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Ehsani M, Maarefvand M, Hosseinzadeh S, Zabihi Poursaadati M. Effectiveness of information technology assisted relapse prevention program on relapse among people who live with severe mental disorders. Int J Soc Psychiatry 2024; 70:531-541. [PMID: 38166425 DOI: 10.1177/00207640231221094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND Severe Mental Disorders (SMDs) cause mental health worldwide challenges because of several relapses and extensive recovery periods of hospitalization, which put a lot of economic and social burden on families and governments. Therefore, interventions are necessary to decrease the relapse of these disorders. AIM This study was conducted to investigate the effect of Information Technology Assisted Relapse Prevention Program (ITAREP) on relapse among people who live with SMDs. METHOD This study was a randomized clinical trial with intervention and control groups. ITAREP is a remote intervention based on monitoring the Early Warning Signs (EWS) to decrease the number of potential relapses. Using convenience sampling, people with SMDs admitted to Sina Juneqan Psychiatric Hospital and their caregivers were recruited in this study and randomly allocated to the control and intervention groups. Two checklists of the EWS for the patient and the patient's caregiver were used for monitoring the relapse signs. Data were collected at baseline and 90 days after discharge and were analyzed using t-test and Chi-square statistical tests and linear regression in SPSS software. RESULTS Fifty-two patients who lived with SMDs participated in this study (26 in the intervention group and 26 in the control group). The two groups were homogeneous regarding age, gender, type of mental disorder, and duration of the disorder. Forty-two males and ten females participated in this research. Most of the participants were diagnosed with schizophrenia. The results showed that the number of relapses in the intervention group was significantly lower than in the control group in the post-test. CONCLUSION Social workers, as the case managers and a member of the interdisciplinary psychiatric team, can actively perform follow-up measures after discharge using ITAREP, and it can be expected that these interventions will reduce the number of relapses among patients who live with SMDs.
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Affiliation(s)
- Mona Ehsani
- Department of Social Work, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoomeh Maarefvand
- Department of Social Work, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Zabihi Poursaadati
- Social Work Department, Public Health School, Alborz University of Medical Sciences and Health Services, Karaj, Iran
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Ricklan SJ, Sohler N, Ezie CEC, Avalone L, Dinsell V, Lewis C, Fattal O, Balan S, McQuistion H, Pastore F, Sarcevic N, Swift R, Espejo G, Lorenz C. Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic. Community Ment Health J 2024; 60:115-123. [PMID: 38105337 DOI: 10.1007/s10597-023-01210-1] [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: 05/17/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
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Affiliation(s)
- Sarah J Ricklan
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA.
| | - Nancy Sohler
- CUNY School of Medicine, Harris Hall, 160 Convent Avenue, New York, 10031, NY, USA
| | - C E Chiemeka Ezie
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Lynsey Avalone
- NYC Health and Hospitals, 125 Worth Street, New York, NY, 10013, USA
| | - Victoria Dinsell
- NYU Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Crystal Lewis
- NYU Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Omar Fattal
- NYC Health and Hospitals, 125 Worth Street, Office 423, New York, NY, 10013, USA
| | - Sabish Balan
- Harlem Hospital, 506 Lenox Avenue, New York, NY, 10037, USA
| | - Hunter McQuistion
- NYU Grossman School of Medicine, One Park Ave, 8th Floor, New York, NY, 10016, USA
| | - Frank Pastore
- North Central Bronx Hospital, 3424 Kossuth Avenue, New York, NY, 10467, USA
| | - Nermica Sarcevic
- Jacobi Hospital, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Ronnie Swift
- NY Health and Hospitals/Metropolitan, 1901 First Avenue, New York, NY, 10029, USA
| | - Gemma Espejo
- Montefiore Medical Center, 111 East 210th St, New York, NY, 10467, USA
| | - Carina Lorenz
- NYC Health and Hospitals-Bellevue, 462 1st Avenue, New York, NY, 10016, USA
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Werkmeister B, Haase AM, Fleming T, Officer TN. Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study. JMIR Form Res 2023; 7:e50486. [PMID: 37738075 PMCID: PMC10519279 DOI: 10.2196/50486] [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: 07/03/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. OBJECTIVE This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians' use of telehealth services to inform policy and practice. METHODS Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between October 1, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. RESULTS The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians' flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. CONCLUSIONS For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives.
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Affiliation(s)
- Benjamin Werkmeister
- School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago (Wellington), Wellington, New Zealand
- Te Whatu Ora, Wellington, New Zealand
| | - Anne M Haase
- School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Theresa Fleming
- School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Tara N Officer
- School of Nursing, Midwifery, and Health Practice, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
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Telepsychiatry during the COVID-19 pandemic: An experience in a low resource setting. Asian J Psychiatr 2022; 69:103000. [PMID: 34990915 PMCID: PMC8715573 DOI: 10.1016/j.ajp.2021.103000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
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Goharinejad S, Hajesmaeel-Gohari S, Jannati N, Goharinejad S, Bahaadinbeigy K. Review of Systematic Reviews in the Field of Telemedicine. Med J Islam Repub Iran 2021; 35:184. [PMID: 36042824 PMCID: PMC9391764 DOI: 10.47176/mjiri.35.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Although the systematic reviews regarding telemedicine have increased in recent decades, no comprehensive studies have been conducted to review these systematic reviews. The present study aimed to review the published systematic reviews regarding telemedicine applications for the report and appraisal of several aspects. Methods: The literature search was performed in the PubMed database for the systematic reviews published during January 2010-June 2020 in the field of telemedicine using "telemedicine" Mesh terms. The extracted data from the selected articles were the year of publication, telemedicine specialty, clinical outcomes, cost evaluation, and satisfaction assessment. Data analysis was performed using descriptive statistics. Results: Among 746 retrieved articles, 191 cases were selected and reviewed. Most of the studies were focused on telemedicine (n=35; 18.3%), followed by telerehabilitation (n=22; 11.5%), tele-diabetes (n=18; 9.4%), telecardiology (n=16; 8.3%), home telecare (n=13; 6.8%), telepsychiatry (n=12; 6.3%), teledermatology (n=11; 5.7%), and teleneurology (n=9; 4.7%). The selected studies were primarily focused on clinical outcomes (72.7%), followed by cost-effectiveness (32.4%) and user satisfaction (29.3%). In addition, they mostly indicated that telemedicine services yielded acceptable clinical outcomes (72.5%), cost-effectiveness (67.7%), and healthcare provider/patient satisfaction (83.9%). Conclusion: Although telerehabilitation, tele-diabetes, telecardiology, home telecare, and telepsychiatry were studied further, there are still some specific specialties such as teleradiology, telepathology, and telepediatric that should be considered more. Moreover, investigation of various outcomes could result in a more comprehensive view of this field. Therefore, further investigations in this regard would improve telemedicine applications and encourage potential telemedicine providers to initiate these applications.
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Affiliation(s)
- Saeideh Goharinejad
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Jannati
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samira Goharinejad
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Abstract
AIMS AND METHOD This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. RESULTS We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. CLINICAL IMPLICATIONS The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.
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Mishkin AD, Cheung S, Capote J, Fan W, Muskin PR. Survey of Provider Experiences of Telepsychiatry and Tele-Consultation-Liaison Psychiatry. J Acad Consult Liaison Psychiatry 2021; 63:334-344. [PMID: 34793997 PMCID: PMC8591977 DOI: 10.1016/j.jaclp.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/15/2021] [Accepted: 10/30/2021] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic created pressure to implement telepsychiatry across practice models. Objective We sought to evaluate the overall success of this change and to identify what types of practice settings, provider groups, and patient groups were best served by telepsychiatry and telepsychotherapy utilization. We were particularly interested in how providers of consultation-liaison psychiatry adapted to remote care. Methods An anonymous provider survey querying demographics, education, training, technological experience, practice setting, treatment modalities, patient groups, transition process, and outcomes was made openly available via social media and professional listservs. We used multivariable regression modeling to evaluate for predictors of the positive outcomes of overall satisfaction, subjective ability to diagnose and treat patients adequately using exclusively telepsychiatric platforms, and patient satisfaction by proxy. Results Three hundred thirty-three respondents, mostly young (59.4% younger than 50 years), female (69.7%), and physicians (67.9%), completed the survey. One hundred ninety-seven (59.1%) worked in consultation-liaison psychiatry. Of the total, 85.9% gave affirmative answers to overall satisfaction. Multivariable linear regression models found that satisfaction was predicted by general comfort with technology (P < 0.001), but negatively correlated with having technical issues (P < 0.001), a priori skepticism (P < 0.001), clinician being male (P = 0.004), and treating LGBTQ+ patients (P = 0.022). Completeness was associated with having training in telehealth (P = 0.039) and general comfort with technology (P < 0.001) but negatively associated with treating LGBTQ+ patients (P = 0.024) or inpatients (P = 0.002). Patient satisfaction by proxy was positively associated with general comfort with technology (P < 0.001) and the respondent being a nonphysician (P = 0.004) and negatively associated with encountering a technical issue (P = 0.013) or treating inpatients (P = 0.045). Consultation-liaison psychiatrists had similar results overall and were more likely to have other staff assist in making televisits effective (mean [standard deviation]: −1.25 [3.57] versus −2.76 [3.27], P < 0.001) especially if consultative (mean [standard deviation]: −0.87 [3.67] versus −2.39 [3.01], P = 0.010). Conclusions This study suggests high rates of overall satisfaction in telepsychiatry adoption, even in consultation-liaison psychiatry. There is distinct benefit in bolstering training, providing technical support, and addressing skepticism. Future research should include patient surveys and control groups and should focus on vulnerable populations such as sexual and gender minorities.
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Cheung SG, Capote J, Fan W, Mishkin AD. Pilot Assessment of Patient and Provider Characteristics Associated With Satisfactory Consultation-Liaison Telepsychiatry Encounters. J Acad Consult Liaison Psychiatry 2021; 62:582-587. [PMID: 34051404 PMCID: PMC8592650 DOI: 10.1016/j.jaclp.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 11/09/2022]
Abstract
Background The COVID-19 pandemic created pressure to attempt remote consultation, but there are limited data on the use of telepsychiatry in general, and almost none about the experience of telepsychiatry in a consultation-liaison context. Objective We looked for attributes that correlated with satisfactory tele-encounters. Methods Eleven consultation-liaison attending surveys and 8 attendings' tele-encounter logs from March to June 2020 were completed and reviewed to assess for patient and provider characteristics associated with barriers to using telepsychiatry. Results A vast majority of 223 tele-psychiatric encounters were acceptable to providers in terms of technology (82%) and their ability to form a connection with the patient (78%). In multivariable logistic regression models, an unresolvable difficulty in using the platform was less common for female patients (odds ratio = 0.239, P = 0.002) and more common for patients who prefer a non-English language (odds ratio = 9.059, P < 0.001); achieving a personal connection that felt right was also less likely for patients who prefer a non-English language (odds ratio = 0.189, P = 0.001). Conclusions Telepsychiatry has previously been limited to outpatient use and, generally, for providers and patients who specifically preferred it. However, abrupt transition to the use of telepsychiatry to limit contagion risk was mostly satisfactory in our center; identifying for which patient encounters it is most and least appropriate will help guide future use.
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Affiliation(s)
- Stephanie G Cheung
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, Columbia University Irving Medical Center, New York, NY.
| | | | - Weijia Fan
- Biostatistics, Epidemiology, and Research Design, Columbia Irving Institute for Clinical and Translational Research, Mailman School of Public Health, New York, NY
| | - Adrienne D Mishkin
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, Columbia University Irving Medical Center, New York, NY; Blood and Marrow Transplantation and Cell Therapy Program, Division of Hematology & Oncology, Columbia University Irving Medical Center, New York, NY
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Cecula P, Yu J, Dawoodbhoy FM, Delaney J, Tan J, Peacock I, Cox B. Applications of artificial intelligence to improve patient flow on mental health inpatient units - Narrative literature review. Heliyon 2021; 7:e06626. [PMID: 33898804 PMCID: PMC8060579 DOI: 10.1016/j.heliyon.2021.e06626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/20/2021] [Accepted: 03/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite a growing body of research into both Artificial intelligence and mental health inpatient flow issues, few studies adequately combine the two. This review summarises findings in the fields of AI in psychiatry and patient flow from the past 5 years, finds links and identifies gaps for future research. METHODS The OVID database was used to access Embase and Medline. Top journals such as JAMA, Nature and The Lancet were screened for other relevant studies. Selection bias was limited by strict inclusion and exclusion criteria. RESEARCH 3,675 papers were identified in March 2020, of which a limited number focused on AI for mental health unit patient flow. After initial screening, 323 were selected and 83 were subsequently analysed. The literature review revealed a wide range of applications with three main themes: diagnosis (33%), prognosis (39%) and treatment (28%). The main themes that emerged from AI in patient flow studies were: readmissions (41%), resource allocation (44%) and limitations (91%). The review extrapolates those solutions and suggests how they could potentially improve patient flow on mental health units, along with challenges and limitations they could face. CONCLUSION Research widely addresses potential uses of AI in mental health, with some focused on its applicability in psychiatric inpatients units, however research rarely discusses improvements in patient flow. Studies investigated various uses of AI to improve patient flow across specialities. This review highlights a gap in research and the unique research opportunity it presents.
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Affiliation(s)
- Paulina Cecula
- Imperial College London Business School, London, UK
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jiakun Yu
- Imperial College London Business School, London, UK
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Fatema Mustansir Dawoodbhoy
- Imperial College London Business School, London, UK
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Jack Delaney
- Imperial College London Business School, London, UK
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2BU, UK
| | - Joseph Tan
- Imperial College London Business School, London, UK
- Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Iain Peacock
- Imperial College London Business School, London, UK
- Brighton and Sussex Medical School, Brighton, East Sussex, BN1 9PX, UK
| | - Benita Cox
- Imperial College London Business School, London, UK
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Chiauzzi E, Clayton A, Huh-Yoo J. Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives. JMIR Ment Health 2020; 7:e24021. [PMID: 33180739 PMCID: PMC7725495 DOI: 10.2196/24021] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has intensified the search for digital approaches in mental health treatment, particularly due to patients and clinicians practicing social distancing. This has resulted in the dramatic growth of videoconferencing-based telemental health (V-TMH) services. It is critical for behavioral health providers and those in the mental health field to understand the implications of V-TMH expansion on the stakeholders who use such services, such as patients and clinicians, to provide the service that addresses both patient and clinical needs. Several key questions arise as a result, such as the following: (1) in what ways does V-TMH affect the practice of psychotherapy (ie, clinical needs), (2) to what extent are ethical and patient-centered concerns warranted in terms of V-TMH services (ie, patient needs), and (3) how do factors related to user experience affect treatment dynamics for both the patient and therapist (ie, patient and clinical needs)? We discuss how behavioral health providers can consider the future delivery of mental health care services based on these questions, which pose strong implications for technological innovation, the adaptation of treatments to new technologies, and training professionals in the delivery of V-TMH services and other digital health interventions.
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Affiliation(s)
| | - Ashley Clayton
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Jina Huh-Yoo
- Department of Information Science, College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
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Telemental Health in Low- and Middle-Income Countries: A Systematic Review. Int J Telemed Appl 2018; 2018:9602821. [PMID: 30519259 PMCID: PMC6241375 DOI: 10.1155/2018/9602821] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction The rising incidence of mental illness and its impact on individuals, families, and societies is becoming a major public health concern, especially in resource-constrained countries. Consequently, there is an increasing demand for mental health services in many middle- and low-income countries (LMIC). Challenges such as inequality in access, lack of staff and hospital beds, and underfunding, often present in the LMIC, might in part be addressed by telemental health services. However, little is known about telemental health in the LMIC. Methods A systematic review was performed, drawing on several electronic databases, including PubMed, PsycINFO, Web of Science, Springer Link, and Google Scholar. Original English language studies on the practice of telemental health in LMIC, involving patients and published between 1 January 2000 and 16 February 2017, were included. Results Nineteen studies met the inclusion criteria. Most of the articles were recent, which may reflect an increasing focus on telemental health in the LMIC. Eight of these studies were from Asia. Eight of the studies were interventional/randomized controlled trials, and 11 examined general mental health issues. Videoconferencing was the most frequently (6) studied telemental modality. Other modalities studied were online decision support systems (3), text messaging and bibliotherapy (1), e-chatting combined with videoconferencing (1), online therapy (2), e-counseling (1), store-and-forward technology (1), telephone follow-up (1), online discussion groups (1), audiovisual therapy and bibliotherapy (1), and computerized occupational therapy (1). Although many of the studies showed that telemental services had positive outcomes, some studies reported no postintervention improvements. Conclusion The review shows a rising trend in telemental activity in the LMIC. There is a greater need for telemental health in the LMIC, but more research is needed on empirical and theoretical aspects of telemental activity in the LMIC and on direct comparisons between telemental activity in the LMIC and the non-LMIC.
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Serhal E, Crawford A, Cheng J, Kurdyak P. Implementation and Utilisation of Telepsychiatry in Ontario: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:716-725. [PMID: 28541753 PMCID: PMC5638186 DOI: 10.1177/0706743717711171] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Rural areas in Ontario have fewer psychiatrists, making access to specialist mental health care challenging. Our objective was to characterise psychiatrists delivering and patients receiving telepsychiatry in Ontario and to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalisation. METHOD We conducted a serial panel study to evaluate the characteristics of psychiatrists providing telepsychiatry from April 2007 to March 2013. In addition, we conducted a cross-sectional study for fiscal year 2012-2013 to examine telepsychiatry patient characteristics and create an in-need patient cohort of individuals with a recent psychiatric hospitalisation that assessed if they had follow-up with a psychiatrist in person or through telepsychiatry within 1 year of discharge. RESULTS In fiscal year 2012-2013, a total of 3801 people had 5635 telepsychiatry visits, and 7% ( n = 138) of Ontario psychiatrists provided telepsychiatry. Of the 48,381 people identified as in need of psychiatric care, 60% saw a local psychiatrist, 39% saw no psychiatrist, and less than 1% saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry within a year. Three northern regions had more than 50% of in-need patients fail to access psychiatry within 1 year. CONCLUSIONS Currently, relatively few patients and psychiatrists use telepsychiatry. In addition, patients scarcely access telepsychiatry for posthospitalisation follow-up. This study, which serves as a preliminary baseline for telepsychiatry in Ontario, demonstrates that telepsychiatry has not evolved systematically to address need and highlights the importance of system-level planning when implementing telepsychiatry to optimise access to care.
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Affiliation(s)
- Eva Serhal
- Centre for Addiction and Mental Health, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Eva Serhal, MBA, Centre for Addiction and Mental Health, 821-250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joyce Cheng
- Centre for Addiction and Mental Health, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario
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The Readmission Problem: A Modest Proposal Seeking a Solution. Am J Med 2017; 130:111-112. [PMID: 27823908 DOI: 10.1016/j.amjmed.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022]
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