate (FDR) was used to adjust p values. Third visits using asynchronous webchats were made to psychiatrists who offered discrepant diagnoses. Thematic content analysis was used for the discrepancies.

Findings

The proportion of diagnostic accuracy was lower for online than in-person visits (76.5% [65/85] vs 91.8% [78/85]; pFDR = 0.0066), as were the proportions of completing questions involving clinical history (16.6% vs 42.7%; pFDR < 0.0001), and management decisions (16.2% vs 27.5%; pFDR < 0.0001) consistent with recommended guidelines. Patient-centeredness was lower online than in-person (pFDR < 0.0001). Fifteen of 16 psychiatrists completed third visits, most of them considered lack of nonverbal information online as a key barrier.

Interpretation

Online consultations using asynchronous webchats were inferior to in-person consultations, with respect to diagnostic accuracy, adherence to recommended clinical guidelines, and patient-centeredness. To fully realise the potential benefits of online consultations and to prevent safety issues, there is an urgent need for major improvement in the quality and oversight of these consultations.

Funding

China Medical Board, National Natural Science Foundation of China, and Swiss Agency for Development and Cooperation Global Cooperation Department.

Teleassault: A Case of Patient Violence During a Telepsychiatry Encounter

Background: Telemedicine in psychiatry (telepsychiatry) is an emerging and rapidly developing tool which is used in many areas of psychiatry. While telepsychiatry has been shown to be efficacious and improves access to psychiatric care, it can also help to mitigate the risk of bodily injury caused by patient assault. The telepsychiatry equipment, however, may be vulnerable to damage from patient assault. Patient Case: We present the case of a 24 year old man being treated for disorganized behaviors and delusional thoughts at a regional hospital. As the regional hospital did not have access to psychiatry, telepsychiatry consultation was used. This patient behaved with violence towards the telepsychiatry equipment. Discussion: There currently is no literature establishing best practices to minimize the risk of violence towards equipment during telepsychiatry encounters. Using this case report, we aim to illustrate the risk of violence in telepsychiatry encounters and to discuss best practices to minimize this risk.

Examining Outcomes and Challenges of Telepsychiatry in Australian Elderly: A Scoping Review

Methods

To find relevant articles, we searched PubMed, Scopus, and Web of Science databases. We used a data extraction form to gather information from primary studies. Two researchers followed inclusion and exclusion criteria to select studies and extract data. Disagreements were resolved through discussion with all researchers. Studies needed to be in English, about telepsychiatry for Australian seniors, and use any technology type (synchronous, asynchronous, or both). We excluded nontelepsychiatry articles, books, book chapters, conference abstracts, and editor letters.

Results

Telepsychiatry was effectively employed to manage depression, anxiety, delirium, and cognitive impairments. Among these four disorders, telepsychiatry was mostly used for depression. Videoconference and telephone were mostly used to provide telepsychiatry services. Most telepsychiatry services for Australian seniors included "patient education on disorder control and management," "creating continuous interaction between the patient and the therapist," and "remote patients' assessment." "Reductions in symptoms of disorders," "improving patients' satisfaction with telepsychiatry," and "cost-effectiveness of telepsychiatry" were the most important positive outcomes of using telepsychiatry. We also identified four challenges in using telepsychiatry for elderly individuals in Australia.

Conclusions

This study is the first scoping review in Australia and provides valuable insight into telepsychiatry for elderly individuals.

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis

BACKGROUND

The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the "new normal."

OBJECTIVE

The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis.

METHODS

We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords.

RESULTS

A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors.

CONCLUSIONS

COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.

The Role of Telemedicine in Child and Adolescent Healthcare in India

Purpose of Review

We highlight the evolution and use of telemedicine in child and adolescent healthcare in India, in pre and post pandemic eras.

Recent Findings

The latest research endorses telemedicine as a successful strategy in resource-limited settings to provide accessible and equitable healthcare.

Summary

Telemedicine was initiated in India in 2001. The pandemic restrictions resulted in an increase in its use. The national telemedicine and telepsychiatry guidelines facilitated and enabled its widespread use. Telehealth was used by private and public health establishments, in urban, rural, and remote areas. It was used for triaging cases; managing and monitoring COVID patients in home isolation, in non-COVID medical and psychiatric care, and follow-up; continuing medical education; and health promotion strategies like teleyoga. The shortcomings included inability to provide privacy and confidentiality, perform physical examination, and provide emergency care. Most patients and their caregivers expressed satisfaction with telehealth services. Telemedicine is likely to become an integral part of healthcare services in the post pandemic era.

Telemedicine in Geriatric Psychiatry: Relevance in India

Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.