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AshaRani PV, Tan YWB, Samari E, Wang P, Cetty L, Satghare P, Verma SK, Tang C, Subramaniam M. The relationship between therapeutic alliance, frequency of consultation and uptake of telemedicine among patients seeking treatment for early psychosis: A moderated mediation model. Digit Health 2024; 10:20552076241247194. [PMID: 38698830 PMCID: PMC11064748 DOI: 10.1177/20552076241247194] [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] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Background Telehealth services ensure the delivery of healthcare services to a wider range of consumers through online platforms. Nonetheless, the acceptance and uptake of telehealth remain elusive. This study aims to understand the (a) uptake and (b) acceptability of telemedicine, (c) if therapeutic alliance mediates the relationship between the frequency of consultations with clinicians and the uptake of telemedicine in patients with early psychosis, and (d) role of education in moderating the relationship between therapeutic alliance and the uptake of telemedicine for their mental healthcare. Methods A convenience sample of outpatients (n = 109) seeking treatment for early psychosis and their care providers (n = 106) were recruited from a tertiary psychiatric care centre. Sociodemographic and clinical characteristics, therapeutic alliance (Working Alliance Inventory), and telemedicine use were captured through self-administered surveys. The moderated mediation analysis was performed using PROCESS macro 3.4.1 with therapeutic alliance and level of education as the mediating and moderating factors, respectively. Results The acceptance of telemedicine was high (possibly will use: 47.7%; definitely will use: 26.6%) whilst the uptake was low (11%). Therapeutic alliance mediated the relationship between the frequency of consultation and the uptake of telemedicine (β: 0.326; CI: 0.042, 0.637). This effect was moderated by the level of education (β: -0.058; p < 0.05). Conclusion Therapeutic alliance mediates the relationship between the frequency of consultations and the uptake of telemedicine services with the level of education moderating this mediation. Focusing on the patients with lower education to improve their telemedicine knowledge and therapeutic alliance might increase the uptake.
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Affiliation(s)
- PV AshaRani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Pratika Satghare
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Swapna K Verma
- Department of Psychosis, Duke-NUS Medical School, Singapore, Singapore
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Werbart A, Byléhn L, Jansson TM, Philips B. Loss of Rituals, Boundaries, and Relationship: Patient Experiences of Transition to Telepsychotherapy Following the Onset of COVID-19 Pandemic. Front Psychol 2022; 13:835214. [PMID: 35401368 PMCID: PMC8988038 DOI: 10.3389/fpsyg.2022.835214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Telepsychotherapy is an increasingly common way of conducting psychotherapy. Previous research has shown that patients usually have positive experiences of online therapy, however, with large individual differences. The aim of this study was to explore patients’ experiences of transition from in-person psychotherapy sessions to telepsychotherapy during the COVID-19 pandemic, as well as variation in the experiences with regard to the patients’ personality orientation. Seven psychotherapy patients in Sweden were interviewed and the transcripts were analyzed using thematic analysis. Additionally, the participants were asked to rate their dissatisfaction/satisfaction with the transition, how hindering/helpful the transition was, and how unsafe/safe they felt after the transition in comparison to before. Personality orientation on relatedness or self-definition was assessed applying a self-assessment instrument (Prototype Matching of Anaclitic-Introjective Personality Configuration; PMAI). The participants experienced telepsychotherapy as qualitatively different from in-person psychotherapy. They reported several essential losses: the rituals surrounding therapy sessions were lost, including the transitional time and space between their every-day life and the therapy sessions, less therapeutic work was done, the therapists could lose their therapeutic stance, the sense of rapport was impaired, and the patients felt less open and emotionally available. On the other hand, some patients could feel freer online. As six of the participants had an anaclitic personality orientation, the present study could especially contribute to the understanding of how patients with strong affiliative needs and fear of abandonment experience the transition to meeting their therapists via communication technology. The participants’ self-ratings showed that they were only marginally dissatisfied with the transition and experienced the transition as slightly hindering, whereas they felt rather safe after the transition, indicating low concordance between qualitative and quantitative evaluations. New studies are needed to explore the introjective patients’ experiences of the transition. An essential topic is also to collect evidence and to test how the impaired sense of rapport when using communication technology can be remedied by adequate, patient-tailored interventions, a topic that has to be included in psychotherapy education and training.
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Thomas N, McDonald C, de Boer K, Brand RM, Nedeljkovic M, Seabrook L. Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychol Psychother 2021; 94:854-883. [PMID: 33620133 PMCID: PMC8451850 DOI: 10.1111/papt.12332] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.
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Affiliation(s)
- Neil Thomas
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Alfred HospitalMelbourneVictoriaAustralia
| | - Caity McDonald
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Kathleen de Boer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Rachel M. Brand
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQldAustralia
| | - Maja Nedeljkovic
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Liz Seabrook
- National eTherapy CentreSwinburne University of TechnologyMelbourneVictoriaAustralia
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
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Bleyel C, Hoffmann M, Wensing M, Hartmann M, Friederich HC, Haun MW. Patients' Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers. J Med Internet Res 2020; 22:e17330. [PMID: 32310139 PMCID: PMC7199141 DOI: 10.2196/17330] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
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Affiliation(s)
- Caroline Bleyel
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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O'Cathail M, Sivanandan MA, Diver C, Patel P, Christian J. The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review. JMIR Med Inform 2020; 8:e15380. [PMID: 32175911 PMCID: PMC7105931 DOI: 10.2196/15380] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The National Health Service (NHS) Long-Term Plan has set out a vision of enabling patients to access digital interactions with health care professionals within 5 years, including by video link. OBJECTIVE This review aimed to examine the extent and nature of the use of patient-facing teleconsultations within a health care setting in the United Kingdom and what outcome measures have been assessed. METHODS We conducted a systematic scoping review of teleconsultation studies following the Joanna Briggs Institute methodology. PubMed, Scopus, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched up to the end of December 2018 for publications that reported on the use of patient-facing teleconsultations in a UK health care setting. RESULTS The search retrieved 3132 publications, of which 101 were included for a full review. Overall, the studies were heterogeneous in design, in the specialty assessed, and reported outcome measures. The technology used for teleconsultations changed over time with earlier studies employing bespoke, often expensive, solutions. Two-thirds of the studies, conducted between 1995 and 2005, used this method. Later studies transitioned to Web-based commercial solutions such as Skype. There were five outcome measures that were assessed: (1) technical feasibility, (2) user satisfaction, (3) clinical effectiveness, (4) cost, (5) logistical and operational considerations. Due to the changing nature of technology over time, there were differing technical issues across the studies. Generally, teleconsultations were acceptable to patients, but this was less consistent among health care professionals. However, among both groups, face-to-face consultations were still seen as the gold standard. A wide range of clinical scenarios found teleconsultations to be clinically useful but potentially limited to more straightforward clinical interactions. Due to the wide array of study types and changes in technology over time, it is difficult to draw definitive conclusions on the cost involved. However, cost savings for health care providers have been demonstrated by the goal-directed implementation of teleconsultations. The integration of technology into routine practice represents a complex problem with barriers identified in funding and hospital reimbursement, information technologies infrastructure, and integration into clinicians' workflow. CONCLUSIONS Teleconsultations appear to be safe and effective in the correct clinical situations. Where offered, it is likely that patients will be keen to engage, although teleconsultations should only be offered as an option to support traditional care models rather than replace them outright. Health care staff should be encouraged and supported in using teleconsultations to diversify their practice. Health care organizations need to consider developing a digital technology strategy and implementation groups to assist health care staff to integrate digitally enabled care into routine practice. The introduction of new technologies should be assessed after a set period with service evaluations, including feedback from key stakeholders.
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Affiliation(s)
- Micheal O'Cathail
- School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Oncology & Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - M Ananth Sivanandan
- Department of Oncology & Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Claire Diver
- School of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Poulam Patel
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Judith Christian
- Department of Oncology & Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,School of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Fischer AJ, Bloomfield BS, Clark RR, McClelland AL, Erchul WP. Increasing student compliance with teacher instructions using telepresence robot problem-solving teleconsultation. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/21683603.2018.1470948] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aaron J. Fischer
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Bradley S. Bloomfield
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, Alabama, USA
| | - Racheal R. Clark
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Amelia L. McClelland
- Department of Educational Psychology, University of Utah, Salt Lake City, Utah, USA
| | - William P. Erchul
- Department of School Psychology, University of California, Riverside, California, USA
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Vaitheswaran S, Crockett P, Wilson S, Millar H. Telemental health: videoconferencing in mental health services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.111.008904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SummaryVideo technology was first used in psychiatric services in the 1950s but came into general use in the 1990s, particularly in North America and Australia. Video has utility across all ages and in a wide range of clinical situations. These include case conferencing for patients with complex problems (e.g. when planning discharge from specialist inpatient units), psychological assessment and treatment, Mental Health Act assessments, suicide risk assessment and work in forensic settings. Potential for benefit may be most obvious in remote locations, but video use is also relevant in urban settings. Lack of training and experience, inadequate access to equipment and insufficient technical support have all limited the take-up of this technology in the UK. This article briefly reviews the literature and outlines technical and cost considerations when using video technology. Three services in Scotland are described to illustrate ways in which videoconferencing can enhance services.
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Cipolletta S, Mocellin D. Online counseling: An exploratory survey of Italian psychologists’ attitudes towards new ways of interaction. Psychother Res 2017; 28:909-924. [DOI: 10.1080/10503307.2016.1259533] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sabrina Cipolletta
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Padova, Italy
| | - Damiano Mocellin
- Dipartimento di Psicologia Generale, Università degli Studi di Padova, Padova, Italy
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Brebner JA, Brebner EM, Ruddick-Bracken H. Experience-based guidelines for the implementation of telemedicine services. J Telemed Telecare 2016; 11 Suppl 1:3-5. [PMID: 16035975 DOI: 10.1258/1357633054461778] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Many telemedicine projects fail to survive beyond the funded research phase. A review of seven Scottish telemedicine services was conducted to identify successes and failures. Qualitative interviews were conducted with key individuals in each project. All projects were partly successful. The main reasons associated with partial failure were: the service was not needs-driven; there was no commitment to provide the service; there was no suitable exit strategy after research funding expired; there was poor communication; there was a lack of training; there were technical problems; work practices were not updated; the protocols for use were poor or non-existent. Based on this, guidelines that might improve the chances of success in future projects were drawn up.
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Affiliation(s)
- J A Brebner
- Telemedicine Laboratory, Remote Health Care Unit, Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, UK.
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10
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Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry 2016; 6:269-82. [PMID: 27354970 PMCID: PMC4919267 DOI: 10.5498/wjp.v6.i2.269] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/27/2016] [Accepted: 03/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To conduct a review of the telepsychiatry literature. METHODS We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to: (1) be published in a peer-reviewed journal after the year 2000; (2) be written in English; (3) use videoconferencing technology for the provision of mental health assessment or treatment services; and (4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in PubMed (Medline database), Ovid medline, PsychInfo, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories: (1) satisfaction; (2) reliability; (3) treatment outcomes; (4) implementation outcomes; (5) cost effectiveness; and (6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion. RESULTS Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry. CONCLUSION A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.
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Fischer AJ, Dart EH, Leblanc H, Hartman KL, Steeves RO, Gresham FM. AN INVESTIGATION OF THE ACCEPTABILITY OF VIDEOCONFERENCING WITHIN A SCHOOL-BASED BEHAVIORAL CONSULTATION FRAMEWORK. PSYCHOLOGY IN THE SCHOOLS 2016. [DOI: 10.1002/pits.21900] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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12
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Fortney JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, Williams DK, Bynum CA, Mattox R, Rost KM. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry 2013; 170:414-25. [PMID: 23429924 PMCID: PMC3816374 DOI: 10.1176/appi.ajp.2012.12050696] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Practice-based collaborative care is a complex evidence-based practice that is difficult to implement in smaller primary care practices that lack on-site mental health staff. Telemedicine-based collaborative care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multisite randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients assigned to practice-based and telemedicine-based collaborative care. METHOD From 2007 to 2009, patients at federally qualified health centers serving medically underserved populations were screened for depression, and 364 patients who screened positive were enrolled and followed for 18 months. Those assigned to practice-based collaborative care received evidence-based care from an on-site primary care provider and a nurse care manager. Those assigned to telemedicine-based collaborative care received evidence-based care from an on-site primary care provider and an off-site team: a nurse care manager and a pharmacist by telephone, and a psychologist and a psychiatrist via videoconferencing. The primary clinical outcome measures were treatment response, remission, and change in depression severity. RESULTS Significant group main effects were observed for both response (odds ratio=7.74, 95% CI=3.94-15.20) and remission (odds ratio=12.69, 95% CI=4.81-33.46), and a significant overall group-by-time interaction effect was observed for depression severity on the Hopkins Symptom Checklist, with greater reductions in severity over time for patients in the telemedicine-based group. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence base in the telemedicine-based group. CONCLUSIONS Contracting with an off-site telemedicine-based collaborative care team can yield better outcomes than implementing practice-based collaborative care with locally available staff.
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Affiliation(s)
- John C. Fortney
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Jeffrey M. Pyne
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Sip B. Mouden
- Community Health Centers of Arkansas Inc. North Little Rock, AR, 72114
| | - Dinesh Mittal
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Teresa J. Hudson
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Gary W. Schroeder
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | - David K. Williams
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | - Carol A. Bynum
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | | | - Kathryn M Rost
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL 33612
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Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
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Steel K, Cox D, Garry H. Therapeutic videoconferencing interventions for the treatment of long-term conditions. J Telemed Telecare 2011; 17:109-17. [PMID: 21339304 DOI: 10.1258/jtt.2010.100318] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a systematic review of literature relating to videoconferencing in therapeutic interventions for chronic conditions. Two hundred articles were reviewed in detail, 35 of which were relevant to the study. Of these, eight were randomized controlled trials (RCTs) and the remainder were service evaluations, pilot studies and case studies. Two major themes emerged, relating specifically to videoconferencing: clinical outcomes and patient satisfaction. There were 14 studies which measured clinical outcomes of interventions for chronic conditions delivered by videoconferencing. A range of evidence, including four RCTs of high quality, indicates that interventions for a variety of conditions, including psychological and physical, delivered by videoconferencing produce similar outcomes to treatment delivered in-person. Evidence suggests that levels of patient satisfaction with telerehabilitation are high and that the formation of a good therapeutic alliance is possible. Several papers reported that clinical staff showed lower levels of satisfaction in using telerehabilitation than patients. It is feasible to use videoconferencing as a means of delivering therapeutic interventions for people with chronic conditions in rural communities.
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Affiliation(s)
- Katie Steel
- Isis Education Centre, Warneford Lane, Headington, Oxford OX3 7JX, UK.
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Abstract
Because of the overwhelming maldistribution of mental health specialists in metropolitan areas and the many underserved families living in rural settings, rural areas are natural homes for the use of telemedicine or videoconferencing technology for clinical services. The authors describe telepsychology services for rural clients, placing best psychology practices within the context of broader telemental health services. The goal is to approximate evidence-based child psychotherapy from face-to-face practice using the videoconferencing technology. Telepsychology is illustrated with a case report of a rural Hispanic teen and her family presenting through the teen's primary care clinic.
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Affiliation(s)
- Eve-Lynn Nelson
- Kansas University Medical Center, Center for Telemedicine and Department of Pediatrics, 2012 Wahl Annex, MS 1048, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
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Shepherd L, Goldstein D, Whitford H, Thewes B, Brummell V, Hicks M. The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: results of a pilot study. J Pain Symptom Manage 2006; 32:453-61. [PMID: 17085271 DOI: 10.1016/j.jpainsymman.2006.05.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 04/01/2006] [Accepted: 05/11/2006] [Indexed: 01/18/2023]
Abstract
The unmet psychological needs of rural cancer patients are numerous. Telepsychology is a novel and feasible option that may provide cost-savings and help overcome inequalities in access to specialists. This is the first known study of psychological treatment for people with cancer delivered entirely via videoconferencing. We hypothesized that a telepsychology service would improve rural cancer patients' anxiety and depression levels and quality of life, and would be an acceptable, satisfactory, and practical mode of service delivery. Twenty-five cancer patients attended an average of three sessions with a clinical psychologist providing brief cognitive-behavioral therapy. Questionnaires were completed at pre-, post-, and 1-month follow-up. Patients benefited in terms of anxiety (P=0.01) and quality of life (P=0.04). The service was both practical and acceptable. These preliminary positive results provide a firm basis to conduct a randomized controlled trial of face-to-face interaction vs. videoconferencing.
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Affiliation(s)
- Louise Shepherd
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
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17
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Simpson S, Bell L, Knox J, Mitchell D. Therapy via videoconferencing: a route to client empowerment? Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.436] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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