1
|
Crawford J, Haffar S, Fernando S, Stephens H, Harvey SB, Black M. Client perspectives: Telehealth for mental health services. Australas Psychiatry 2024:10398562241270986. [PMID: 39126425 DOI: 10.1177/10398562241270986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
OBJECTIVE The COVID-19 pandemic required mental health clinicians globally to transition to the delivery of care via telehealth. This study aimed to gain an understanding of clients' satisfaction with and attitudes towards telehealth mental health services. METHOD Seventy adults who had attended a clinic for mood and anxiety disorders, and participated in at least one telehealth consultation with a psychologist or psychiatrist, completed an anonymous online survey. RESULTS The majority of participants (81.5%) reported satisfaction with telehealth mental health care provided during the COVID-19 pandemic. However, satisfaction overall was significantly higher amongst participants who had received both telehealth and face-to-face mental health care, compared to participants who received care via telehealth only. Advantages of telehealth care reported included convenience and increased access to mental health clinicians. However, disadvantages of telehealth care included greater difficulty developing a rapport with a clinician and expressing oneself via telehealth. CONCLUSIONS Whilst client satisfaction with telehealth mental health care for mood and anxiety disorders is generally high, clinicians should consider the limitations of telehealth from clients' perspectives. In particular, strategies to enhance therapeutic connection during telehealth sessions may be needed, and client preferences for mode of delivery should be taken into consideration when possible.
Collapse
Affiliation(s)
| | - Sam Haffar
- Black Dog Institute, UNSW Sydney, Australia
| | | | | | | | - Melissa Black
- Black Dog Institute, UNSW Sydney, Australia
- School of Psychology, UNSW Sydney, Australia
| |
Collapse
|
2
|
Woon LSC. Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study. Australas Psychiatry 2024; 32:204-209. [PMID: 38438122 PMCID: PMC11103898 DOI: 10.1177/10398562241237128] [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] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. METHODS out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. RESULTS Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. CONCLUSIONS Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.
Collapse
Affiliation(s)
- Luke S-C Woon
- Luke S-C Woon, Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Building 8, Level 4, Canberra Hospital, Garran, ACT 2605, Australia.
| |
Collapse
|
3
|
Woon LSC, Maguire PA, Reay RE, Looi JCL. Telepsychiatry in Australia: A Scoping Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237116. [PMID: 38462906 DOI: 10.1177/00469580241237116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation.
Collapse
Affiliation(s)
- Luke Sy-Cherng Woon
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| |
Collapse
|
4
|
Pai N, Gupta R, Lakra V, Vella SL, Kalra H, Yadav T, Chaturvedi S, Gill NS. Indian psychiatrists in the Australian workforce - From brain drain to brain exchange. Aust N Z J Psychiatry 2022; 56:752-756. [PMID: 34498491 DOI: 10.1177/00048674211044099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Worldwide doctors have been migrating from low- and middle-income countries to high-income countries for decades. This contributes to dearth of doctors, especially psychiatrists, in low- and middle-income countries - often referred to as 'brain drain'. Australia has a fair share of psychiatrists of Indian origin in its workforce. This article endeavours to re-formulate the migration phenomenon as 'brain exchange' through the experiential insight of the authors along with published literature and discusses the contribution of substantial number of psychiatrists of Indian origin to the Australian society. Furthermore, the article highlights the potential for the Royal Australian and New Zealand College of Psychiatrists to be a leader in this area by facilitating globally responsible practice by giving back to countries from which psychiatrists originate. The key observations and recommendations are transferrable to other similar countries and equally to other medical specialities.
Collapse
Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Rahul Gupta
- Hunter New England Mental Health Service, Newcastle, NSW, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Vinay Lakra
- North West Area Mental Health Service, North Western Mental Health, Parkville, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Shae-Leigh Vella
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Harish Kalra
- Ballarat Clinical School, School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Grampians Area Mental Health Services, Ballarat, VIC, Australia
| | - Tarun Yadav
- Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Drug and Alcohol Service, Newcastle, NSW, Australia
| | | | - Neeraj S Gill
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.,Rural Clinical School, The University of Queensland, Toowoomba, QLD, Australia.,Mental Health and Specialist Services, Gold Coast Health, Gold Coast, QLD, Australia
| |
Collapse
|
5
|
Looi JCL, Allison S, Bastiampillai T, Kisely SR. The Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA): Aims, model, outputs, and implications for clinical academic advocacy. Australas Psychiatry 2022; 30:313-315. [PMID: 34839737 DOI: 10.1177/10398562211052887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We describe an independent model of clinical academic mental health services research that is able to provide synthesised views for medico-political organisations that are engaged in advocacy for national and state evidence-based policy and planning of mental healthcare. CONCLUSIONS CAPIPRA focuses on independent research and policy analysis using publicly available datasets on population mental health at national and state/territory levels, published in international and national peer-reviewed journals (>50 papers since 2019). We partner with medico-political organisations in evidence-based advocacy across a wide range of issues.
Collapse
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, Monash University, Wellington Road, Clayton, Victoria, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
6
|
Looi JC, Allison S, Bastiampillai T, Pring W, Kisely SR. Telepsychiatry and face-to-face psychiatric consultations during the first year of the COVID-19 pandemic in Australia: patients being heard and seen. Australas Psychiatry 2022; 30:206-211. [PMID: 34809483 PMCID: PMC8988455 DOI: 10.1177/10398562211046301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Australian federal government introduced additional Medicare Benefits Schedule (MBS) telehealth-items to facilitate care by private psychiatrists during the COVID-19 pandemic. METHOD We analysed private psychiatrists' uptake of video and telephone-telehealth, as well as total (telehealth and face-to-face) consultations for April 2020-April 2021. We compare these to face-to-face consultations for April 2018-April 2019. MBS-Item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with face-to-face consultations for the whole of Australia. RESULTS Psychiatric consultation numbers (telehealth and face-to-face) were 13% higher during the first year of the pandemic compared with 2018-2019, with telehealth accounting for 40% of this total. Face-to-face consultations were 65% of the comparative number of 2018-2019 consultations. There was substantial usage of telehealth consultations during 2020-2021. The majority of telehealth involved short telephone consultations of ⩽15-30 min, while video was used more, in longer consultations. CONCLUSIONS Private psychiatrists and patients continued using the new telehealth-items during 2020-2021. This compensated for decreases in face-to-face consultations and resulted in an overall increase in the total patient contacts compared to 2018-2019.
Collapse
Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia.,Private Psychiatry, Canberra, ACT, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - William Pring
- Monash University, and Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia.,Private Psychiatry, Melbourne, VIC, Australia
| | - Stephen R Kisely
- School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
7
|
Hélène K, Gourret Baumgart J, El Hage W, Deloyer J, Maes C, Lebas MC, Marazziti D, Thome J, Fond-Harmant L, Denis F. Uses of digital technologies in the time of Covid-19: opportunities and challenges for professionals in psychiatry and mental health care. JMIR Hum Factors 2021; 9:e30359. [PMID: 34736224 PMCID: PMC8820762 DOI: 10.2196/30359] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/06/2021] [Accepted: 10/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. OBJECTIVE As part of a research project that was co-funded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, we carried out a systematic literature review to investigate how such uses of digital technologies have been developing. METHODS The present systematic review was conducted following the PRISMA guidelines. The search was carried out in MEDLINE (PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts, and then on full texts, 61 articles were included. RESULTS The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up an experience of remote care, and thus better identify the possibilities and limits of these digital technologies. CONCLUSIONS The new uses of such technologies essentially consist in a transition from the classic consultation model towards teleconsultation and makes less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular so as to promote the autonomy and empowerment of mental health service users. CLINICALTRIAL
Collapse
Affiliation(s)
- Kane Hélène
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| | - Jade Gourret Baumgart
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| | - Wissam El Hage
- Centre d'Investigation Clinique, Institut national de la santé et de la recherche médicale (INSERM), Tours, FR.,Centre Hospitalier Régional Universitaire Tours (CHRU), Tours, FR
| | - Jocelyn Deloyer
- Centre Neuro Psychiatrique St. Martin (CNP St. Martin), Dave Namur, BE
| | - Christine Maes
- Centre Neuro Psychiatrique St. Martin (CNP St. Martin), Dave Namur, BE
| | - Marie-Clotilde Lebas
- Département des Sciences de la Santé Publique et de la Motricité, Haute Ecole de la Province de Namur (HEPN), Namur, BE
| | - Donatella Marazziti
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, IT.,Unicamillus, University of Rome and Brain Research Foundation, Lucca, IT
| | - Johannes Thome
- Department of Psychiatry, University of Rostock, Rostock, DE
| | - Laurence Fond-Harmant
- Agence de Coopération Scientifique Europe-Afrique-Luxembourg (ASCAL), Luxembourg, LU.,Education et Pratiques en Santé, Paris 13, Université Sorbonne Paris Nord, Paris, FR
| | - Frédéric Denis
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| |
Collapse
|
8
|
Looi JC, Allison S, Bastiampillai T, Pring W, Reay R. Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services. Australas Psychiatry 2021; 29:183-188. [PMID: 33280401 PMCID: PMC7723735 DOI: 10.1177/1039856220975294] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Australian Commonwealth Government introduced new psychiatrist Medicare-Benefits-Schedule (MBS)-telehealth items in the first wave of the COVID-19 pandemic to assist with previously office-based psychiatric practice. We investigate private psychiatrists' uptake of (1) video- and telephone-telehealth consultations for Quarter-2 (April-June) of 2020 and (2) total telehealth and face-to-face consultations in Quarter-2, 2020 in comparison to Quarter-2, 2019 for Australia. METHODS MBS item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with a baseline of the Quarter-2, 2019 (April-June 2019) of face-to-face consultations for the whole of Australia. RESULTS Combined telehealth and face-to-face psychiatry consultations rose during the first wave of the pandemic in Quarter-2, 2020 by 14% compared to Quarter-2, 2019 and telehealth was approximately half of this total. Face-to-face consultations in 2020 comprised only 56% of the comparative Quarter-2, 2019 consultations. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations comprised 38% of the total telehealth provision (for new patient assessments and longer consultations). CONCLUSIONS There has been a flexible, rapid response to patient demand by private psychiatrists using the new COVID-19-MBS-telehealth items for Quarter-2, 2020, and in the context of decreased face-to-face consultations, ongoing telehealth is essential.
Collapse
Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, ACT, Australia.,Private Psychiatry, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, SA, Australia.,Department of Psychiatry, Monash University, VIC, Australia
| | - William Pring
- Monash University, and Centre for Mental Health Education and Research at Delmont Private Hospital, VIC, Australia.,Private Psychiatry, VIC, Australia
| | - Rebecca Reay
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, ACT, Australia.,Private Practice, ACT, Australia
| |
Collapse
|