1
|
Gu Y, Andargoli AE, Mackelprang JL, Meyer D. Design and implementation of clinical decision support systems in mental health helpline Services: A systematic review. Int J Med Inform 2024; 186:105416. [PMID: 38552266 DOI: 10.1016/j.ijmedinf.2024.105416] [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: 10/28/2023] [Revised: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Clinical Decision Support Systems (CDSSs) are electronic systems used to conduct assessments based on patient characteristics and to offer treatment recommendations for clinicians to consider during their decision-making processes. CDSSs are needed by mental health helpline services to optimise service delivery for clients and counsellors, while also collecting the data needed for the administration of the service. The aim of this systematic review was to provide a comprehensive overview of the design and implementation of CDSSs in mental health helpline services, to identify current issues in their design and implementation, and to provide recommendations that may address any identified issues. MATERIALS AND METHODS Keywords related to mental health, helplines and CDSS were searched in three databases in April 2022 and September 2023. In total, 21 articles published between 1987 and 2023 met the inclusion criteria. RESULTS The objectives of the mental health helplines services included in this study included suicide risk reduction, diagnosis, treatment and monitoring of mental health disorders, and support of clinicians or counsellors in making better and more accurate decisions by incorporating real-time data analysis. All included studies demonstrated co-design activities, however, the level and degree of end-user involvement differed across the studies. The factors that impact CDSS implementation success depend on the design and implementation approach, user experience and context. CDSS evaluations in the included studies assessed reliability, utility, user friendlessness, cost-effectivenessand participant satisfaction. Few studies considered data privacy and integration issues. CONCLUSION More interactive methods should be adopted during the design of CDSSs for mental health helpline services. Increased frequency and intensity of user participation in system design, that goes beyond providing feedback on research materials, enables user opinions to be fully understood and addressed. Comprehensive frameworks should be developed to guide requirements gathering, system design and system evaluation practices. These factors are interrelated and may impact implementation success. From the outset therefore, the design of a CDSS in the mental health helpline domain should consider the full system development cycle.
Collapse
Affiliation(s)
- Yueming Gu
- Swinburne University of Technology, Melbourne, Australia.
| | | | | | - Denny Meyer
- Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
2
|
Prabhune A, Bhat S, Mallavaram A, Mehar Shagufta A, Srinivasan S. A Situational Analysis of the Impact of the COVID-19 Pandemic on Digital Health Research Initiatives in South Asia. Cureus 2023; 15:e48977. [PMID: 38111408 PMCID: PMC10726017 DOI: 10.7759/cureus.48977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
The objective of this paper was to evaluate and compare the quantity and sustainability of digital health initiatives in the South Asia region before and during the COVID-19 pandemic. The study used a two-step methodology of (a) descriptive analysis of digital health research articles published from 2016 to 2021 from South Asia in terms of stratification of research articles based on diseases and conditions they were developed, geography, and tasks wherein the initiative was applied and (b) a simple and replicable tool developed by authors to assess the sustainability of digital health initiatives using experimental or observational study designs. The results of the descriptive analysis highlight the following: (a) there was a 40% increase in the number of studies reported in 2020 when compared to 2019; (b) the three most common areas wherein substantive digital health research has been focused are health systems strengthening, ophthalmic disorders, and COVID-19; and (c) remote consultation, health information delivery, and clinical decision support systems are the top three commonly developed tools. We developed and estimated the inter-rater operability of the sustainability assessment tool ascertained with a Kappa value of 0.806 (±0.088). We conclude that the COVID-19 pandemic has had a positive impact on digital health research with an improvement in the number of digital health initiatives and an improvement in the sustainability score of studies published during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Akash Prabhune
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| | - Sachin Bhat
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| | | | | | - Surya Srinivasan
- Health and Information Technology, Institute of Health Management Research, Bangalore, IND
| |
Collapse
|
3
|
Cai PY, Balthazar A, Logvinenko T, Nelson CP, Finkelstein JB. Accuracy of telemedicine for diagnosis and pre-operative assessment of pediatric penile conditions. J Pediatr Urol 2023; 19:521.e1-521.e7. [PMID: 37055341 PMCID: PMC11211001 DOI: 10.1016/j.jpurol.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Patients with penile conditions comprise a significant proportion of any pediatric urology practice, and physical examination is the mainstay of diagnosis for such conditions. While the rapid adoption of telemedicine (TM) facilitated access to pediatric urology care during the pandemic, the accuracy of TM-based diagnosis for pediatric penile anatomy and pathology has not been studied. Our aim was to characterize the diagnostic accuracy of TM-based evaluation of pediatric penile conditions by comparing diagnosis during the initial virtual visit (VV) with a subsequent in-person visit (IPV). We also sought to assess the agreement between scheduled and actual surgical procedure performed. METHODS A single-institution prospective database of male patients less than 21 years of age who presented for evaluation of penile conditions between August 2020 and December 2021 was analyzed. Patients were included if they had an IPV with the same pediatric urologist within 12 months of the initial VV. Diagnostic concordance was based on a surgeon-reported survey of specific penile diagnoses, completed at both initial VV and follow-up IPV. Surgical concordance was assessed based on the proposed versus billed CPT code(s). RESULTS Median age among 158 patients was 10.6 months. The most frequent VV diagnoses were penile adhesions (n = 37), phimosis (n = 26), "other" (n = 24), post-circumcision redundancy (n = 18), and buried penis (n = 14). Initial VV and subsequent IPV diagnoses were concordant in 40.5% (64/158); 40/158 (25%) had partial concordance (at least one diagnosis matched). There was no difference in age, race, ethnicity, median time between visits, or device type between patients with concordant vs. discordant diagnoses. Of 102 patients who underwent surgery, 44 had VV only while 58 had IPV prior to surgery. Concordance of scheduled versus actual penile surgery was 90.9% in those patients who only had a VV prior to surgery. Overall, surgery concordance was lower among those with hypospadias repairs vs. non-hypospadias surgery (79.4% vs. 92.6%, p = 0.05). CONCLUSION Among pediatric patients being evaluated by TM for penile conditions, there was poor agreement between VV-based and IPV-based diagnoses. However, besides hypospadias repairs, agreement between planned and actual surgical procedures performed was high, suggesting that TM-based assessment is generally adequate for surgical planning in this population. These findings leave open the possibility that, among patients not scheduled for surgery or IPV, certain conditions might be misdiagnosed or missed entirely.
Collapse
Affiliation(s)
- Peter Y Cai
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Andrea Balthazar
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| | - Julia B Finkelstein
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 3, Boston, MA 02115, USA.
| |
Collapse
|
4
|
Munoli RN, Bhandary PR, Sharma PSVN. Manipal model of telepsychiatry. Indian J Psychiatry 2023; 65:878-881. [PMID: 37736234 PMCID: PMC10510639 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_455_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023] Open
Abstract
Telepsychiatry can be understood as an interactive mental health service providing mode using information and communication technology. In recent decades, services provided under the umbrella term of telepsychiatry expanded to cater clinical services, diagnostic services, interventions, therapies, education, and research. Since telepsychiatry has been practiced in India for two decades, various models have emerged to meet the country's demands and the logistics that are available. Both synchronous and asynchronous modes of telepsychiatry had been in practice in India depending on the availability of logistics. Most of the telepsychiatry services in India had focused on providing clinical care to reach the unreached population. Furthermore, telepsychiatry had been used to train mental health professionals and healthcare workers from other disciplines. However, not many models had incorporated the idea of hands-on training of the postgraduates/trainees of psychiatric social work (PSW) in telepsychiatry under supervision. This was addressed in the Manipal model of telepsychiatry. Manipal model of telepsychiatry has begun in 2016 with a novel idea to train mental health profession trainees in addition to cover other clinical services, research, and education. In the last eight years, four centers of Karnataka state have been covered under this model with progressive growth in a number of patients and this acted as a hands-on training model for the postgraduate trainees in starting telepsychiatry services independently. Furthermore, it provided an opportunity to develop the organization skills of trainees, improved their oratory skills, and improved their expertise in using information technology for mental healthcare delivery.
Collapse
Affiliation(s)
- Ravindra N. Munoli
- Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - P Rajeshkrishna Bhandary
- Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | |
Collapse
|
5
|
Demaerschalk BM, Pines A, Butterfield R, Haglin JM, Haddad TC, Yiannias J, Colby CE, TerKonda SP, Ommen SR, Bushman MS, Lokken TG, Blegen RN, Hoff MD, Coffey JD, Anthony GS, Zhang N. Assessment of Clinician Diagnostic Concordance With Video Telemedicine in the Integrated Multispecialty Practice at Mayo Clinic During the Beginning of COVID-19 Pandemic From March to June 2020. JAMA Netw Open 2022; 5:e2229958. [PMID: 36053531 PMCID: PMC9440401 DOI: 10.1001/jamanetworkopen.2022.29958] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE There was a shift in patient volume from in-person to video telemedicine visits during the COVID-19 pandemic. OBJECTIVE To determine the concordance of provisional diagnoses established at a video telemedicine visit with diagnoses established at an in-person visit for patients presenting with a new clinical problem. DESIGN, SETTING, AND PARTICIPANTS This is a diagnostic study of patients who underwent a video telemedicine consultation followed by an in-person outpatient visit for the same clinical problem in the same specialty within a 90-day window. The provisional diagnosis made during the video telemedicine visit was compared with the reference standard diagnosis by 2 blinded, independent medical reviewers. A multivariate logistic regression model was used to determine factors significantly related to diagnostic concordance. The study was conducted at a large academic integrated multispecialty health care institution (Mayo Clinic locations in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; and Jacksonville, Florida; and Mayo Clinic Health System locations in Iowa, Wisconsin, and Minnesota) between March 24 and June 24, 2020. Participants included Mayo Clinic patients residing in the US without age restriction. Data analysis was performed from December 2020 to June 2021. EXPOSURES New clinical problem assessed via video telemedicine visit to home using Zoom Care Anyplace integrated into Epic. MAIN OUTCOMES AND MEASURES Concordance of provisional diagnoses established over video telemedicine visits compared against a reference standard diagnosis. RESULTS There were 2393 participants in the analysis. The median (IQR) age of patients was 53 (37-64) years; 1381 (57.7%) identified as female, and 1012 (42.3%) identified as male. Overall, the provisional diagnosis established over video telemedicine visit was concordant with the in-person reference standard diagnosis in 2080 of 2393 cases (86.9%; 95% CI, 85.6%-88.3%). Diagnostic concordance by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision chapter ranged from 64.7% (95% CI, 42.0%-87.4%) for diseases of the ear and mastoid process to 96.8% (95% CI, 94.7%-98.8%) for neoplasms. Diagnostic concordance by medical specialty ranged from 77.3% (95% CI, 64.9%-89.7%) for otorhinolaryngology to 96.0% (92.1%-99.8%) for psychiatry. Specialty care was found to be significantly more likely than primary care to result in video telemedicine diagnoses concordant with a subsequent in-person visit (odds ratio, 1.69; 95% CI, 1.24-2.30; P < .001). CONCLUSIONS AND RELEVANCE This diagnostic study of video telemedicine visits yielded a high degree of diagnostic concordance compared with in-person visits for most new clinical concerns. Some specific clinical circumstances over video telemedicine were associated with a lower diagnostic concordance, and these patients may benefit from timely in-person follow-up.
Collapse
Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Andrew Pines
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
- Now with Department of Psychiatry, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Richard Butterfield
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Jack M. Haglin
- Mayo Clinic Alix School of Medicine, Phoenix, Arizona
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Tufia C. Haddad
- Department of Medical Oncology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - James Yiannias
- Department of Dermatology and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Christopher E. Colby
- Department of Pediatric and Adolescent Medicine, Neonatology, Critical Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Sarvam P. TerKonda
- Department of Surgery and Plastic and Reconstructive Surgery, Center for Digital Health, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Steve R. Ommen
- Department of Cardiovascular Medicine and Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Matthew S. Bushman
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Troy G. Lokken
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Rebecca N. Blegen
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Mekenzie D. Hoff
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Jordan D. Coffey
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Greg S. Anthony
- Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Nan Zhang
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| |
Collapse
|
6
|
Li L, Kulp W, Krieg H, Aptaker D, Klink B, Knox D, Pincus HA. An Initiative to Improve Performance on a National Transition of Care Measure and to Reduce Readmissions in an Academic Psychiatric Hospital. Jt Comm J Qual Patient Saf 2022; 48:205-213. [DOI: 10.1016/j.jcjq.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
|
7
|
Singh GP. Telepsychiatry: A game-changer during Covid-19 pandemic and a wave of future psychiatry in India. Asian J Psychiatr 2021; 64:102795. [PMID: 34329841 PMCID: PMC8419214 DOI: 10.1016/j.ajp.2021.102795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Gurvinder Pal Singh
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Ghosh A, Mahintamani T, B N S, Pillai RR, Mattoo SK, Basu D. Telemedicine-assisted stepwise approach of service delivery for substance use disorders in India. Asian J Psychiatr 2021; 58:102582. [PMID: 33607350 PMCID: PMC9760420 DOI: 10.1016/j.ajp.2021.102582] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
Restricted access to healthcare during COVID-19 pandemic warranted an urgent adaptation of telemedicine practice. We describe a synchronous, stepwise (telephonic, video, and in-person consultation) direct-care model. From 18th May to 31st August 2020, 128 new and 198 follow-up patients received consultation. Eighty-nine percent of new patients required video-consultation. Sixty-eight percent of follow-up cases were managed by telephonic consultation. A third of new and a fifth of the follow-up patients had to be called for physical consultation. Limited access to and understanding of the technologies, potential breach in privacy, and restrictions imposed on online prescription of medications posed significant challenges.
Collapse
Affiliation(s)
- Abhishek Ghosh
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tathagata Mahintamani
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Subodh B N
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Renjith R Pillai
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - S K Mattoo
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Debasish Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| |
Collapse
|
10
|
Abstract
Ethical and legal frameworks are essential components in mental health care, due to inherent nature of illnesses and practice modules. These serve to safeguard rights and privileges of patients and mental health professional. Gradual evolution of technology and its' application in assessments and interventions is making it as an essential part of mental health care delivery. This transition will bring innovative challenges for mental health care delivery in terms of practice, ethical and legal aspects. Existing ethical and legal frameworks are time tested for real time/face to face delivery of mental health care. Ongoing pandemic provided opportunity and necessitated use of technology for delivering health care needs. Newer operational and practice guidelines have emerged for practice of telemedicine in general and telepsychiatry in specific. These are in lines with existing ethical and legal frameworks. However, additional frameworks with specific definitions about what constitutes consultation, assessment methods, prescription modes and contents of prescription, documentation, certification, eligible platforms for telepsychiatry, need to be incorporated and observed. The article addresses these ethical and legal aspects in telepsychiatry practice with the background of existing practice guidelines and rules.
Collapse
Affiliation(s)
- Bevinahalli Nanjegowda Raveesh
- Dept. of Psychiatry, Mysore Medical College & Research Institute, Mysore, Karnataka, India.,Legal Subcommittee, Indian Psychiatry Society (National)
| | | |
Collapse
|
11
|
Malhotra S, Chakrabarti S, Shah R. A model for digital mental healthcare: Its usefulness and potential for service delivery in low- and middle-income countries. Indian J Psychiatry 2019; 61:27-36. [PMID: 30745651 PMCID: PMC6341930 DOI: 10.4103/psychiatry.indianjpsychiatry_350_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Using digital technology to deliver mental health care can possibly serve as a viable adjunct or alternative to mainstream services in lessening the mental health gap in a large number of resource deficient and LAMI countries. Conventional models of telepsychiatric services available so far, however, have been inadequate and ineffective, as these address only a small component of care, and rely on engagement of specialists who are grossly insufficient in numbers. AIM To describe an innovative digital model of mental health care, enabling and empowering the non-specialists to deliver high quality mental health care in remote areas. METHODS The model is powered by an online, fully automated clinical decision support system (CDSS), with interlinked modules for diagnosis, management and follow-up, usable by non-specialists after brief training and minimal supervision by psychiatrist, to deliver mental health care at remote sites. RESULTS The CDSS has been found to be highly reliable, feasible, with sufficient sensitivity and specificity. This paper describes the model and initial experience with the digital mental health care system deployed in three geographically difficult and remote areas in northern hill states in India. The online system was found to be reasonably comprehensive, brief, feasible, user-friendly, with high levels of patient satisfaction. 2594 patients assessed at the three remote sites and the nodal center represented varied diagnoses. CONCLUSIONS The digital model described here has the potential to serve as an effective alternative or adjunct for delivering comprehensive and high quality mental health care in LAMI countries like India in the primary and secondary care settings.
Collapse
Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
12
|
Gowda GS, Kulkarni K, Bagewadi V, Rps S, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study on collaborative telepsychiatric consultations to outpatients of district hospitals of Karnataka, India. Asian J Psychiatr 2018; 37:161-166. [PMID: 30278379 DOI: 10.1016/j.ajp.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Indian National Mental Health Survey (NMHS) of 2015-2016 has estimated 13.7% lifetime and 10.6% point prevalence for mental illnesses. It has identified that the treatment gap for mental illnesses ranges between 70% and 92%. Tele-Psychiatric consultations could be an alternative and innovative approach to bridge this gap in low resource settings. AIMS To study the sociodemographic and clinical profiles of patients who have received collaborative Tele-Psychiatric consultations across district hospitals in Karnataka, India. METHODOLOGY We performed a retrospective review of case files of patients who have received collaborative Tele-Psychiatric consultations from January 2013 to June 2017 through video-conferencing. A total of 139 consultations were provided to patients in the state of Karnataka. RESULTS The mean age of the sample is 31 (±15.5) years. 61.8% were male and 79.8% were aged more than 18 years. In total, 25.9% of them had schizophrenia and other psychotic disorders, 14.4% had mental retardation, 13.7% had a mood disorder and 14.4% had a substance use disorder. 67.6% of patients had been advised pharmacotherapy, 7.9% had been advised rehabilitation along with pharmacotherapy and 24.4% were advised further evaluation of illness and inpatient care at a higher centre. CONCLUSION Collaborative tele-psychiatric consultations to district hospitals from an academic tertiary care hospital can be feasible and are likely to benefit patients from rural areas. There is a need for more studies to elucidate their acceptability by patients, caregivers and professionals.
Collapse
Affiliation(s)
- Guru S Gowda
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Karishma Kulkarni
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Virupaksha Bagewadi
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Shyam Rps
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Harihara N Shashidhara
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Vinay Basavaraju
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India.
| | - Sydney Moirangthem
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - C Naveen Kumar
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| | - Suresh Bada Math
- Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, 560029, Karnataka, India
| |
Collapse
|
13
|
Affiliation(s)
| | | | - Kanika Kumar
- Department of Psychiatry, Jawaharlal Nehru Medical College, Wardha 442 004, India
| |
Collapse
|
14
|
Chakrabarti S, Shah R. Telepsychiatry in the developing world: Whither promised joy? INDIAN JOURNAL OF SOCIAL PSYCHIATRY 2016. [DOI: 10.4103/0971-9962.193200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|