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Shalev L, Eitan R, Rose AJ. The Use of Telepsychiatry Services in Emergency Settings: Scoping Review. J Med Internet Res 2024; 26:e51814. [PMID: 39008831 PMCID: PMC11287096 DOI: 10.2196/51814] [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] [Received: 08/13/2023] [Revised: 02/25/2024] [Accepted: 04/29/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP's effectiveness in the ED setting, as well as the process of implementing TP in this setting. OBJECTIVE This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. METHODS The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. RESULTS A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. CONCLUSIONS Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP's effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment.
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Affiliation(s)
- Ligat Shalev
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Renana Eitan
- Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Adam J Rose
- School of Public Health, Hebrew University, Jerusalem, Israel
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2
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Fisker Christensen L, Sørensen L, Johansen KK. Staff experiences with videoconferences during the COVID-19 pandemic in forensic psychiatry outpatients. Nord J Psychiatry 2024; 78:370-375. [PMID: 38546409 DOI: 10.1080/08039488.2024.2331209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/14/2024]
Abstract
AIM To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. METHOD Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. RESULTS Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact-pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? CONCLUSION Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences.
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Affiliation(s)
- Lone Fisker Christensen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
| | - Line Sørensen
- Department of Psychiatry Odense, Region of Southern Denmark, Odense, Denmark
| | - Kirsten Kjær Johansen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
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Reliford A, Zhang E, Lanina O, Williams SZ, Sanichar N, Khan S, Dapkins I, Frankle WG. Patient and Clinician Satisfaction with the Early Implementation of Telemental Health Services in an Urban Behavioral Health Clinic During the COVID-19 Pandemic. Telemed J E Health 2023; 29:1713-1722. [PMID: 36912813 DOI: 10.1089/tmj.2022.0480] [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: 03/14/2023] Open
Abstract
Objective: The COVID-19 pandemic served as an impetus for the rapid expansion of telehealth. In this study, we examined the experience of rapid transition to telemental health (TMH) within The Family Health Centers at NYU Langone, a large, urban, Federally Qualified Health Center, in the 3 months after the onset of the COVID-19 pandemic. Methods: We administered surveys to clinicians and patients who utilized TMH between March 16, 2020 and July 16, 2020. Patients were sent a web-based survey via email or received a phone survey (for those without email) with four languages choices: English, Spanish, Traditional Chinese, or Simplified Chinese. Results: The majority (79%) of clinicians (n = 83) rated the experience of TMH as "excellent" or "good," and felt that they could establish and maintain the patient relationship through TMH. Four thousand seven hundred seventy-two survey invitations were sent out to patients, and 654 (13.7%) responded. Ninety percent reported that they were satisfied with the service they received and rated TMH as better or the same as in-person care (81.6%) with a high mean satisfaction score (4.5 out of 5). Patients were more likely to rate TMH as better or the same as in-person care relative to the clinicians. Conclusions: These results are consistent with several recent studies that have explored patient satisfaction with TMH during the COVID-19 pandemic and demonstrate that both clinicians and patients experienced a high degree of satisfaction with mental health care delivered virtually compared with face-to-face encounters.
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Affiliation(s)
- Aaron Reliford
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Emily Zhang
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| | - Olga Lanina
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| | - Sharifa Z Williams
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Navin Sanichar
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Shabana Khan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Isaac Dapkins
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - W Gordon Frankle
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
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Shalev L, Bistre M, Lubin G, Avirame K, Raskin S, Linkovski O, Eitan R, Rose AJ. Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study. JMIR Res Protoc 2023; 12:e49405. [PMID: 37847548 PMCID: PMC10618883 DOI: 10.2196/49405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission. OBJECTIVE The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link. METHODS This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation's viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records. RESULTS This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others. CONCLUSIONS Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49405.
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Affiliation(s)
- Ligat Shalev
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Moises Bistre
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Gadi Lubin
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Keren Avirame
- Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Sergey Raskin
- Department of Forensic Psychiatry, Ministry of Health, Jerusalem, Israel
| | - Omer Linkovski
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Renana Eitan
- Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Adam J Rose
- School of Public Health, Hebrew University, Jerusalem, Israel
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5
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Achtyes ED, Glenn T, Monteith S, Geddes JR, Whybrow PC, Martini J, Bauer M. Telepsychiatry in an Era of Digital Mental Health Startups. Curr Psychiatry Rep 2023; 25:263-272. [PMID: 37166622 PMCID: PMC10172730 DOI: 10.1007/s11920-023-01425-9] [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] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE OF REVIEW Telepsychiatry practiced by psychiatrists is evidence-based, regulated, private, and effective in diverse settings. The use of telemedicine has grown since the COVID-19 pandemic as people routinely obtain more healthcare services online. At the same time, there has been a rapid increase in the number of digital mental health startups that offer various services including online therapy and access to prescription medications. These digital mental health firms advertise directly to the consumer primarily through digital advertising. The purpose of this narrative review is to contrast traditional telepsychiatry and the digital mental health market related to online therapy. RECENT FINDINGS In contrast to standard telepsychiatry, most of the digital mental health startups are unregulated, have unproven efficacy, and raise concerns related to self-diagnosis, self-medicating, and inappropriate prescribing. The role of digital mental health firms for people with serious mental illness has not been determined. There are inadequate privacy controls for the digital mental health firms, including for online therapy. We live in an age where there is widespread admiration for technology entrepreneurs and increasing emphasis on the role of the patient as a consumer. Yet, the business practices of digital mental health startups may compromise patient safety for profits. There is a need to address issues with the digital mental health startups and to educate patients about the differences between standard medical care and digital mental health products.
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Affiliation(s)
- Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
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Freeman RE, Zhong C, Bahar P, Boggs KM, Faridi MK, Sullivan AF, Zachrison KS, Camargo CA. U.S. Emergency Department Telepsychiatry Use in 2019. Telemed J E Health 2023; 29:366-375. [PMID: 35867053 PMCID: PMC10024260 DOI: 10.1089/tmj.2022.0191] [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] [Received: 04/28/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Although many emergency departments (EDs) receive telehealth services for psychiatry, or telepsychiatry, to manage acute psychiatric emergencies, national research on the usage of ED telepsychiatry is limited. To investigate ED telepsychiatry usage in the pre-COVID-19 era, we surveyed a sample of EDs receiving telepsychiatry in 2019, as a follow-up to a survey targeted to similar EDs in 2017. Methods: All U.S. EDs open in 2019 (n = 5,563) were surveyed to characterize emergency care. A more in-depth second survey on telepsychiatry use (2019 ED Telepsychiatry Survey) was then sent to 235 EDs. Of these EDs, 130 were randomly selected from those that reported telepsychiatry receipt in 2019, and 105 were selected based on their participation in a similar survey in 2017 (2017 ED Telepsychiatry Survey). Results: Of the 235 EDs receiving the 2019 Telepsychiatry Survey, 192 (82%) responded and 172 (90% of responding EDs) confirmed 2019 telepsychiatry receipt. Of these, five were excluded for missing data (analytic samplen = 167). Telepsychiatry was the only form of emergency psychiatric services for 92 (55%) EDs. The most common usage of telepsychiatry was for admission or discharge decisions (82%) and transfer coordination (70%). The most commonly reported telepsychiatry mental health consultants were psychiatrists or other physician-level mental health professionals (74%). Discussion: With telepsychiatry as the only form of psychiatric services for most telepsychiatry-receiving EDs, this innovation fills a critical gap in access to emergency psychiatric care. Further research is needed to investigate the impact of the COVID-19 pandemic on usage of ED telepsychiatry.
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Affiliation(s)
- Rain E. Freeman
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cordelia Zhong
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Piroz Bahar
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Krislyn M. Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohammed K. Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Warwicker S, Sant D, Richard A, Cutajar J, Bellizzi A, Micallef G, Refalo D, Camilleri L, Grech A. A Retrospective Longitudinal Analysis of Mental Health Admissions: Measuring the Fallout of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1194. [PMID: 36673950 PMCID: PMC9858631 DOI: 10.3390/ijerph20021194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND In this research article, we review the infrequently considered long-term impact of the pandemic on inpatient mental health, by reviewing the clinical parameters of all psychiatric admissions to Mount Carmel Hospital, our region's main psychiatric healthcare facility, from 2019-2021. METHODS 4292 patients were admitted during the research period of this retrospective longitudinal analysis. Taking 2019 as the pre-COVID reference year, we compared mean monthly admissions from 2020 and 2021, looking at patient demographics, status under the Mental Health Act, diagnosis, and self-injurious behaviour. RESULTS While the pandemic was reflected in a moderate increase in mean monthly presentations with suicidal ideation and suicidal self-injury, presentations in 2020 otherwise remained largely stable. This contrasted with a surge in presentations in 2021 with mood disorders, schizophrenia, anxiety, personality disorders, and autism spectrum disorders. Furthermore, presentations involving self-injurious behaviour continued to grow. Involuntary admissions also increased significantly in 2021. CONCLUSIONS This paper highlights the pernicious long-term impact of the pandemic on mental health presentations, demonstrated by an increase in hospital admissions and more serious presentations. These findings should be considered in the guidance for responses to any future pandemic, giving attention to the evidence of the impact of restrictive measures on mental health.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Refalo
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Liberato Camilleri
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Anton Grech
- Mount Carmel Hospital, ATD 9033 H’Attard, Malta
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
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Yung HY, Yeung WT, Law CW. The reliability of symptom assessment by telepsychiatry compared with face to face psychiatric interviews. Psychiatry Res 2022; 316:114728. [PMID: 35908348 PMCID: PMC9301901 DOI: 10.1016/j.psychres.2022.114728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION With the start of the COVID-19 pandemic, the various social distancing policies imposed have mandated psychiatrists to consider the option of using telepsychiatry as an alternative to face-to-face interview in Hong Kong. Limitations over sample size, methodology and information technology were found in previous studies and the reliability of symptoms assessment remained a concern. AIM To evaluate the reliability of assessment of psychiatric symptoms by telepsychiatry comparing with face-to-face psychiatric interview. METHOD This study recruited a sample of adult psychiatric patients in psychiatric wards in Queen Mary Hospital. Semi-structural interviews with the use of standardized psychiatric assessment scales were carried out in telepsychiatry and face-to-face interview respectively by two clinicians and the reliability of psychiatric symptoms elicited were assessed. RESULTS 90 patients completed the assessments The inter-method reliability in Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Columbia Suicide Severity Rating Scale and Brief Psychiatric Rating Scale showed good agreement when compared with face-to-face interview. CONCLUSION Symptoms assessment by telepsychiatry is comparable to assessment conducted by face-to-face interview.
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Affiliation(s)
- Hiu Yan Yung
- Department of Psychiatry, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong.
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Farrell A, George N, Amado S, Wozniak J. A systematic review of the literature on telepsychiatry for bipolar disorder. Brain Behav 2022; 12:e2743. [PMID: 36102239 PMCID: PMC9575613 DOI: 10.1002/brb3.2743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/28/2022] [Accepted: 07/26/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Bipolar (BP) disorder is a highly morbid disorder that is often misdiagnosed or undiagnosed and affects a large number of adults and children. Due to the coronavirus disease 2019 public health emergency stay at home orders, most outpatient mental health care was provided via telepsychiatry, and the many benefits of virtual care ensure that this will continue as an ongoing practice. The main aim of this review was to investigate what is currently known about the use of telepsychiatry services in the diagnosis and treatment of BP disorder across the lifespan. METHOD A systematic literature review assessing the use of telepsychiatry in BP disorder was conducted in PubMed, PsychINFO, and Medline. RESULTS Six articles were included in the final review. All included articles assessed populations aged 17 years or older. The literature indicates that BP disorder was addressed in telepsychiatry services at a similar rate as in-person services, reliable diagnoses can be made using remote interviews, satisfaction rates are comparable to in-person services, telepsychiatry services are able to reach and impact patients with BP disorder, are sustainable, and patient outcomes can improve using a telepsychiatry intervention. CONCLUSIONS Given the morbidity of BP disorder, the research addressing the telepsychiatry diagnosis and treatment of BP disorder is sparse, with only emerging evidence of its reliability, effectiveness, and acceptance. There is no research assessing the safety and efficacy of telepsychiatry in pediatric populations with BP disorder. Given the morbidity associated with BP disorder at any age, further research is needed to determine how to safely and effectively incorporate telepsychiatry into clinical care for BP adult and pediatric patients.
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Affiliation(s)
- Abigail Farrell
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychology, University of Houston, Houston, Texas, USA
| | - Nevita George
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Selen Amado
- Clinical Psychology Department, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Janet Wozniak
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Bistre M, Juven-Wetzler A, Argo D, Barash I, Katz G, Teplitz R, Said MM, Kohn Y, Linkovski O, Eitan R. Comparable reliability and acceptability of telepsychiatry and face-to-face psychiatric assessments in the emergency room setting. Int J Psychiatry Clin Pract 2022; 26:228-233. [PMID: 34565277 DOI: 10.1080/13651501.2021.1979586] [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: 10/20/2022]
Abstract
OBJECTIVE This study aims to compare the reliability and acceptability of psychiatric interviews using telepsychiatry and face-to-face modalities in the emergency room setting. METHODS In this prospective observational feasibility study, psychiatric patients (n = 38) who presented in emergency rooms between April and June 2020, went through face-to-face and videoconference telepsychiatry interviews in a non-randomised varying order. Interviewers and a senior psychiatry resident who observed both interviews determined diagnosis, recommended disposition and indication for involuntary admission. Patients and psychiatrists completed acceptability post-assessment surveys. RESULTS Agreement between raters on recommended disposition and indication for involuntary admission as measured by Cohen's kappa was 'strong' to 'almost perfect' (0.84/0.81, 0.95/0.87 and 0.89/0.94 for face-to-face vs. telepsychiatry, observer vs. face-to-face and observer vs. telepsychiatry, respectively). Partial agreement between the raters on diagnosis was 'strong' (Cohen's kappa of 0.81, 0.85 and 0.85 for face-to-face vs. telepsychiatry, observer vs. face-to-face and observer vs. telepsychiatry, respectively).Psychiatrists' and patients' satisfaction rates, and psychiatrists' perceived certainty rates, were comparably high in both face-to-face and telepsychiatry groups. CONCLUSIONS Telepsychiatry is a reliable and acceptable alternative to face-to-face psychiatric assessments in the emergency room setting. Implementing telepsychiatry may improve the quality and accessibility of mental health services.Key pointsTelepsychiatry and face-to-face psychiatric assessments in the emergency room setting have comparable reliability.Patients and providers report a comparable high level of satisfaction with telepsychiatry and face-to-face modalities in the emergency room setting.Providers report a comparable level of perceived certainty in their clinical decisions based on telepsychiatry and face-to-face psychiatric assessments in the emergency room setting.
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Affiliation(s)
- Moises Bistre
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | | | - Daniel Argo
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Igor Barash
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Gregory Katz
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Ronen Teplitz
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | | | - Yoav Kohn
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Omer Linkovski
- The Jerusalem Mental Health Center, Jerusalem, Israel.,Psychology, Bar Ilan University, Israel
| | - Renana Eitan
- The Jerusalem Mental Health Center, Jerusalem, Israel.,Medical Neurobiology, The Hebrew University, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Grover S, Rai B, Chakravarty R, Sahoo S, Mehra A, Chakrabarti S, Basu D. Suicidal behavior in new patients presenting to the Telepsychiatry services in a Tertiary Care center: An exploratory study. Asian J Psychiatr 2022; 74:103152. [PMID: 35716578 PMCID: PMC9385195 DOI: 10.1016/j.ajp.2022.103152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. AIM To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre. METHODS 1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). RESULTS In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management. CONCLUSIONS Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Bhavika Rai
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aseem Mehra
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Debasish Basu
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
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12
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Johnson S, Dalton-Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd-Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, School of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Karen Newbigging
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sarah E Carr
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher Unterland, Winterthur, Switzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Justin J Needle
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
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13
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Kaphzan H, Sarfati Noiman M, Negev M. The Attitudes and Perceptions of Israeli Psychiatrists Toward Telepsychiatry and Their Behavioral Intention to Use Telepsychiatry. Front Psychiatry 2022; 13:829965. [PMID: 35386519 PMCID: PMC8977602 DOI: 10.3389/fpsyt.2022.829965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although telemedicine care has grown in recent years, telepsychiatry is growing at a slower pace than expected, because service providers often hamper the assimilation and expansion of telepsychiatry due their attitudes and perceptions. The unified theory of acceptance and use of technology (UTAUT) is a model that was developed to assess the factors influencing the assimilation of a new technology. We used the UTAUT model to examine the associations between the attitudes and perceptions of psychiatrists in Israel toward telepsychiatry and their intention to use it. Methods An online, close-ended questionnaire based on a modified UTAUT model was distributed among psychiatrists in Israel. Seventy-six questionnaires were completed and statistically analyzed. Results The behavioral intention of Israeli psychiatrists to use telepsychiatry was relatively low, despite their perceptions of themselves as capable of high performance with low effort. Nonetheless, they were interested in using telepsychiatry voluntarily. Experience in telepsychiatry, and to a lesser extent, facilitating conditions, were found to be positively correlated with the intention to use telepsychiatry. Psychiatrists have a positive attitude toward treating patients by telepsychiatry and perceive its risk as moderate. Discussion Despite high performance expectancy, low effort expectancy, low perceived risk, largely positive attitudes, high voluntariness, and the expectancy for facilitating conditions, the intention to use telepsychiatry was rather low. This result is explained by the low level of experience, which plays a pivotal role. We recommend promoting the facilitating conditions that affect the continued use of telepsychiatry when initiating its implementation, and conclude that it is critical to create a sense of success during the initial stages of experience.
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Affiliation(s)
- Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | | | - Maya Negev
- Division of Health Systems Policy and Administration, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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14
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Menon AK, Adhya S, Kanitkar M. Health technology assessment of telemedicine applications in Northern borders of India. Med J Armed Forces India 2021; 77:452-458. [PMID: 34594075 PMCID: PMC8459044 DOI: 10.1016/j.mjafi.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Economic evaluations of health technology help to decide which interventions are to be continued and which are to be terminated. In the Armed Forces, the provision of efficient medical services requires meticulous planning for optimal utilization of scarce resources. We report a cost analysis of telemedicine and air transportation of casualties, and attempt to identify the strengths, weaknesses, opportunities and threats of telemedicine services. METHODS The costs incurred in telemedicine were compared with the cost of air evacuation. A qualitative assessment of telemedicine was undertaken through in-depth interviews with the hospital authorities and focused group discussions with medical officers and paramedical staff. RESULTS 34.2% of casualties could successfully be stabilized on-site using available healthcare resources with the peripheral hospitals. 18 casualties were managed at the periphery on-site by teleconsultations each year, averting air-transportation efforts. Estimated cost savings achieved in the initial management of casualty by teleconsultation was Rs. 146,111 per case. The strengths of telemedicine are knowledge updation, faster decision making, improved pre-hospital care and improved confidence in case management. CONCLUSION The reduction in air efforts and remote management of casualties make a substantive case for scaling up telemedicine interventions.
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Affiliation(s)
| | - Saibal Adhya
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
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15
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Challinor A, Ogundalu A, McIntyre JC, Bramwell V, Nathan R. The empirical evidence base for the use of the HCR-20: A narrative review of study designs and transferability of results to clinical practice. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 78:101729. [PMID: 34425379 DOI: 10.1016/j.ijlp.2021.101729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/30/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
The HCR-20, a widely used method of assessing and managing risk, relies on the structured professional judgement approach. This paper reports a narrative literature review of the HCR-20 studies to explore the applicability of the study results to the use of the HCR-20 in clinical practice. From a literature search using terms "HCR-20" and "HCR 20", 206 papers were included. Of studies using the HCR-20 version 2 (n = 191), 92% (n = 176) relied on variables based on scores derived by adding item scores, and 50% (n = 95) tested the HCR-20 using predictive validity methodology. Of the HCR-20 version 3 studies (n = 21), the "presence of risk factors" step was the most commonly examined (n = 18, 86%), but 2 of the 7 steps ("scenario planning" and "management") were not examined at all. Amongst those studies whose primary focus was on the HCR-20, 67% (n = 64/95) did so by assessing the predictive validity of the tool. Only one employed a design to test whether the use of the HCR-20 affected violence rates. The predominant study design provides support for the use of the HCR-20 as an actuarial tool, and there is limited empirical evidence in support of its effectiveness as a structured professional judgement approach to the assessment and management of the risk of violence.
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Affiliation(s)
- Alexander Challinor
- University of Liverpool, UK; Health Education England North West, Liverpool, UK; Mersey Care NHS Foundation Trust, UK.
| | | | | | | | - Rajan Nathan
- Cheshire and Wirral Partnership NHS Trust, UK; University of Liverpool, UK; University of Chester, UK; John Moores University Liverpool, UK
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16
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Liu J, Gao L. Are Diverse Media Better than a Single Medium? The Relationship between Mixed Media and Perceived Effect from the Perspective of Online Psychological Counseling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8603. [PMID: 34444351 PMCID: PMC8392227 DOI: 10.3390/ijerph18168603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
The progress of new media has promoted the development of online health consultations. Previous research has investigated the impact of media richness on user satisfaction; however, little attention has been given to the mixed effects of the nesting of multiple media. The purpose of this study is to analyze the impact and differences of the use of single or mixed media on users' perceived effect from the perspectives of social support and satisfaction by mining user reviews on online health platforms. The data were collected from a professional online psychological counseling platform. We collected data on 48,807 reviews from 11,694 users. Text annotation and sentiment analysis were then used to extract variable eigenvalues from the reviews. One-way analysis of variance (ANOVA) and hierarchical regression analysis were used for statistical analysis. The results show that mixed media with different richness has a significant impact on the users' perceived effects. Among them, compared to "text + audio," using "text + audio + video/face to face" can significantly improve the users' perceived social support and satisfaction. However, compared to single medium, mixed media with higher richness may not necessarily achieve a better effect. We found that the inclusion of "video/face to face" mixed media significantly reduced the users' perceived social support and satisfaction compared to text or audio use alone. These research results complement the blank media richness theory in the field of online health care and provide guidance for improving the personalized customization of online psychological counseling platforms.
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Affiliation(s)
| | - Lu Gao
- School of Management, Shanghai University, Shanghai 201800, China;
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17
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Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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18
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Kulkarni KR, Shyam RPS, Bagewadi VI, Gowda GS, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study of collaborative telepsychiatric consultations for a rehabilitation centre managed by a primary healthcare centre. Indian J Med Res 2021; 152:417-422. [PMID: 33380707 PMCID: PMC8061593 DOI: 10.4103/ijmr.ijmr_676_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background & objectives: Telepsychiatric methods can be used for the purpose of providing clinical care comparable to in-person treatment in various settings including rehabilitation. Previous evidence has shown that clinical outcomes for both are comparable. In view of challenges posed in the implementation of traditional psychiatric care in India, telepsychiatry offers an avenue to provide feasible, affordable and clinically useful psychiatric services. This study was conducted to examine the utility, feasibility and clinical effectiveness of providing collaborative telepsychiatric services with a primary care doctor for inpatients in a rehabilitation centre through a telepsychiatrist of estabilished psychiatry department in a tertiary care centre in south India in a collaborative care model with a primary care doctor. Methods: Patients at the rehabilitation centre attached to an urban primary healthcare centre received collaborative care using telepsychiatry for a period from January 2013 to December 2016. A retrospective review of their charts was performed and sociodemographic, clinical and treatment details were collected and analyzed. Results: The sample population (n=132) consisted of 75 per cent males, with a mean age of 43.8 ± 12.1 yr. Each patient received an average of 7.8 ± 4.9 live video-consultations. Initially, an antipsychotic was prescribed for 84.1 per cent (n=111) of patients. Fifty four patients (40.9%) had a partial response and 26 (19.7%) patients showed a good response. Interpretation & conclusions: The study sample represented the population of homeless persons with mental illness who are often brought to the rehabilitation centre. This study results demonstrated the successful implementation of inpatients collaborative telepsychiatry care model for assessment, follow up, investigation and treatment of patients through teleconsultation.
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Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R P S Shyam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harihara N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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19
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Impact of the COVID-19 Pandemic on Psychiatric Admissions to a Large Swiss Emergency Department: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031174. [PMID: 33525740 PMCID: PMC7908206 DOI: 10.3390/ijerph18031174] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/22/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency with profound mental health consequences. The psychiatric emergency department (ED) plays a key role during this mental health crisis. This study aimed to investigate differences in admissions at a Swiss psychiatric ED from 1 April to 15 May during a “pandemic-free” period in 2016 and a “during-pandemic” period in 2020. The study included 579 consultations at psychiatric ED in the “during-pandemic” period and 702 in the “pandemic-free” period. Sociodemographic and clinical characteristics were compared, and logistic regression analysis was performed to identify variables associated with psychiatric admissions during the pandemic. A reduction in total psychiatric ED admissions was documented during COVID-19. Logistic regression analysis predicted the independent variable (ED admission during the pandemic) and estimated odds ratio (OR) for being unmarried/not in a relationship, arrival in an ambulance, suicidal behavior, behavioral disorders and psychomotor agitation. Though only statistically significant in bivariate analysis, patients were also more likely to be involuntarily hospitalized. This picture appears to be reversed from a sociodemographic and clinical point of view to our observation of psychiatric ED consultation in 2016. These findings highlight that the reduction in psychiatric ED admissions during the pandemic seems to be associated with living alone and more severe psychopathologies, which must alert psychiatrists to ensure access to mental health care in times of pandemic.
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20
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Expert opinion in bipolar disorder: Impact of COVID-19 on outcomes and treatment of bipolar disorder. PERSONALIZED MEDICINE IN PSYCHIATRY 2021; 27:100074. [PMCID: PMC9767409 DOI: 10.1016/j.pmip.2021.100074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Bipolar disorder is a common mental illness with a high burden of disability and comorbidity including highly prevalent medical conditions that increase risk for severe COVID-19 illness. Moreover, increased vulnerability to stress, routine and lifestyle disruption in people living with bipolar disorder is well-established. Although data examining the impact of COVID-19 disease and the resulting pandemic on those with bipolar disorder are limited, the present paper aims to discuss existing research at the intersection of COVID-19 and mental health with the goal of considering potential impacts of COVID-19 on outcomes and treatment of bipolar disorder.
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21
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Guinart D, Marcy P, Hauser M, Dwyer M, Kane JM. Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey. JMIR Ment Health 2020; 7:e24761. [PMID: 33302254 PMCID: PMC7758084 DOI: 10.2196/24761] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. OBJECTIVE The aim of this study is to examine a large number of patients' experiences of, use of, and attitudes toward telepsychiatry. METHODS An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. RESULTS In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2%) participants using video and 2312 (81.5%) using telephone. In addition, 1922 (63.6%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1%) and flexible scheduling/rescheduling (n=1389, 45.5%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. CONCLUSIONS Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients' perceptions change over time.
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Affiliation(s)
- Daniel Guinart
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, NY, United States
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | | | - Marta Hauser
- Vanguard Research Group, Glen Oaks, NY, United States
| | - Michael Dwyer
- Ambulatory Care Division, The Zucker Hillside Hospital, Northwell Health, New York, NY, United States
| | - John M Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, NY, United States
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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22
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Abstract
The utilization of telemedicine and telepsychiatry (TP) services in the outpatient department (OPD) has been increasing in recent years. The information about the technological, administrative, and clinical challenges is being addressed by the telemedicine and TP guidelines published by several individual nations. TP aims to address the treatment gaps, barriers for utilization, accessibility, diagnostic validity, financial implications, and individual client preferences. Utilization of TP in the OPD varies from country to country depending upon their healthcare delivery systems. It also varies in populations utilizing the TP services-urban, rural, child and adolescent, geriatric, and differently abled. TP services in the OPDs are being incorporated differentially by government organizations, insurance recognized psychiatric healthcare organizations, private psychiatric group practice deliverers, and individual, standalone psychiatric healthcare deliverers. TP may not replace the traditional in-person consultations completely. Covid-19 pandemic has hastened its utilization across several healthcare delivery systems. Healthcare organizations, clinicians, other healthcare deliverers, and end users are in the process of adapting to the new scenario. Incorporation of the big data, machine learning, artificial intelligence, virtual reality, and other technological advances in the psychiatric healthcare delivery systems into TP services in the OPDs would significantly contribute to the overall quality and efficacy of the psychiatric healthcare delivery systems in the future.
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Affiliation(s)
| | | | - Amala Emani
- Columbus Hospital, Hyderabad, Telangana, India
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23
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Wasserman D, Iosue M, Wuestefeld A, Carli V. Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic. World Psychiatry 2020; 19:294-306. [PMID: 32931107 PMCID: PMC7491639 DOI: 10.1002/wps.20801] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de-crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and pro-tective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con-texts.
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Affiliation(s)
- Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Miriam Iosue
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Anika Wuestefeld
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
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Costanza A, Mazzola V, Radomska M, Amerio A, Aguglia A, Prada P, Bondolfi G, Sarasin F, Ambrosetti J. Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry. ACTA ACUST UNITED AC 2020; 56:medicina56060295. [PMID: 32545811 PMCID: PMC7353920 DOI: 10.3390/medicina56060295] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Correspondence: ; Tel.: +41-22-379-59-00
| | - Viridiana Mazzola
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland;
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, Switzerland;
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Mood Disorders Program, Tufts Medical Center, Boston, MA 02111, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paco Prada
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland;
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland;
| | - François Sarasin
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland; (P.P.); (G.B.); (F.S.)
- Emergency Department, Emergency Medicine Unit, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Julia Ambrosetti
- Department of Psychiatry and Emergency Department, Emergency Psychiatric Unit, Geneva University Hospitals, 1211 Geneva, Switzerland;
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Gonzalez K, Patel F, Cutchins LA, Kodish I, Uspal NG. Advocacy to Address Emergent Pediatric Mental Health Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Freeman RE, Boggs KM, Zachrison KS, Freid RD, Sullivan AF, Espinola JA, Camargo CA. National Study of Telepsychiatry Use in U.S. Emergency Departments. Psychiatr Serv 2020; 71:540-546. [PMID: 32019430 DOI: 10.1176/appi.ps.201900237] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The receipt of telemedicine for the management of mental illness, also known as telepsychiatry, is being adopted in emergency departments (EDs), but little is known about this approach. This study investigated the prevalence and applications of telepsychiatry in general EDs in the United States. METHODS All 5,375 U.S. EDs were surveyed to characterize emergency care in 2016. From the EDs that reported receiving telepsychiatry services, a 15% random sample was selected for a second survey that confirmed telepsychiatry use in 2017 and collected data on emergency psychiatric services and applications of telepsychiatry in each ED. RESULTS The 2016 national survey (4,507 of 5,375; 84% response) showed that 885 (20%) EDs reported receiving telepsychiatry. Characteristics associated with higher likelihood of ED telepsychiatry receipt included higher annual total visit volumes, rural location, and Critical Access Hospital designation. Characteristics associated with lower likelihood of telepsychiatry receipt included being an autonomous freestanding ED. In the second survey (105 of 130; 81% response), 95 (90%) EDs confirmed telepsychiatry use. Most (59%) of these reported telepsychiatry as their ED's only form of emergency psychiatric services, and 25% received services at least once a day. The most common applications of telepsychiatry were in admission or discharge decisions (80%) and transfer coordination (76%). CONCLUSIONS In 2016, 20% of EDs received telepsychiatry services, and most receiving telepsychiatry had no other emergency psychiatric services. The latter finding suggests that telepsychiatry is used to fill a critical need. Further studies are warranted to investigate barriers to implementing telepsychiatry in EDs without access to emergency psychiatric services.
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Affiliation(s)
- Rain E Freeman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Rachel D Freid
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
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Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
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Videoconferencing in psychiatry, a meta-analysis of assessment and treatment. Eur Psychiatry 2020; 36:29-37. [DOI: 10.1016/j.eurpsy.2016.03.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/16/2016] [Accepted: 03/30/2016] [Indexed: 12/16/2022] Open
Abstract
AbstractContextVideoconferencing in psychiatry allows psychiatric counseling to be dealt remotely. A number of human randomised clinical trials (RCTs) on this topic were conducted but not systematically analysed since 2005.ObjectsA meta-analysis was undertaken to test the hypothesis of non-inferiority of remote psychiatric counseling, including both assessment and treatment, compared to face-to-face setting. Focus of research was the general psychiatric approach, which includes pharmacotherapy, counseling and some not specific psychotherapeutic techniques such as listening, reformulation and clarification among others. Specific forms of psychotherapies were not included in this analysis.DesignRCTs including ≥ 10 subjects per arm were identified in Medline, the Cochrane Library, Embase and the reference list of single papers. A random-effect and a mixed-effect model served for test the hypothesis under analysis.ResultsTwenty-six RCTs were included in the analysis, involving 765 (assessment) and 1585 patients (efficacy). The non-inferiority of remote psychiatric counseling was reported both for assessment and treatment. Heterogeneity could not be excluded for assessment, but was excluded for treatment while taking into account clinical and study related variables (P-values = 0.003 and 0.06, respectively).ConclusionHigh levels of consistency between remote and in vivo psychiatric assessment is reported. Efficacy of remote psychiatric counseling was shown to be not inferior compared to in vivo settings. Heterogeneity could not be excluded for assessment, and further analyses are mandatory. The presence of multiple diagnoses included in the analysis was a limit of the present investigation.
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Spivak S, Spivak A, Cullen B, Meuchel J, Johnston D, Chernow R, Green C, Mojtabai R. Telepsychiatry Use in U.S. Mental Health Facilities, 2010-2017. Psychiatr Serv 2020; 71:121-127. [PMID: 31615370 DOI: 10.1176/appi.ps.201900261] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the use of telepsychiatry in U.S. mental health facilities between 2010 and 2017. METHODS Changes over time in the availability of telepsychiatry were examined by using multiple waves of a national survey of mental health facilities. State and facility correlates of offering telepsychiatry in 2017 were examined. RESULTS The proportion of state facilities that self-reported offering telepsychiatry increased significantly from 15.2% in 2010 to 29.2% in 2017, with wide variability among states.. In 2017, facilities with telepsychiatry were more commonly publicly owned than to have others forms of ownership (odds ratio [OR]=2.72, 95% confidence interval [CI]=2.47-2.99, p<0.001), although the percentage of privately owned facilities offering telepsychiatry has increased significantly since 2010 (OR=2.94, 95% CI=2.14-4.05, p<.001). Facilities offering telepsychiatry had lower odds of receiving funding from Medicaid (OR=0.86, 95% CI=0.75-0.98, p<0.001) but higher odds of receiving funding from all other sources. Facilities in states that did not fund telepsychiatry had lower odds of offering these services in 2017 (OR=0.57, 95% CI=0.51-0.62, p<0.001). Telepsychiatry was more commonly offered in states with higher proportions of rural population (OR=1.64, 95% CI=1.45-1.85, p<0.001) and designated medically underserved areas (OR=1.36, 95% CI=1.25-1.47, p<0.001), compared with other states. CONCLUSIONS Nearly twice as many U.S. mental health facilities offered telepsychiatry in 2017 than in 2010. Medicaid funding lagged behind other funding sources, suggesting state administrative barriers. Telepsychiatry was commonly used by facilities in medically underserved and rural areas.
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Affiliation(s)
- Stanislav Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Amethyst Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Jennifer Meuchel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Rachel Chernow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Charee Green
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
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Correction to Hopper et al. Psychiatr Serv 2020; 71:127. [PMID: 32008474 DOI: 10.1176/appi.ps.712correction] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Santillanes G, Axeen S, Lam CN, Menchine M. National trends in mental health-related emergency department visits by children and adults, 2009-2015. Am J Emerg Med 2019; 38:2536-2544. [PMID: 31902702 DOI: 10.1016/j.ajem.2019.12.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Examine trends in mental health-related emergency department (ED) visits, changes in disposition and length of stay (LOS), describe disposition by age and estimate proportion of ED treatment hours dedicated to mental health-related visits. METHODS Retrospective analysis of ED encounters in the National Hospital Ambulatory Medical Care Visit Survey with a mental health primary, secondary or tertiary discharge diagnosis from 2009 to 2015. We report survey-weighted estimates of the number and proportion of ED visits that were mental health-related and disposition by age and survey year. We estimate the proportion of ED treatment hours dedicated to mental health-related visits. We analyze trends in disposition and LOS for mental health and non-mental health-related visits using multivariate regression analysis. RESULTS Mental health-related ED visits increased by 56.4% for pediatric patients and 40.8% for adults, accounting for over 10% of ED visits by 15-64 year-olds and nearly 9% by 10-14 year-olds in 2015. Mental health-related visit disposition of admission or transfer declined from 29.8% to 20.4% (p < .001); predicted median ED LOS for admissions or transfers increased from 6.5 to 9.0 hours while median LOS for discharges was stable at 4.4 hours. During the study period, mental health-related visits accounted for 5.0% (95% CI 4.6-5.3) of all pediatric and 11.1% (95% CI 11.0-11.3) of adult ED treatment hours. CONCLUSIONS Mental health-related visits account for an increasing proportion of ED visits and a considerable proportion of treatment hours. A decreasing proportion of mental health-related visits resulted in inpatient disposition and ED LOS increased for admissions and transfers.
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Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah Axeen
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Weigel P, Bhagianadh D, Merchant KA, Wittrock A, Rahmouni H, Bell A, Laws S, Ward MM. Tele-emergency behavioural health in rural and underserved areas. J Telemed Telecare 2019; 27:453-462. [PMID: 31726903 DOI: 10.1177/1357633x19887027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Challenges accessing behavioural health services in rural and underserved areas are compounded by severe shortages of behavioural health specialists, and difficulties placing patients. Tele-emergency (tele-ED) behavioural health is a promising solution for enhancing access to specialists and assisting in patient placement. This paper describes two tele-ED behavioural health models in the Midwest delivering mental- and substance use disorder services to rural and underserved adult populations. METHODS We performed an in-depth examination of two tele-ED behavioural health programmes and their consultation processes. We provide a retrospective case-control analysis of patient characteristics, patient diagnoses, and disposition status for each model. Data were collected from 19 spoke hospitals across the two programmes between November 2015 and December 2017. RESULTS Tele-ED was activated in 15% of the Avera Health sample and 58% of the Union Hospital sample. This is primarily a reflection of the sample selection process in each model and how each programme is operationalised. Suicide and/or poisoning by drugs were the most frequent diagnoses followed by mood disorders. Rate of transfer to another inpatient facility was much higher for tele-ED cases than controls in both models. DISCUSSION This paper describes how two distinct tele-ED behavioural health models operating in unique contexts address challenges in access and placement for patients in rural and underserved areas presenting to EDs with behavioural health conditions. The notable difference in disposition rates between cases and controls is indicative of the impact each model is having on care practices and processes.
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Affiliation(s)
- Paula Weigel
- Department of Health Management and Policy, University of Iowa, College of Public Health, Iowa City, IA, US
| | - Divya Bhagianadh
- Department of Health Management and Policy, University of Iowa, College of Public Health, Iowa City, IA, US
| | - Kimberly As Merchant
- Department of Health Management and Policy, University of Iowa, College of Public Health, Iowa City, IA, US
| | | | - Hicham Rahmouni
- Richard G Lugar Center for Rural Health, Terra Haute, IN, Union Hospital, US
| | | | | | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa, College of Public Health, Iowa City, IA, US
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Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate recent literature on the use of telepsychiatry in mental crises or emergency situations. RECENT FINDINGS Results from recent studies which evaluated the implementation of a telepsychiatric consultation model in emergency departments point at a reduction of length of stay and a drop in admissions, increased cost-effectiveness, and improved satisfaction of patients and staff. There was almost no empirical evidence on videoconferencing in crisis intervention within the context of crisis resolution teams or online therapies. No study reporting on telepsychiatry videoconferencing in the context of disasters was found. There is still very little but increasing empirical evidence supporting the implementation of telepsychiatry in emergencies. Other mental crisis-related implementation settings remain to be researched. The implications and future research potential are discussed.
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Santillanes G, Rowland K, Demarest M, Lam CN, Wilson MP, Claudius I, Menchine M. Discontinuing involuntary mental health holds for children: Does psychiatrist specialty matter? A pilot study. Am J Emerg Med 2019; 38:702-708. [PMID: 31204151 DOI: 10.1016/j.ajem.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Involuntary mental health detainments should only be utilized when less restrictive alternatives are unavailable and should be discontinued as soon as safety can be ensured. The study objective was to determine if child and adolescent psychiatrists discontinue a greater proportion of involuntary holds than general psychiatrists for similar pediatric patients. METHODS Retrospective analysis of consecutive patients under 18 years placed on an involuntary hold in the prehospital setting presenting over a 1-year period to one high-volume emergency department (ED) where youth on involuntary holds are seen by child and adolescent psychiatrists when available and general psychiatrists otherwise. The primary outcome of interest was hold discontinuation after initial psychiatric consultation. The key predictor of interest was psychiatrist specialty (child and adolescent vs. general). We conducted multivariate logistic regression modeling adjusting for patient characteristics and time of arrival. RESULTS Child and adolescent psychiatrists discontinued 27.4% (51/186) of prehospital holds while general psychiatrists discontinued only 10.6% (22/207). After adjusting for observable confounders, holds were over 3 times as likely to be discontinued in patients evaluated by child and adolescent psychiatrists rather than general emergency psychiatrists (adjusted OR 3.2, 95% CI 1.7-5.9, p < 0.001). CONCLUSIONS Child and adolescent psychiatrists are much more likely to discontinue prehospital involuntary mental health holds compared with general emergency psychiatrists. While inappropriate hold discontinuation places patients at risk of harm, prolonged hold continuation limits patients' rights and potentially increases psychiatric boarding in EDs. Earlier access to child and adolescent psychiatry may facilitate early hold discontinuation and standardize patient care.
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Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Kathleen Rowland
- Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Matthew Demarest
- Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research Lab and Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4395 Shuffield Dr., Little Rock, AR 72205, United States of America.
| | - Ilene Claudius
- Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA 90509, United States of America
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America; Leonard D. Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, 635 Downey Way Verna & Peter Dauterive Hall (VPD), Los Angeles, CA 90089, United States of America
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Abstract
Los desarrollos tecnológicos pueden ser un complemento a la atención tradicional, por ello primero se revisa el impacto que tiene la tecnología en la alianza de trabajo terapéutico. A continuación se señalan algunos recursos tecnológicos disponibles para la actividad psicológica, así como una clasificación de las tecnologías. Finalmente se revisan las posibles ventajas y riesgos en la aplicación de tratamiento mediados por tecnologías, así como los resultados en cuanto a efectividad.
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Heyland M, Delaney KR, Shattell M. Steps to Achieve Universal Suicide Screening in Emergency Departments: A Call to Action. J Psychosoc Nurs Ment Health Serv 2018; 56:21-26. [PMID: 29741746 DOI: 10.3928/02793695-20180503-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/01/2018] [Indexed: 11/20/2022]
Abstract
American individuals attempt suicide at alarmingly high rates of approximately 1.1 million times per year. Yet the United States has failed to adopt a systematic approach to suicide prevention, particularly via universal screening. Given the increasing number of individuals with suicidal ideation presenting to emergency departments (EDs), all patients who present to the ED for treatment should be screened, as opposed to only individuals with mental health complaints. In the current article, barriers to suicide screening in the ED are discussed, as well as strategies to move ED providers toward the goal of universal screening. The current article entreats nurses to be leaders in achieving universal screening and provides practical actions to begin the process. Specific recommendations for action include improving training, increasing lethal means assessment, and achieving compliance with The Joint Commission suicide screening guidelines. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 21-26.].
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Affiliation(s)
- Christina A Olson
- Telehealth Department, Children's Hospital Colorado, B720, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| | - John F Thomas
- Telehealth Department, Children's Hospital Colorado, B720, 13123 East 16th Avenue, Aurora, CO 80045, USA
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Newton AS, Hartling L, Soleimani A, Kirkland S, Dyson MP, Cappelli M. A systematic review of management strategies for children’s mental health care in the emergency department: update on evidence and recommendations for clinical practice and research. Emerg Med J 2017; 34:376-384. [DOI: 10.1136/emermed-2016-205939] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 11/04/2022]
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Tso JV, Farinpour R, Chui HC, Liu CY. A Multidisciplinary Model of Dementia Care in an Underserved Retirement Community, Made Possible by Telemedicine. Front Neurol 2016; 7:225. [PMID: 28066313 PMCID: PMC5179531 DOI: 10.3389/fneur.2016.00225] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/28/2016] [Indexed: 01/18/2023] Open
Abstract
The need for memory specialists is increasing as the incidence of dementia rapidly rises across the globe. In rural areas, demand for these specialists far outstrips supply. It is increasingly difficulty for patients to receive care in a timely manner. In this paper, we document our experience using videoconference telemedicine to bring a multidisciplinary model of care to a rural retirement community in Southern California. To our knowledge, we are one of the first to integrate telemedicine into dementia care on this large a scale. Given the relatively remote location, patients and neurologists have previously had to travel great distances and bear with long wait times. With neurological consultation by telemedicine and a local team consisting of a geriatrician, a neuropsychologist, and a case manager, we have been able to provide comprehensive dementia care in this underserved area, comparable to university-affiliated California Alzheimer’s Disease Centers, typically found only in major metropolitan areas. We have shown that telemedicine can be very effective in improving access and quality of dementia care.
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Affiliation(s)
- Jason V Tso
- Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
| | - Roxanna Farinpour
- Department of Neurology, Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
| | - Helena C Chui
- Department of Neurology, Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
| | - Collin Y Liu
- Department of Neurology, Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
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Langabeer JR, Champagne-Langabeer T, Alqusairi D, Kim J, Jackson A, Persse D, Gonzalez M. Cost-benefit analysis of telehealth in pre-hospital care. J Telemed Telecare 2016; 23:747-751. [PMID: 27913657 DOI: 10.1177/1357633x16680541] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.
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Affiliation(s)
- James R Langabeer
- 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
| | | | - Diaa Alqusairi
- 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.,2 Houston Fire Department Emergency Medical Services, Houston, TX, USA
| | - Junghyun Kim
- 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
| | - Adria Jackson
- 3 City of Houston Health Department, Houston, TX, USA
| | - David Persse
- 2 Houston Fire Department Emergency Medical Services, Houston, TX, USA
| | - Michael Gonzalez
- 2 Houston Fire Department Emergency Medical Services, Houston, TX, USA
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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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Tolia V, Castillo E, Guss D. EDTITRATE (Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency). J Telemed Telecare 2016; 23:484-488. [PMID: 27279469 DOI: 10.1177/1357633x16648535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Emergency Department (ED) patient volumes are unpredictable, which can result in service delays and patients leaving without care. We initiated a programme of emergency physician (EP) telepresence in the ED with the objectives of assessing feasibility, safety, patient and provider acceptance, and throughput time. Methods This was a prospective convenience study. Patients presenting to the ED during operation of the study who were planned for placement in the waiting room were considered for enrolment. A faculty EP conducted patient evaluations via telepresence with confirmatory evaluation by the onsite faculty EP prior to disposition. Patient care was either taken to completion by the telemedicine EP or initiated and handed off to the onsite team. Measures included patient demographics, triage class (ESI 1-5), throughput time and a single question satisfaction survey (rating 1-5, 5 most favourable) completed by patients, registered nurses and EPs. Patients were called within 3 days and the electronic health record reviewed at 7 days looking for unscheduled visits and adverse events. Results In total, 130 patients were enrolled. Mean triage class was 3.9 with a median throughput of 150 minutes (IQR = 116.5, 206). Non-telemedicine patients during the same time period with similar triage classes had a median throughput of 287 minutes (IQR = 199, 408). Mean satisfaction scores were: patient 4.91, nurse 4.75, onsite EP 4.47 and telemedicine EP 4.79. There was one potential misdiagnosis and no adverse events. Conclusion Patient evaluation by EP via telepresence is feasible, safe, readily accepted by patients and providers and associated with reduced throughput time.
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Affiliation(s)
- Vaishal Tolia
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
| | - Eddie Castillo
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
| | - David Guss
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
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Tebbs J. Letter regarding 'characteristics of the relationship that develops from nurse-caregiver communication during telecare'. J Clin Nurs 2016; 25:2678-9. [PMID: 27240039 DOI: 10.1111/jocn.13404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jeffrey Tebbs
- Department of Biobehavioral Nursing and Health Systems, Univeristy of Washington, Seattle, WA, USA
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DeVido J, Glezer A, Branagan L, Lau A, Bourgeois JA. Telepsychiatry for Inpatient Consultations at a Separate Campus of an Academic Medical Center. Telemed J E Health 2015; 22:572-6. [PMID: 26701608 DOI: 10.1089/tmj.2015.0125] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Many hospitals do not have regular access to psychiatry consult services. This is well understood as a common shortage at nonacademic community hospitals (especially in rural environments, and may also be a problem at noncontiguously located smaller hospitals that are affiliated with academic medical centers in urban settings. The authors sought to deliver timely inpatient psychiatric consultation-liaison services via telemedicine to a local but physically separated hospital affiliated with an academic medical center. MATERIALS AND METHODS The authors collaborated with an office dedicated to the advancement of telemedicine technology at their academic medical center. They developed a telemedicine-based care model to deliver inpatient consultation-liaison psychiatry consultations to an affiliated (but physically separate) small academic hospital that did not have its own on-site consultation-liaison psychiatry team. RESULTS The authors were able to successfully complete 30 consultations, each within 24 h. Only 1 patient was ultimately unwilling to participate in the telemedicine interview. As consultations were accomplished on same day as request, patient length of stay was unaffected. CONCLUSIONS This pilot study suggests that telemedicine is a viable model for inpatient consultation-liaison psychiatry services to hospitals without on-site psychiatry resources and represents a viable alternative model of service delivery.
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Affiliation(s)
- Jeffrey DeVido
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, California
| | - Anna Glezer
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, California
| | - Linda Branagan
- 2 Telehealth Resource Center, University of California , San Francisco, San Francisco, California
| | - Alvin Lau
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, California
| | - James A Bourgeois
- 1 Department of Psychiatry, University of California , San Francisco, San Francisco, California
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Campbell R, O'Gorman J, Cernovsky ZZ. Reactions of Psychiatric Patients to Telepsychiatry. Ment Illn 2015; 7:6101. [PMID: 26605038 PMCID: PMC4620286 DOI: 10.4081/mi.2015.6101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 01/18/2023] Open
Abstract
Telepsychiatry could offer a viable medical service to remote or isolated social communities if it does not generate adverse reactions such as delusional ideation, particularly in patients in settlements without adequate exposure to mainstream culture and internet. We examined subjective reactions to telepsychiatry of randomly selected 84 psychiatric patients from remote locations in Ontario, Canada. They rated the quality of their teleconferencing sessions via 10 item questionnaire and were asked about advantages and disadvantages of telepsychiatry. The majority of patients indicated that they were able to communicate as if physically present (92.9%) and were comfortable with telepsychiatric service (95.2%). They found the sessions as beneficial as direct meetings with their psychiatrist (84.5%) and would use this service again (98.8%). There were no instances of telepsychiatry being associated with adverse reactions in patients from remote communities with inadequate exposure to modern mainstream culture and internet.
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Affiliation(s)
- Robbie Campbell
- Lawson Health Research Institute and Department of Psychiatry, University of Western Ontario , London, ON
| | | | - Zack Z Cernovsky
- Lawson Health Research Institute and Department of Psychiatry, University of Western Ontario , London, ON
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Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry 2015; 5:286-304. [PMID: 26425443 PMCID: PMC4582305 DOI: 10.5498/wjp.v5.i3.286] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 02/05/2023] Open
Abstract
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
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Letvak S, Rhew D. Assuring Quality Health Care in the Emergency Department. Healthcare (Basel) 2015; 3:726-32. [PMID: 27417792 PMCID: PMC4939572 DOI: 10.3390/healthcare3030726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/02/2015] [Accepted: 08/13/2015] [Indexed: 01/18/2023] Open
Abstract
The provision of quality healthcare is an international mandate. The provision of quality healthcare for mental health patients poses unique challenges. Nowhere is this challenge greater than in the emergency department. The purpose of this manuscript is to describe evidence-based initiatives for improving the quality of care of mental health patients in the emergency department. Specifically, the use of telepsychiatry and reducing provider biases will be presented.
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Affiliation(s)
- Susan Letvak
- The University of North Carolina at Greensboro, Greensboro, NC 27402, USA.
| | - Denise Rhew
- Emergency Services, Cone Health, Greensboro, NC 27401, USA.
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