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Suddenly Becoming a "Virtual Doctor": Experiences of Psychiatrists Transitioning to Telemedicine During the COVID-19 Pandemic
Abstract
Objective:
In response to the COVID-19 pandemic, many psychiatrists have rapidly transitioned to telemedicine. This qualitative study sought to understand how this dramatic change in delivery has affected mental health care, including modes of telemedicine psychiatrists used, barriers encountered, and future plans. The aim was to inform the ongoing COVID-19 response and pass on lessons learned to psychiatrists who are starting to offer telemedicine.
Methods:
From March 31 to April 9, 2020, semistructured interviews were conducted with 20 outpatient psychiatrists practicing in five U.S. states with significant early COVID-19 activity. Inductive and deductive approaches were used to develop interview summaries, and a matrix analysis was conducted to identify and refine themes.
Results:
At the time of the interviews, all 20 psychiatrists had been using telemedicine for 2-4 weeks. Telemedicine encompassed video visits, phone visits, or both. Although many continued to prefer in-person care and planned to return to it after the pandemic, psychiatrists largely perceived the transition positively. However, several noted challenges affecting the quality of provider-patient interactions, such as decreased clinical data for assessment, diminished patient privacy, and increased distractions in the patient's home setting. Several psychiatrists noted that their disadvantaged patients lacked reliable access to a smartphone, computer, or the Internet. Participants identified several strategies that helped them improve telemedicine visit quality.
Conclusions:
The COVID-19 pandemic has driven a dramatic shift in how psychiatrists deliver care. Findings highlight that although psychiatrists expressed some concerns about the quality of these encounters, the transition has been largely positive for both patients and physicians.
... The advantages of telemedicine identified in this study align with the literature, particularly in improving access to care for individuals facing mobility limitations [69]. Telemedicine has also been shown to enhance patient engagement, satisfaction, and adher-ence, while promoting continuity in the therapeutic process [70,71]. ...
... Regarding the challenges, one of the most central issues was the reduced ability to observe patients' non-verbal language, a concern consistent with the literature [68,69,73,74,77,79]. However, "empathic accuracy" (the ability to perceive how the patient feels) and the "therapeutic alliance" (the establishment of a trustworthy and collaborative relationship) are not significantly affected in the telepsychiatry format [78], which justifies the development of strategies to focus on verbal language during the therapeutic process to establish a satisfactory doctor-patient relationship. ...
... The technical challenges identified in this study, including the need for secure, userfriendly platforms and data protection, align with findings from other studies [69,71,73]. The WPA [67,80] emphasizes prerequisites such as interoperability, compatibility, patient safety, and data security, which must be addressed to ensure successful telemedicine implementation within the network. ...
Introduction: African healthcare professionals face significant mental health challenges; therefore, telemedicine can overcome geographical barriers and improve access to mental healthcare. Objective: The objective of this study was to identify the key factors influencing the adoption of telemedicine as a tool to support healthcare workers’ mental health in an Angolan healthcare network and develop a telemedicine model tailored to this context. Methodology: This mixed-method study collected quantitative data from a questionnaire applied to healthcare workers (n = 275), which were analyzed using descriptive statistics and logistic regressions. Qualitative data were obtained through structured interviews (n = 5) with psychologists and psychiatrists, and analyzed using thematic analysis in MAXQDA (Version 2022, VERBI Software, Germany), to identify recurring patterns and themes. The data were triangulated to ensure the rigor and consistency of the findings. Participation was anonymous and voluntary, and informed consent was obtained from all participants. Results: Previous experiences with mental health consultations, perceptions of teleconsultations, and doctor–patient relationship were significant in influencing telemedicine adoption by workers. The thematic analysis revealed four themes: perception and ease of telemedicine use, intention to use, and the perception of mental health in Angola. The key adoption factors for providers included project feasibility, management support, training, payment policies, and adherence to legal, ethical, and deontological standards. Conclusions: The adoption of telemedicine for occupational mental health requires culturally adapted interventions and compliance with technological and data protection standards. Hospital management must address infrastructure challenges and mental health perceptions, and implement sustainable strategies that promote occupational well-being within the organization.
... The advantages of telemedicine identified in this study align with the literature, particularly in improving access to care for individuals facing mobility limitations [69]. Telemedicine has also been shown to enhance patient engagement, satisfaction, and adher-ence, while promoting continuity in the therapeutic process [70,71]. ...
... Regarding the challenges, one of the most central issues was the reduced ability to observe patients' non-verbal language, a concern consistent with the literature [68,69,73,74,77,79]. However, "empathic accuracy" (the ability to perceive how the patient feels) and the "therapeutic alliance" (the establishment of a trustworthy and collaborative relationship) are not significantly affected in the telepsychiatry format [78], which justifies the development of strategies to focus on verbal language during the therapeutic process to establish a satisfactory doctor-patient relationship. ...
... The technical challenges identified in this study, including the need for secure, userfriendly platforms and data protection, align with findings from other studies [69,71,73]. The WPA [67,80] emphasizes prerequisites such as interoperability, compatibility, patient safety, and data security, which must be addressed to ensure successful telemedicine implementation within the network. ...
Introduction: African healthcare professionals face significant mental health challenges. Telemedicine, widely adopted during the pandemic, has shown promise in overcoming geographical barriers and improving access to mental healthcare.Objective: To identify the key factors influencing the adoption of telemedicine as a tool to support healthcare workers’ mental health in an Angolan healthcare network and to develop a telemedicine model tailored to this context. Methodology: A cross-sectional study was conducted, collecting quantitative data via a questionnaire applied to healthcare workers (n=275) and qualitative data through structured interviews (n=5) with psychologists and psychiatrists.Results: Previous experiences with mental health consultations, perceptions of teleconsultations, and the doctor-patient relationship were significant in influencing telemedicine adoption. Thematic analysis revealed four themes: perception and ease of telemedicine use, intention to use, and the perception of mental health in Angola. Key adoption factors included project feasibility, management support, training, payment policies, and adherence to legal, ethical, and deontological standards.Conclusion: Telemedicine can be a viable tool to support healthcare workers’ mental health. While there is clear intention to use it, establishing occupational mental health foundations in Angola’s healthcare network is essential. Overcoming barriers is crucial to incorporate digital transformation and create value.
... The user-related factors predominantly center on individual attributes, encompassing personal perspectives, skills, and past experiences with the digital modality being utilized for care. Just over one-third of the articles (34.69%) discussed facilitators 18,20,39 and barriers 19,20,22,28,29,31,32,37,39,41,44,49,[55][56][57][58]61 concerning user constructs. Subconstructs focused on demographic variables, mental health status, beliefs, mental health and technology experiences, as well as the integration of intervention into everyday life. ...
... The examined literature included eight articles that focused on barriers, while none of the articles mentioned facilitators associated with experiences involving mental health and technology. 22,28,32,41,49,56,58,61 Technology literacy was the primary barrier cited across the articles. Inability or limited proficiency in technology literacy can obstruct the navigation of online interventions typically associated with the ...
... The central emphasis of this subconstruct surrounds data storage and sharing, specifically, in terms of the comfort levels of users in revealing sensitive details during an intervention. Eleven articles highlighted language pertaining to privacy and confidentiality, 18,22,26,38,42,49,51,55,58,59,61 all of which were considered barriers. The primary focus of these articles predominantly centered around issues on the utilization of data, 42,55,58,59 protection of private data, 18,38,42,49,55,61 and safety. ...
Introduction
During the Coronavirus Disease 2019 pandemic, there was a surge in demand for mental health services worldwide, presenting challenges for healthcare institutions as they navigated changes in policy and safety regulations. In the United States, this resulted in many behavioral health modality changes to remain in compliance with the Center for Disease Control guidelines. A growing body of literature has documented these, yet few explored barriers and facilitators affecting the adoption of these modality delivery changes. The researchers conducted a systematic review using the PRISMA method, focusing on service delivery changes across healthcare systems in the United States from March 2020 to May 2022.
Objective
The study objective was to identify barriers and facilitators affecting the adoption of changes to modality delivery of behavioral health services due to pandemic restrictions.
Methods
This was a systematic review that utilized the PRISMA method. The researchers identified 445 initial articles from eight databases using predetermined keywords and implemented a three-round screening process to select the most pertinent articles for this review. The researchers used a thematic analysis focused on user-related, program-related, technology, and environment-related constructs relevant to engagement with digital mental health interventions, and also addressed provider and administrative-related barriers and facilitators of virtual behavioral health modality changes. Barriers and facilitators were operationalized using the Borghouts Model.
Results
This systematic review revealed several common barriers and facilitators, including underdeveloped technology infrastructure, privacy and confidentiality concerns, poor technology literacy, availability of diverse technology options, provider technology training, and ease of integration into everyday life.
Conclusion
This review provides insights into barriers and facilitators of modality change adoption, which could inform the development and implementation of virtual mental healthcare services and may help optimize the application of these services by improving our understanding and ability to overcome barriers influencing their adoption.
... Throughout healthcare, telemedicine use exponentially increased, bringing challenges and opportunities (Hollander and Carr 2020;Whaibeh et al. 2020). Telemedicine utilises technologies and telecommunications to deliver healthcare where patients are geographically separated from providers (Harst et al. 2019) Telemedicine has had success internationally, including in psychiatry (Haxhihamza et al. 2020;Kapoor et al. 2020;Kissi et al. 2020;Uscher-Pines et al. 2020). It has been touted as key in addressing healthcare challenges, but obstacles impede widespread adoption (Kho et al. 2020) including deficiencies in training and experience (Punatar et al. 2022). ...
... The literature demonstrates overall satisfaction with telemedicine among clinicians and patients (Hanson et al. 2019;Kissi et al. 2020;Haxhihamza et al. 2021). However, telepsychiatry is not without its challenges for both groups (Cowan et al. 2019;Lopez et al. 2019;Uscher-Pines et al. 2020), and despite remote assessment options, some patients still require in-person review (Kapoor et al. 2020). In this study limitations were acknowledged including in the areas of physical examination, management of emergencies and its use in certain patient subgroups and illnesses. ...
Introduction
In order to minimise physical interaction during the COVID-19 pandemic, telepsychiatry became a key part of clinical practice for many psychiatrists.
Methods
This study involved an exploratory, cross-sectional, opt-in online survey circulated to non-consultant doctors in psychiatry working in Ireland. It assessed experience and attitudes in relation to telepsychiatry use.
Discussion
The response rate was 11.6% ( n = 61). Forty-eight individuals (78.6%) had delivered clinical care using telepsychiatry. Fifty-nine individuals (96.7%) were unfamiliar with telepsychiatry prior to the pandemic. Most respondents had not received specific training around use of a telepsychiatry platform (86.9%, n = 63) and were unaware of published guidelines around its optimal use (54.1%, n = 33). Respondents’ concerns included issues around connectivity, medico-legal uncertainty and clinical effectiveness.
Conclusion
Conclusions drawn are limited by the potential for selection bias in this study. Nonetheless the paper has highlighted important issues including the need for more research assessing telepsychiatry clinical and curricular experience. Additional curricular interventions during training could build skillset and confidence in telepsychiatry.
... The downside of this adaptation is that the speech generated in this manner features frequent unintended phonatory breaks, frequency shifts, unvoiced segments, and high irregularity, and might be aperiodic (see Figure 2) [13]. It becomes even more problematic when the patient has to use the phone or speak in a loud environment, which may lead to social isolation [14,15]. The inability to communicate is most prominent in the early postoperative period before any speech rehabilitation occurs when patients have to rely on written text to communicate with their physician and family. ...
... Implementing noise-reduction strategies can help mitigate this issue by improving the overall clarity and naturalness of the patient's speech [7]. However, a speech handicap becomes more problematic when the patient has to use the phone or speak in a loud environment, which may lead to social isolation [14,15]. ...
The problem of cleaning impaired speech is crucial for various applications such as speech recognition, telecommunication, and assistive technologies. In this paper, we propose a novel approach that combines Pareto-optimized deep learning with non-negative matrix factorization (NMF) to effectively reduce noise in impaired speech signals while preserving the quality of the desired speech. Our method begins by calculating the spectrogram of a noisy voice clip and extracting frequency statistics. A threshold is then determined based on the desired noise sensitivity, and a noise-to-signal mask is computed. This mask is smoothed to avoid abrupt transitions in noise levels, and the modified spectrogram is obtained by applying the smoothed mask to the signal spectrogram. We then employ a Pareto-optimized NMF to decompose the modified spectrogram into basis functions and corresponding weights, which are used to reconstruct the clean speech spectrogram. The final noise-reduced waveform is obtained by inverting the clean speech spectrogram. Our proposed method achieves a balance between various objectives, such as noise suppression, speech quality preservation, and computational efficiency, by leveraging Pareto optimization in the deep learning model. The experimental results demonstrate the effectiveness of our approach in cleaning alaryngeal speech signals, making it a promising solution for various real-world applications.
... The top five reported barriers were inadequate access to technology, diminished therapeutic alliance, technological issues, diminished quality of delivered care or effectiveness, and privacy concerns. The top barriers to telepsychology use at the beginning of the COVID-19 pandemic found in this study are broadly consistent with findings in other studies during this time with other healthcare providers [49][50][51]. For instance, a qualitative study exploring the transition of 20 psychiatrists to telemedicine at the beginning of the pandemic found similar concerns related to patient privacy, disparities in access to reliable technology for visits, and concerns about the quality of delivered care [49]. ...
... The top barriers to telepsychology use at the beginning of the COVID-19 pandemic found in this study are broadly consistent with findings in other studies during this time with other healthcare providers [49][50][51]. For instance, a qualitative study exploring the transition of 20 psychiatrists to telemedicine at the beginning of the pandemic found similar concerns related to patient privacy, disparities in access to reliable technology for visits, and concerns about the quality of delivered care [49]. A larger qualitative study examining 934 mental health professionals' views at the beginning of the pandemic found similar barriers including concerns about its effectiveness, problems with technology use (i.e., poor connectivity and video quality), and worries about replicating the therapeutic environment [52]. ...
The COVID-19 pandemic transformed the delivery of psychological services as many psychologists adopted telepsychology for the first time or dramatically increased their use of it. The current study examined qualitative and quantitative data provided by 2619 practicing psychologists to identify variables facilitating and impeding the adoption of telepsychology in the U.S. at the beginning of the COVID-19 pandemic. The top five reported barriers were: inadequate access to technology, diminished therapeutic alliance, technological issues, diminished quality of delivered care or effectiveness, and privacy concerns. The top five reported facilitators were: increased safety, better access to patient care, patient demand, efficient use of time, and adequate technology for telepsychology use. Psychologists’ demographic and practice characteristics robustly predicted their endorsement of telepsychology barriers and facilitators. These findings provide important context into the implementation of telepsychology at the beginning of the pandemic and may serve future implementation strategies in clinics and healthcare organizations attempting to increase telepsychology utilization.
... Direct-to-consumer telemedicine services have evolved distinct financial models, including subscription-based access, episode-based pricing, employer-sponsored benefits, and retail integration. These consumer-oriented financial models operate partially outside traditional reimbursement frameworks, creating alternative sustainability mechanisms when insurance coverage remains uncertain [46]. ...
The COVID-19 pandemic catalyzed unprecedented adoption of telemedicine, transforming it from an alternative care modality into a mainstream healthcare delivery mechanism. This chapter examines how telemedicine has evolved beyond its pandemic-driven expansion, exploring the innovations that have emerged, the persistent challenges that remain, and the trajectory of digital healthcare’s future. Through analysis of technological advancements, regulatory adaptations, and changing patient and provider behaviors, this chapter identifies the key factors that will determine telemedicine’s long-term integration into healthcare systems. Special attention is given to emerging care models, health equity considerations, and the evolving regulatory landscape that will shape how digital health technologies address unmet healthcare needs. By examining post-pandemic telemedicine implementation across diverse healthcare settings, this chapter provides insights into creating sustainable telemedicine ecosystems that enhance access, quality, and efficiency in healthcare delivery.
... Dieser Digital Divide trifft insbesondere bereits unterversorgte -z. B. ältere oder bildungsferne -Patientengruppen [19,20]. Viele Patienten verfügen oft auch nicht über ausreichend moderne Smartphones oder die notwendige digitale Gesundheitskompetenz, um DiGAs gewinnbringend einzusetzen [21]. ...
ZUSAMMENFASSUNG
Hintergrund In Deutschland warten Patienten in der Regel mehrere Monate auf einen psychotherapeutischen Behandlungsplatz. Digitale Gesundheitsanwendungen (DiGAs) ermöglichen dagegen eine zeitnahe Unterstützung der psychischen Gesundheit, werden aber nur begrenzt genutzt. Digitale Navigatoren (DN) sind speziell geschulte Gesundheitsfachkräfte, die Behandler und Patienten bei der Auswahl und Nutzung von DiGAs unterstützen und dabei sprachliche, sozioökonomische und soziodemografische Besonderheiten berücksichtigen. Dadurch kann die digitale Gesundheitskompetenz gestärkt, das Engagement erhöht und die Behandler entlastet werden.
Ziel Die DigiNavi-Studie pilotiert erstmals DN exemplarisch in der hausärztlichen und ambulanten psychiatrischen Versorgung in Deutschland.
Methoden 1. Die Akzeptanz und die Erwartungen von Behandlern und Patienten gegenüber DN werden qualitativ exploriert. 2. Das Trainingsmanual für DN der Harvard Medical School wird adaptiert und an n = 6 Studienzentren werden Medizinische Fachangestellte (MFA) zu DN ausgebildet. 3. Die DN begleiten n = 48 Pt bei der Nutzung von jeweils einer DiGA. Die digitale Gesundheitskompetenz und die psychische Symptomschwere der Pt werden im Prä-Post-Vergleich quantitativ evaluiert. Zusätzlich werden die Nutzungserfahrungen und Implementierungshürden qualitativ exploriert.
Ergebnisse Die Studie liefert wichtige Erkenntnisse zur Akzeptanz und Machbarkeit von Human Guidance zur Kompetenzentwicklung mit Mental Health Apps in multiprofessionellen Gesundheitsteams.
Diskussion Die erfolgreiche Implementierung von DN kann die Nutzung von DiGAs in Deutschland fördern und damit die Versorgungssituation von Menschen mit psychischen Erkrankungen verbessern.
... Much of what does exist in the implementation space focuses on single-centre qualitative studies [28][29][30][31][32][33]. Notably, there also remains a gap when considering telehealth use in delivering services for populations with more severe mental health need and variable perspectives around the impact telehealth may have on therapeutic alliances in mental health [34][35][36][37][38]. ...
Background: The mental health service delivery gap remains high globally. Appropriate telehealth use may increase capacity through flexible remote care provision. Despite the historical lack of telehealth integration into publicly funded mental health services, during COVID-19 lockdowns, services rapidly switched to telephone and audiovisual care provision. In Aotearoa New Zealand (NZ), this was abandoned when no longer required by COVID-19 restrictions. This study explores environmental factors associated with telehealth implementation and ongoing use or discontinuation across a multiregional outpatient mental health service. This work contributes to understanding system-level factors influencing telehealth use and thus informs policy and practice in postpandemic environments.
Methods: This mixed methods study applied an interpretive description methodology. Semistructured interviews with 33 mental health clinicians were thematically analysed. Qualitative findings were reframed and evaluated using time series analyses of population-level quantitative data (prior to and throughout the pandemic). Findings were synthesised with qualitative themes to develop an understanding of environmental factors contributing to telehealth use.
Results: Findings highlighted an increase in clients assessed by mental health services and declining clinician numbers, contributing to pressure placed on clinicians. There was a lack of culture supporting telehealth, including limited awareness, leadership, and champions to facilitate implementation. Some teams provided services suited to telehealth; other subspeciality teams had limited applications for telehealth. There was a general lack of policy and guidelines to support telehealth use and limited technical support for clinicians unfamiliar with audiovisual software.
Conclusion: Disorganised telehealth adoption in the study regions provides insight into wider environmental drivers affecting telehealth uptake. For telehealth to become a workable service delivery mode following COVID-19, stewardship and culture shifts are required, including policy development, technical support, and resources to support clinical teams. Telehealth may address growing service demand by improving interfaces with primary care and providing timely access to specialist input.
... Several other studies have reported similar skillsets that are required to effectively use telehealth. Uscher-Pines et al. [30] conducted research on the experiences of psychiatrists moving to telemedicine during the COVID-19 pandemic and noted challenges affecting the quality of provider-patient interactions and difficulty conducting assessment through the window of a screen. Henry et al. [31] documented a list of interpersonal skills considered essential for the use of telehealth encompassing attributes related to set-up, verbal and non-verbal communication, relationship building, and environmental considerations. ...
Background
The use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations.
Methods
This research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach.
Results
Sixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments.
Conclusions
This research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.
... These data were analyzed using a matrix analysis approach, in which responses to each item were coded for primary themes and subthemes. This approach has been previously used to characterize key thematic content in open-ended survey responses (Uscher-Pines et al., 2020;Vaismoradi et al., 2013). ...
Objectives:
To determine the incidence and trajectory of distress, pain, and nausea and vomiting at postoperative day (POD) 1 and at POD 14 following breast-conserving surgery.
Sample & setting:
75 women aged 18 years or older receiving breast-conserving surgery with sentinel lymph node biopsy for treatment of early-stage primary breast cancer at an ambulatory surgery center.
Methods & variables:
This prospective, repeated-measures study assessed distress, pain, and nausea and vomiting using the National Comprehensive Cancer Network Distress Thermometer and Problem List on POD 1 and POD 14.
Results:
Pain and distress scores were highest on POD 1. The number of women who reported depression increased from POD 1 to POD 14. Thematic analysis revealed that family concerns, fears and worries, and postoperative issues contributed to pain and distress.
Implications for nursing:
Women experience pain and distress during recovery at home after breast-conserving surgery. Nurses can use these results to apply evidence-based practice to reduce this symptom burden. Future nursing research should focus on targeted interventions outside of the hospital setting.
... This panel has been used in many federally funded research studies and is comprised of physicians who have joined an online platform to access clinical content (news, condition and drug information, and journal articles), continuing medical education activities, and clinical tools. 15,16 Upon joining the platform, physicians are given the option to opt-in to be contacted regarding research opportunities. Approximately 2000 PCPs in the panel were emailed information about the study opportunity and invited to complete a nine-item screener to assess eligibility for participation. ...
Background
The COVID-19 pandemic resulted in greater use of remote patient monitoring (RPM). However, the use of RPM has been modest compared to other forms of telehealth.
Objective
To identify and describe barriers to the implementation of RPM among primary care physicians (PCPs) that may be constraining its growth.
Design
We conducted 20 semi-structured interviews with PCPs across the USA who adopted RPM. Interview questions focused on implementation facilitators and barriers and RPM’s impact on quality. We conducted thematic analysis of semi-structured interviews using both inductive and deductive approaches. The analysis was informed by the NASSS (non-adoption and abandonment and challenges to scale-up, spread, and sustainability) framework.
Participants
PCPs who practiced at least 10 h per week in an outpatient setting, served adults, and monitored blood pressure and/or blood glucose levels with automatic transmission of data with at least 3 patients.
Key Results
While PCPs generally agreed that RPM improved quality of care for their patients, many identified barriers to adoption and maintenance of RPM programs. Challenges included difficulties handling the influx of data and establishing a manageable workflow, along with digital and health literacy barriers. In addition to these barriers, many PCPs did not believe RPM was profitable.
Conclusions
To encourage ongoing growth of RPM, it will be necessary to address implementation barriers through changes in payment policy, training and education in digital and health literacy, improvements in staff roles and workflows, and new strategies to ensure equitable access.
... The main concerns and barriers raised by clinicians and patients include limitations in establishing a good therapeutic alliance and in observing nonverbal communication, safety and privacy concerns, and reimbursement/ financial, legal/regulatory, and licensure/credentialing issues [34][35][36]. Furthermore, psychiatrists transitioning to TP during the COVID-19 pandemic noted challenges affecting the quality of provider-patient interactions, such as decreased clinical data for assessment, reduced patient privacy, and increased distractions in the patient's home, as well as a lack of reliable access to Internet and technological limitations and issues for the patient [37]. ...
A comprehensive handbook covering current, controversial, and debated topics in psychiatric practice, aligned to the EPA Scientific Sections. All chapters been written by international experts active within their respective fields and they follow a structured template, covering updates relevant to clinical practice and research, current challenges, and future perspectives. This essential book features a wide range of topics in psychiatric research from child and adolescent psychiatry, epidemiology and social psychiatry to forensic psychiatry and neurodevelopmental disorders. It provides a unique global overview on different themes, from the recent dissemination in ordinary clinical practice of the ICD-11 to the innovations in addiction and consultation-liaison psychiatry. In addition, the book offers a multidisciplinary perspective on emerging hot topics including emergency psychiatry, ADHD in adulthood, and innovation in telemental health. An invaluable source of evidence-based information for trainees in psychiatry, psychiatrists, and mental health professionals.
... In Taiwan, methadone-based opioid agonist treatment entails daily visits to clinics for medication administration, overseen by a nurse. The advent of the COVID-19 pandemic in 2019 has compelled adjustments in methadone treatment approaches (5), such as incorporating mobile outreach (6), waiving urine toxicology screening, and authorizing take-home methadone (7)(8)(9). Adapting opioid agonist treatment to the evolving landscape during the pandemic is imperative, necessitating flexibility while upholding treatment effectiveness. ...
Introduction
Opioid use disorder is a cause for concern globally. This study aimed to optimize methadone dose adjustments using mixed modeling and machine learning.
Methods
This retrospective study was conducted at Taichung Veterans General Hospital between January 1, 2019, and December 31, 2020. Overall, 40,530 daily dosing records and 1,508 urine opiate test results were collected from 96 patients with opioid use disorder. A two-stage approach was used to create a model of the optimized methadone dose. In Stage 1, mixed modeling was performed to analyze the association between methadone dose, age, sex, treatment duration, HIV positivity, referral source, urine opiate level, last methadone dose taken, treatment adherence, and likelihood of treatment discontinuation. In Stage 2, machine learning was performed to build a model for optimized methadone dose.
Results
Likelihood of discontinuation was associated with reduced methadone doses (β = 0.002, 95% CI = 0.000–0.081). Correlation analysis between the methadone dose determined by physicians and the optimized methadone dose showed a mean correlation coefficient of 0.995 ± 0.003, indicating that the difference between the methadone dose determined by physicians and that determined by the model was within the allowable range (p < 0.001).
Conclusion
We developed a model for methadone dose adjustment in patients with opioid use disorders. By integrating urine opiate levels, treatment adherence, and likelihood of treatment discontinuation, the model could suggest automatic adjustment of the methadone dose, particularly when face-to-face encounters are impractical.
... The higher proportion of in-person Choice appointments compared with Partnership appointments is in keeping with a previously published survey of child and adolescent mental health clinicians, who reported a preference for initial in-person meetings to establish rapport and develop a therapeutic relationship before transferring to virtual care. [22][23][24] However, our results demonstrate a role for virtual care in first contact with clinicians. Participants in the present study noted the relative advantage of virtual care for initial appointments to establish rapport with clients who would otherwise not attend in-person appointments due to reluctance to come to the clinic related to the clinical presenting concern (eg, social anxiety) or logistical barriers (such as caregivers having to take a day off of work, access transport or find childcare). ...
Objective
To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service.
Design
A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics.
Setting
Child and adolescent outpatient mental health service, Nova Scotia, Canada.
Participants
IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12–18 years) and caregivers of clients (aged 3–18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13–18 years (mean 15.7 years), 10 caregivers of clients aged 5–17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians.
Results
During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of ‘outer setting’ (eg, external policies, client needs and resources), ‘inner setting’ (eg, communications within the service), ‘individual characteristics’ (eg, personal attributes, knowledge and beliefs about virtual care) and ‘intervention characteristics’ (eg, relative advantage of virtual or in-person care).
Conclusions
Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.
... There is also a high level of satisfaction with AI-enabled technologies through the autonomy that clients feel by choosing when, where, and how to seek mental health services [22]. In comparison with being in a provider's office, some clients may feel more at ease disclosing personal information at home [23]. ...
Background
Artificial intelligence (AI) is transforming the mental health care environment. AI tools are increasingly accessed by clients and service users. Mental health professionals must be prepared not only to use AI but also to have conversations about it when delivering care. Despite the potential for AI to enable more efficient and reliable and higher-quality care delivery, there is a persistent gap among mental health professionals in the adoption of AI.
Objective
A needs assessment was conducted among mental health professionals to (1) understand the learning needs of the workforce and their attitudes toward AI and (2) inform the development of AI education curricula and knowledge translation products.
Methods
A qualitative descriptive approach was taken to explore the needs of mental health professionals regarding their adoption of AI through semistructured interviews. To reach maximum variation sampling, mental health professionals (eg, psychiatrists, mental health nurses, educators, scientists, and social workers) in various settings across Ontario (eg, urban and rural, public and private sector, and clinical and research) were recruited.
Results
A total of 20 individuals were recruited. Participants included practitioners (9/20, 45% social workers and 1/20, 5% mental health nurses), educator scientists (5/20, 25% with dual roles as professors/lecturers and researchers), and practitioner scientists (3/20, 15% with dual roles as researchers and psychiatrists and 2/20, 10% with dual roles as researchers and mental health nurses). Four major themes emerged: (1) fostering practice change and building self-efficacy to integrate AI into patient care; (2) promoting system-level change to accelerate the adoption of AI in mental health; (3) addressing the importance of organizational readiness as a catalyst for AI adoption; and (4) ensuring that mental health professionals have the education, knowledge, and skills to harness AI in optimizing patient care.
Conclusions
AI technologies are starting to emerge in mental health care. Although many digital tools, web-based services, and mobile apps are designed using AI algorithms, mental health professionals have generally been slower in the adoption of AI. As indicated by this study’s findings, the implications are 3-fold. At the individual level, digital professionals must see the value in digitally compassionate tools that retain a humanistic approach to care. For mental health professionals, resistance toward AI adoption must be acknowledged through educational initiatives to raise awareness about the relevance, practicality, and benefits of AI. At the organizational level, digital professionals and leaders must collaborate on governance and funding structures to promote employee buy-in. At the societal level, digital and mental health professionals should collaborate in the creation of formal AI training programs specific to mental health to address knowledge gaps. This study promotes the design of relevant and sustainable education programs to support the adoption of AI within the mental health care sphere.
... "…the most frequently reported challenge concerns the lack of nonverbal signals that practitioners normally use in face-toface communication, such as posture and hand movements,but also general demeanor." (Uscher-Pines et al., 2020) Aspek nonverbal penting dalam penilaian psikolog dalam proses komunikasi. Sejalan dengan penelitian (Feijt et al., 2020),aspek nonverbal krusial dalam komunikasi terapeutik karena tantangan dalam telemedicine terletak pada ketiadaan isyarat nonverbal yang biasanya digunakan oleh psikolog dalam interaksi tatap muka, seperti gerakan tubuh, gerakan tangan, dan lainnya. ...
Keterbatasan jumlah psikolog yang tidak merata dan banyak terpusat di kota-kota besar, menjadi tantangan signifikan bagi kesehatan mental di Indonesia, karena mengakibatkan akses terbatas terhadap layanan konseling dan terapi bagi individu yang tinggal di daerah terpencil. Telemedicine seperti yang dilakukan oleh Halodoc, menjadi populer saat pandemi Covid-19. Aplikasi telemedicine memudahkan masyarakat mendapatkan bantuan untuk masalah kesehata mental. Penelitian ini menggunakan metode penelitian kualitatif dengan melakukan wawancara dengan psikolog, klien, dan keluarga klien untuk mencari tahu apa yang bagus dan sulit dalam menggunakan Halodoc untuk masalah kesehatan mental. Terdapat kelebihan dalam menggunakan Halodoc seperti privasi, bisa membuat janji sesuai waktu luang, menghemat waktu dan uang, serta lebih mudah diakses. Tapi juga ada masalah seperti tidak dapat melihat ekspresi tubuh, masalah teknis dan jaringan, sulit memahami masalah klien, dan susahnya membangun hubungan baik dengan psikolog. Sebagai kesimpulan, aplikasi telemedicine Halodoc menawarkan banyak manfaat layanan kesehatan mental, sementara tantangan tetap ada. Melalui model komunikasi yang tepat dan adaptasi berkelanjutan, telemedicine dapat terus merevolusi perawatan kesehatan mental, meningkatkan aksesibilitas, dan memberdayakan individu dan keluarga untuk aktif terlibat dalam kesejahteraan mental mereka.
... VOL. 29 Table 2. ...
Objective:
The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from low-income families and propelled a shift to telemental health. Yet, little is known about barriers to and facilitators of MH care access when services are delivered via synchronous telehealth to Medicaid-enrolled youth.
Study design:
Between December 2020 and March 2021, we conducted in-depth interviews with 19 therapists from a large safety-net organization who served Medicaid-enrolled youth (< 18 years of age) to elucidate their perspectives on barriers to and facilitators of access to telemental health services among this population.
Methods:
We conducted a thematic content analysis, guided by the 5 dimensions of health care access identified by Fortney and colleagues: geographical, temporal, digital, cultural (including acceptability of services), and financial access.
Results:
Therapists noted that when components of digital access are met (ie, access to hardware and software, connectivity, and technological literacy), then telehealth could facilitate temporal access and eliminate geographic barriers; elimination of these barriers was particularly beneficial for youth in rural and hard-to-reach communities. Notably, many families depended on smartphones for telemental health access, and many youth depended on their caregiver's smartphone. When considering acceptability of services, some youth preferred in-person services, whereas other youth (especially some teenagers with high technological literacy) had a preference for telemental health.
Conclusions:
Our results highlight the need for flexibility in reimbursement policies that allows providers to optimize MH care access by offering telehealth delivered via telephone and video as well as in-person services, depending on the needs and preferences of youth and families.
... Telemedicine is a communication tool for mitigating the distance between patients and medical experts. It has gained immense traction recently, mainly due to the need to reduce in-person contacts during the Covid-19 pandemic [45,49]. Video-based consultation systems for patient education were investigated even before, e.g., for plastic surgery [53], or regular and specialized check-ups [14,31]. ...
Enabling collaborative telepresence in healthcare, especially surgical procedures, presents a critical challenge. The decompressive craniotomy procedure stands out as particularly complex and timesensitive. The current teleconsultation approach relies on 2D color cameras, often offering only a fixed view and limited visual capabilities between experts and surgeons. However, teleconsultation can be addressed with Mixed Reality and immersive technology to potentially enable a better consultation of the procedure. We conducted an extensive user study focusing on decompressive craniotomy to investigate the advantages and challenges of our 3D teleconsultation system compared to a 2D video-based consultation system. Our 3D teleconsultation system leverages real-time 3D reconstruction of the patient and environment to empower experts to provide guidance and create virtual 3D annotations. The study utilized 3D-printed head models to perform a lifelike surgical intervention. It involved 14 medical residents and demonstrated an in-vitro 17% improvement in accurately describing the incision size on the patient’s head, contributing to potentially improved patient outcomes.
... Utilizing technology may increase the availability of mental health services [27], but is not without limitations [28,29]. Such limitations may include logistical challenges, less engagement from clients and other clinical challenges [30][31][32]. Potential long-term effects of phone consultations should also be considered. One possibility is that conducting a portion of the appointments by phone freed up clinicians' time and provided more flexibility for the in-person appointments. ...
Purpose:
People with psychotic disorders may be particularly vulnerable to adverse effects from restrictions implemented to limit the COVID-19 pandemic. Mental health professionals may also be at risk of adverse effects. The aim of this study was to investigate the impact of potential changes in accessibility, quality of care and vocational activity on people with psychotic disorders and the impact on clinicians working in these conditions.
Materials and methods:
Patients and clinicians in specialized mental health services for psychotic disorders answered questionnaires regarding changes in treatment, quality of treatment, vocational activity, and well-being. Data was analyzed with nonparametric tests.
Results:
Inpatients appeared more influenced by the restrictions than outpatients, however, quality of treatment was regarded relatively unaffected. Clinicians seemed satisfied working under these conditions, though a larger portion of clinicians reported changes in treatment compared to patients. The patients who reported being affected by changes in vocational activity tended to report negative effects, but the majority reported being unaffected.
Conclusion:
Overall, patients and clinicians appeared to cope well with the changes they experienced in accessibility, quality of care and vocational activity during the early phases of the pandemic.
... Telemedicine alters the information available to both patient and physician, particularly if both are working from home. Inquiring about the patient's safety at home, ability to talk privately and a time in which they will not be interrupted is important to sustain the relationship over telehealth encounters (Uscher-Pines et al., 2020). ...
... The panel comprises physicians who have joined the platform to access clinical content and continuing medical education activities and has been used in multiple research studies. [24][25][26] We limited our sample to physicians to increase the likelihood that we would obtain saturation with a sample size of 15-25, as clinicians with different training (eg, nurse practitioners, physician assistants) are likely to have different perspectives on prescribing. Further, we limited the sample to physicians who had some experience with MAUD to focus on barriers to assimilation (ie, consistent use of MAUD across all patients who may benefit) rather than the unique barriers among those who have never prescribed (eg, philosophical objections to MAUD). ...
Purpose:
Over 29 million Americans have alcohol use disorder (AUD). Though there are effective medications for AUD (MAUD) that can be prescribed within primary care, they are underutilized. We aimed to explore how primary care physicians familiar with MAUD make prescribing decisions and to identify reasons for underuse of MAUD within primary care.
Methods:
We conducted semistructured interviews with 19 primary care physicians recruited from a large online database of medical professionals. Physicians had to have started a patient on MAUD within the last 6 months in an outpatient setting. Inductive and deductive thematic analysis was informed by the theory of planned behavior.
Results:
Physicians endorsed that it is challenging to prescribe MAUD due to several reasons, including: (1) somewhat negative personal beliefs about medication effectiveness and likelihood of patient adherence; (2) competing demands in primary care that make MAUD a lower priority; and, (3) few positive subjective norms around prescribing. To make MAUD prescribing a smaller component of their practice, physicians reported applying various rules of thumb to select patients for MAUD. These included recommending MAUD to the patients who seemed the most motivated to reduce drinking, those with the most severe AUD, and those who were also receiving other treatments for AUD.
Conclusions:
There is a challenging implementation context for MAUD due to competing demands within primary care. Future research should explore which strategies for identifying a subset of patients for MAUD are the most appropriate and most likely to improve population health and health equity.
... This outcome was also reported in another study where patients were responding positively to the alternative and had provided good feedback about telemedicine; however, they also pointed out that the positive response may have been driven by patient's fear about ongoing access to care during the emergency, rather than by their general acceptance of telemedicine visits. [10] Some participants in our study shared that nothing had helped them overcome the pandemic challenges. ...
Objective: The COVID-19 pandemic has (and will continue to have) quite a strong impact on patients whose mental conditions worsen due to isolation, disruption of usual routine, activities, and loss of community support, if not the infection itself. Therefore, exploring and evaluating existing ways and proposing new ways to communicate and maintain a strong therapeutic alliance between therapists and patients was important.Methods: A semi-structured interview based on a homemade grid designed to assess participants’ opinions on access to telehealth services and their efficiency. Period of study: March 2020 to June 2021.Results: Impact of COVID-19 on daily life: 70% experienced isolation due to the pandemic life-changing, 65% experienced anxiety, 42% depression, and 28% anger. Teleconsultations’ perceptions during the COVID-19 pandemic were perceived as a good solution for a pandemic era and no need for displacement (30%). 38% thought that video consultation is a better option than telephone consultations, with 60% stating a similar level of comfort in video/phone consultation compared to in-person. Recommendations to address Mental Health (MH) care delivery soon after this pandemic were: Patients (60%) are interested in accessing a website (or mobile application) on resources of MH services available in their city/region.Conclusions: Results show that isolation and anxiety were the factors most affecting the social life and conditions of participants, with some significant levels of depression and anger. Participants largely accepted the transition to virtual care with some improvements.
... Employing a qualitative approach is essential to elucidate the reported challenges and successes in the recent literature, including perceptions of the therapeutic relationship and provider satisfaction [21]. Indeed, qualitative studies have begun to explore the experiences of service users and providers with telemental health during the pandemic [22,23], though less research has explicitly focused on implementation [14]. Many of these studies have focused on experiences within specific contexts, namely hospital outpatient settings, and on homogenous patient and provider groups [14]. ...
Background
Remote mental health consultations were swiftly implemented across mental health services during the COVID-19 pandemic. Research has begun to inform future design and delivery of telemental health services. Exploring the in-depth experiences of those involved is important to understand the complex, multi-level factors that influence the implementation of remote mental health consultations. The aim of this study was to explore stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic in Ireland.
Methods
A qualitative study was conducted whereby semi-structured, individual interviews were undertaken with mental health providers, service users, and managers (n = 19) to acquire rich information. Interviews were conducted between November 2021 and July 2022. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically using a deductive and inductive approach.
Results
Six themes were identified. The advantages of remote mental health consultations were described, including convenience and increased accessibility to care. Providers and managers described varying levels of success with implementation, citing complexity and incompatibility with existing workflows as barriers to adoption. Providers’ access to resources, guidance, and training were notable facilitators. Participants perceived remote mental health consultations to be satisfactory but not equivalent to in-person care in terms of quality. Views about the inferior quality of remote consultations stemmed from beliefs about the inhibited therapeutic relationship and a possible reduction in effectiveness compared to in-person care. Whilst a return to in-person services was mostly preferred, participants acknowledged a potential adjunct role for remote consultations in certain circumstances.
Conclusions
Remote mental health consultations were welcomed as a means to continue care during the COVID-19 pandemic. Their swift and necessary adoption placed pressure on providers and organisations to adapt quickly, navigating challenges and adjusting to a new way of working. This implementation created changes to workflows and dynamics that disrupted the traditional method of mental health care delivery. Further consideration of the importance of the therapeutic relationship and fostering positive provider beliefs and feelings of competence are needed to ensure satisfactory and effective implementation of remote mental health consultations going forward.
... For instance, the lack of internet access, the lack of computers or computer software [5], and preference for face-to-face interactions [6] are barriers that have been reported previously. Tele-mental interventions do not yet have proven effectiveness when used with children and young people with mental health problems [7,8], and in older persons, prior experience with technology is a critical factor [9]. ...
A tele-mental health model called Head to Health was implemented in the state of Victoria, Australia to address the crisis caused by the COVID-19 pandemic. It was a free centralized intake service that adopted a targeted approach with several novel elements, such as stepped care and telehealth. This study examines the views and experiences of clinicians and service users of the tele-mental health service in the Gippsland region of Victoria during the COVID-19 pandemic. Data from clinicians were obtained via an online 10-item open-ended survey instrument and from service
users through semi-structured interviews. Data were obtained from 66 participants, including 47 clinician surveys and 19 service user interviews. Six categories emerged from the data. They were: ‘Conditions where use of tele-mental health is appropriate’, ‘Conditions where tele-mental health may not be useful’, ‘Advantages of tele-mental health’, ‘Challenges in using tele-mental health’, ‘Client outcomes with tele-mental health’, and ‘Recommendations for future use’. This is one of a few
studies where clinicians’ and service users’ views and experiences have been explored together to provide a nuanced understanding of perspectives on the efficacy of tele-mental health when it was implemented alongside public mental health services.
... However, limited evidence suggests that BHO utilization did not drop among individuals with schizophrenia following the pandemic onset, in part from their robust uptake of telehealth (Lynch et al., 2020;Yang et al., 2020). On the other hand, evidence that disadvantaged populations have less reliable access to telehealth-enabling technology (smartphones, computers, the Internet) (Raja et al., 2021;Uscher-Pines et al., 2020) suggests that among individuals with schizophrenia, racial and ethnic minority groups may have had lower telehealth adoption than Whites. ...
COVID-19 has had a disproportionate impact on the most disadvantaged members of society, including minorities and those with disabling chronic illnesses such as schizophrenia. We examined the pandemic’s impacts among New York State’s Medicaid beneficiaries with schizophrenia in the immediate post-pandemic surge period, with a focus on equity of access to critical healthcare. We compared changes in utilization of key behavioral health outpatient services and inpatient services for life-threatening conditions between the pre-pandemic and surge periods for White and non-White beneficiaries. We found racial and ethnic differences across all outcomes, with most differences stable over time. The exception was pneumonia admissions—while no differences existed in the pre-pandemic period, Black and Latinx beneficiaries were less likely than Whites to be hospitalized in the surge period despite minorities’ heavier COVID-19 disease burden. The emergence of racial and ethnic differences in access to scarce life-preserving healthcare may hold lessons for future crises.
... Community healthcare agencies could also improve access to CBT-I through telehealth. Telehealth services have rapidly gained relevance during the COVID-19 pandemic [57]; telehealth could also be used to bridge more long-standing barriers like limited transportation and childcare services. The VA offers programs that connect veterans to internet services and personal electronic tablets for those with limited tele-capabilities [58]. ...
Sleep problems are common among United States (U.S.) veterans and are associated with poor health, mental health, and functioning. Yet, little is known about insufficient sleep and factors contributing to sleep disparities among veterans experiencing homelessness. We conducted semi-structured interviews to better understand the clinical, environmental, and structural factors contributing to insufficient sleep among veterans and to improve care for this population. Interviews were conducted with 13 providers caring for veterans experiencing homelessness, including physicians, psychologists, nurses, social workers, and peer support specialists. Providers worked at a West Coast VA institution serving a large population of veterans experiencing homelessness. Interviews were analyzed for themes pertaining to sleep using the social-ecological model as a framework. On an individual level, factors influencing sleep included psychiatric disorders and use of substances. On an interpersonal level, factors included safety concerns while sleeping. On an environmental level, factors included noise and proximity to others as barriers to sleep. On the organizational level, logistical issues scheduling sleep clinic appointments and lack of transportation to attend sleep clinic appointments were identified as treatment barriers. These findings can inform future research studying the impact of sleep on health and housing outcomes and interventions addressing sleep among veterans experiencing homelessness.
... The successful delivery of an OGEP is dependent on good telehealth infrastructure including internet speeds and access to devices. Clinicians have voiced concerns about disadvantaged patients having poorer telehealth infrastructure [40]. There is a difference between watching an exercise being demonstrated on a small mobile phone screen compared with a large computer screen and also internet reliability effects the enjoyment of and ability to successfully participate with the synchronous delivery of an OGEP [41]. ...
Introduction:
The COVID-19 pandemic saw the migration of many physiotherapy-led group exercise programmes towards online platforms. This online survey aimed to ascertain the patients' views of online group exercise programmes (OGEP), including their satisfaction with various aspects of these programmes, the advantages and disadvantages and usefulness beyond the pandemic.
Methods:
A mixed-methods design was utilised with a cross-sectional national online survey of patients who had previously attended a physiotherapy-led OGEP in Ireland. The survey collected both qualitative and quantitative data. Descriptive statistics were used to summarise the ordinal and continuous data and conventional content analysis was used to analyse the free-text responses.
Results:
In total, 94 patients completed the surveys. Fifty percent of patients questioned would prefer in-person classes. Despite only a quarter of patient respondents preferring online classes going forward, satisfaction with the OGEPs was high with nearly 95% of respondents somewhat or extremely satisfied. Decreased travel and convenience were cited as the main benefits of OGEPs. Decreased social interaction and decreased direct observation by the physiotherapist were the main disadvantages cited.
Conclusion:
Patients expressed high satisfaction rates overall with online classes, but would value more opportunities for social interaction. Although 50% of respondents would choose in-person classes in the future, offering both online and in-person classes beyond the pandemic may help to suit the needs of all patients and improve attendance and adherence.
... The platform has been commonly used to recruit clinicians in many federal studies including projects sponsored by the Centers for Disease Control (CDC) and by the Food and Drug Administration (FDA). [16][17][18][19][20] To recruit survey participants, WebMD/Medscape emailed all psychiatrists in their online panel and a random sample of primary care physicians, nurse practitioners, and physician assistants. 15 Clinicians who expressed interest were then screened for eligibility via an online instrument. ...
Background
During the pandemic, there was a dramatic shift to telemedicine for opioid use disorder (OUD) treatment. Little is known about how clinician attitudes about telemedicine use for OUD treatment are evolving or their preferences for future use.Objective
To understand OUD clinician views of and preferences regarding telemedicine.DesignLongitudinal survey (wave 1, December 2020; wave 2, March 2022).SubjectsNational sample of 425 clinicians who treat OUD.Main MeasuresSelf-reported proportion of OUD visits delivered via telemedicine (actual vs. preferred), comfort in using video visits for OUD, impact of telemedicine on work-related well-being.Key ResultsThe mean reported percentage of OUD visits delivered via telemedicine (vs. in person) dropped from 56.9% in December 2020 to 41.5% in March 2022; the mean preferred post-pandemic percentage of OUD visits delivered via telemedicine was 34.8%. Responses about comfort in using video visits for different types of OUD patients remained similar over time despite clinicians having substantially more experience with telemedicine by spring 2022 (e.g., 35.8% vs. 36.0% report being comfortable using video visits for new patients). Almost three-quarters (70.9%) reported that most of their patients preferred to have the majority of their visits via telemedicine, and 76.7% agreed that the option to do video visits helped their patients remain in treatment longer. The majority (58.7%) reported that telemedicine had a positive impact on their work-related well-being, with higher rates of a positive impact among those who completed training more recently (68.5% of those with < 10 years, 62.1% with 10–19 years, and 45.8% with 20 + years, p < 0.001).Conclusions
While many surveyed OUD clinicians were not comfortable using telemedicine for all types of patients, most wanted telemedicine to account for a substantial fraction of OUD visits, and most believed telemedicine has had positive impacts for themselves and their patients.
Background
Contingency management (CM) is an effective yet underutilized behavioral intervention that uses rewards to improve outcomes in medication for opioid use disorder (MOUD) treatment. Prior implementation attempts have focused on specialized addiction clinics, using intensive daily treatment with methadone and high reward values (e.g. >75 total) CM program for the family medicine context, we conducted qualitative interviews with patients and staff in the buprenorphine treatment program of a family medicine department. We gathered and analyzed qualitative data on CM knowledge, preferred program parameters, and implementation considerations.
Method
Participants (N = 24) were buprenorphine treatment staff (n = 12) and patients (n = 12). Participants completed 30–50-minute semi-structured interviews, analyzed using rapid matrix analysis.
Results
Participants had little experience with CM, but generally viewed CM as acceptable, appropriate, and feasible. Interviewees coalesced around having staff who were not providers with prescription privileges conduct CM, consistent rather than escalating payments, and physical rewards delivered in-person. Potential challenges included medical record integration, demands on staff time, and confirmation of patients’ goal completion.
Conclusions
Patient and staff feedback was well-aligned, especially regarding rewards as an opportunity for staff-patient connection and the need for simplicity. Some consensus suggestions (e.g. non-escalating rewards) conflict with extant CM literature. Implications for implementation of CM in this setting are presented. These findings inform user-centered design and iteration of a CM program for this accessible, non-specialized family medicine setting.
People living with HIV (PLWH) have a higher prevalence of mental ill health compared to the general population. We aimed to understand the impact of the COVID-19 pandemic and omitting routine HIV appointments on the mental health (MH) of PLWH. Between April 2020 and March 2021, routine appointments for "stable" PLWH were replaced by virtual consultations. MH assessments using standardised questionnaires were compared before and during the pandemic. Full data were available for 426 individuals after excluding those with incomplete data and those requiring early review for non-MH-related issues. The results showed that 277 (65%) experienced no/minimal MH symptoms throughout, indicating robust MH. For depression, scores worsened in 59 (13.8%), improved in 62 (14.6%) and remained stable in 305 (71.6%). For anxiety, scores worsened in 55 (12.9%), improved in 64 (15%) and remained stable in 307 (72.1%). A total of 98.4% of individuals remained virally suppressed, with 7 developing a detectable viral load. One person stopped antiretroviral treatment secondary to an MH crisis. Findings suggest that the COVID-19 pandemic did not significantly impact the overall MH in our cohort of PLWH. It also demonstrates an effective implementation of virtual consultations. The complex nature of MH in PLWH highlights the need for individualised MH care.
COVID-19 increased the burden of childcare on parents, leaving women vulnerable to increased disparities in the division of domestic labor. Women healthcare workers may be at heightened risk of worsening gender parity in the workplace as a result.
To examine the impact of the COVID-19 pandemic on gender parity in the division of household responsibilities among women healthcare workers.
Cross-sectional survey assessing changes in the workplace and changes in the balance of domestic duties with partners via multiple open-ended and Likert-scale type questions. Data were analyzed descriptively, including thematic analysis of free-text responses.
This survey study included 1459 women healthcare workers and 244 of their partners.
Primary outcomes were levels of responsibility for domestic labor, including housework, childcare, and child education. Free-text questions focused on the impact of household responsibilities on the workplace.
In total, 1459 healthcare workers identifying as women responded to this survey. Of them, 655 (45%) practice in an academic setting, and 1025 (70%) are physicians. Additionally, 244 self-identifying partners of women healthcare workers responded; the majority were men (204 [84%]), and over one-third (91 [38%]) work in healthcare. Among respondents overall, women reported doing most of the housework (52% of respondents [756/1459] versus 27% of partners [61/244]) and child education, compared with their partners (31% of respondents [451/1459] versus 23% of partners [55/244]). Thematic analysis of free-text questions revealed that women experienced worsened gender parity in the workplace because of increased household responsibilities.
We observed significant gender-based disparities in the division of household labor among healthcare workers, with negative impacts on work performance, focus, and academic productivity. Our results support the notion that the COVID-19 pandemic worsened gender parity in the homes of healthcare workers, thus negatively affecting gender parity in the medical workplace.
Background: Audio-only (phone) telemental health care can increase access to care, but its lack of nonverbal information may negatively impact care quality as compared to video or in-person visits. The objective of this work was to understand patient and provider attitudes toward phone care via a review of qualitative research. Methods: A qualitative evidence synthesis was conducted of peer-reviewed qualitative research published between 2013 and 2023. Studies were required to include qualitative data regarding patient and/or provider attitudes toward audio-only telemental health care. Results pertinent to phone care were extracted and underwent coding followed by theme identification. Results: We identified 2,065 abstracts and 29 articles were ultimately included in the synthesis; 27 of these studies were conducted during the COVID-19 pandemic. Five themes described benefits of phone care, nine described drawbacks, and three themes were neutral. Phone care was seen as easy to use, particularly for briefer check-ins or as a back-up option if video calls failed, and some patients preferred the privacy of not being seen. However, the loss of visual information during phone visits was considered particularly challenging in the treatment of more complex or severe patients; providers questioned whether they were able to provide high quality care, and patients reported feeling less supported and understood by their providers. Conclusions: The relative benefits and drawbacks of audio-only telemental health care must be carefully weighed against the options of video or in-person treatment based on patient needs and severity. Future work should continue to examine patient and provider attitudes toward phone care as the mental health landscape evolves postpandemic.
This paper was written in the framework of my internship at the National Commission for Bioethics and Technoethics of the Hellenic Republic. It constitutes an attempt at exploring the ethical and legal dilemmas of the medical practice of telepsychiatry. Telepsychiatry, as well as other forms of telemedicine, has become a prevalent way through which patients gain access to healthcare and with many research papers reporting on its effectiveness and advantages, telepsychiatry has gained a lot of proponents in the scientific and healthcare community. However, several questions regarding the ethical and legal nature of the practice remain unanswered and this can put patients and other users of telemental health services under risk for basic rights violations. In this paper, at first the scientific data supporting the use of telepsychiatry will be cited. In addition to that, there will be discussion of several ethical dilemmas that have been reported concerning the use of telemedicine in psychiatry during the past few years and there will be reference to the medical code of ethics. Following that, there will be reference to the existing legislation for telepsychiatry in Greece and the legal issues that can arise will be analyzed. In spite of the fact that the advantages and ethical pitfalls of telepsychiatry are common in many countries, the focus of this paper will be on Greece’s code of medical ethics and legislation due to the lack of relevant bibliography on the matter, even though telepsychiatry is widely used by Greek patients. Finally some suggestions will be made on what ought to be ameliorated in regards to the current conditions, so as to make sure telepsychiatry is in line with the basic principles of bioethics.
Introduction
The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used.
Methods
To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review.
Results
Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail.
Discussion
Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.
Background
The usage and implementation of telemedicine by urologists to diagnose, treat, mentor, and prevent diseases have grown worldwide. Numerous clinical, legal, and ethical issues are addressed by this practice. This is a cross-sectional study based on an anonymous online questionnaire, aimed to assess the current urologists’ knowledge and attitude towards telemedicine use in Egypt. A total of 108 Egyptian urologists filled out the questionnaire which included sociodemographic data, urologist knowledge, attitude regarding telemedicine, and common concerns and barriers.
Results
Out of the total sample, 75.9% of participants did not use telemedicine modalities until COVID-19 pandemic. Nearly 66.7% of participants did not receive formal medicolegal training on using telemedicine. About 62% of participants used personal accounts on social media, and 73.1% of teleconsultations were to assess radiological and laboratory data. Several concerns were highlighted such as possible malpractice risks (79.6%), defamation (72.2%), and keeping patient records (71.3%). Urologists raised many considerable barriers regarding telemedicine, such as lack of patient technology skills (84.3%), absence of regulations or laws (76.9%), insurance reimbursement (57.4%), and lack of administrative support (53.7%). Most of the participants have a positive impression of the advantages of tele-urology. There was a statistically significant difference between the number of cases seen per week and positive total attitude score.
Conclusions
Although most participants practiced telemedicine, many obstacles were highlighted through the study. Ignoring legal, ethical, personal, and patient issues may also jeopardize the future of telemedicine. Well-established health policies, formal education, and the implementation of regulated laws of telemedicine are fundamental.
Introduction
Video psychotherapy (VPT) demonstrated strong clinical efficacy in the past, with patients and psychotherapists expressing satisfaction with its outcomes. Despite this, VPT only gained full recognition from the German healthcare system during the COVID-19 pandemic. As society increasingly relies on new media, it seems likely that VPT will become even more relevant. Previous studies surveyed practicing psychotherapists and patients about advantages and disadvantages of VPT. In contrast, our approach targets a younger generation, specifically psychology students intending to become licensed practitioners after graduation.
Methods
Our mixed-methods study was conducted in an online survey format and had two main objectives. Firstly, we investigated which person-related variables are associated with psychology students’ behavioral intention to offer VPT after graduation, using a multiple regression analysis. Secondly, we explored psychology students’ perception of advantages and disadvantages of VPT and identified their desired learning opportunities regarding VPT in their study program, using qualitative content analysis.
Results
A sample of 255 psychology students participated. The multiple regression model explains 73% of inter-individual variance in the intention to offer VPT, with attitudes toward VPT showing the strongest relationship with intention to offer VPT. Expected usefulness, satisfaction with video conferencing, and subjective norm also showed significant relations. The students provided 2,314 statements about advantages, disadvantages, and desired learning opportunities, which we coded by means of three category systems. In terms of advantages, the most frequently mentioned categories were low inhibition threshold, flexibility in terms of location, and no need to travel. For disadvantages, the predominant categories included lack of closeness between patient and psychotherapist, lack of nonverbal cues, and problems with technology or internet connection. Regarding desired learning opportunities, training for technical skills, practical application through role-playing and self-experience, and general information about VPT were the most mentioned categories. In addition, we identified numerous other aspects related to these topics, reflecting a differentiated and balanced assessment of VPT.
Discussion
We discuss the theoretical and practical implications of our findings for training the next generation of psychotherapists and outline a specific five-step plan for integrating VPT into study programs.
This paper presents the initial stage of the development of an angioplasty simulator. Along with it, the authors explain the reasons for choosing cardiovascular disease treatment procedures and describe the project’s work plan. The authors conducted a literature review on the use of extended reality (XR) technologies in various fields of medicine and analyzed the existing virtual simulator market.The problems and possible disadvantages of the virtual simulations are another object of the authors’ attention. The paper emphasizes the importance of paying attention to the nuances of the project to ensure that it successfully achieves its goals.The main purpose of the project is to provide students with a proper level of knowledge and skills using promising and modern tools such as virtual reality and modern human-computer interaction tools, thereby improving the quality of medical education and practice in Kazakhstan.This article provides information about the current development of medical simulators in Kazakhstan for coronary angioplasty and the use of XR technologies in medical education that can be useful to researchers, educators, and healthcare professionals around the world.Keywordsmetaversesurgery simulatormathematical modelling
Introduction: The COVID-19 pandemic led to a rapid transition to telemedicine for mental health care and redefined many providers' work environments and practices. The purpose of the study was to investigate the impact of work location on telemental health (TMH) benefits, disruptions, and concerns to further understand the rapid implementation of telemedicine for mental health treatment. Methods: A sample of 175 practicing TMH providers completed an online survey between July and August 2020. Providers answered questions about personal demographics and practice characteristics. Next, they answered questions about benefits, disruptions, and concerns regarding the use of telemedicine in their practice. Chi-square and independent samples t-test were conducted to identify work location differences for personal demographics and clinical practice characteristics. Three multivariate analyses of covariance were conducted to examine overall differences in perceptions of telemedicine benefits, concerns, and disruptions based on work location while covarying for provider race, ethnicity, percentage of caseload seen through telemedicine, practice type, specialty, and primary method of reimbursement. Results: TMH providers who primarily work from an office reported more benefit of reduced costs/overhead (ηp2 = 0.039), less benefit of limiting the spread of the virus (ηp2 = 0.028), and more concern about reimbursement (ηp2 = 0.046) than those who primarily work from home. We observed no difference in disruptions, patient access to care, quality of care, and work-life balance. Discussion: Exploration into work location of TMH providers aids in understanding of clinical workflows and provider wellbeing. Our findings suggest that telemedicine may be easily integrated into different types of clinical workflows and work locations.
Due to advancements in information and communication technology, the Internet of Things has gained popularity in a variety of academic fields. In IoT-based healthcare systems, numerous wearable sensors are employed to collect various data from patients. The healthcare system has been challenged by the increase in the number of people living with chronic and infectious diseases. There are several existing IoT-based healthcare systems and ontology-based methods to judiciously diagnose, and monitor patients with chronic diseases in real-time and for a very long term. This was done to drastically minimize the vast manual labor in healthcare monitoring and recommendation systems. The current monitoring and recommendation systems generally utilised Type-1 Fuzzy Logic (T1FL) or ontology that is unsuitable owing to uncertainty and inconsistency in the processing, and analysis of observed data. Due to the expansion of risk and unpredictable factors in chronic and infectious patients such as diabetes, heart attacks, and COVID-19, these healthcare systems cannot be utilized to collect thorough physiological data about patients. Furthermore, utilizing the current T1FL ontology-based method to extract the ideal membership value of risk factors becomes challenging and problematic, resulting in unsatisfactory outcomes. Therefore, this chapter discusses the applicability of IoT-based enabled Type-2 Fuzzy Logic (T2FL) in the healthcare system, and the challenges and prospects of their applications were also reviewed. The chapter proposes an IoT-based enabled T2FL system for monitoring patients with diabetes by extracting the physiological factors from patients’ bodies. The wearable sensors were used to capture the physiological factors of the patients, and the data capture was used for the monitoring of patients. The results from the experiment reveal that the model is very efficient and effective for diabetes patient monitoring, using patient risk factors.KeywordsType-2 fuzzy logicInternet of ThingsOntology fuzzy logicHealthcare systemsPatients monitoringRisk factorsChronic and infectious diseases
Background
An important goal of the patient-centered medical home is increasing timely access for urgent needs, while maintaining continuity. In academic primary care clinics, meeting this goal, along with training medical residents and associated professionals, is challenging.
Methods
The aim of this study was to understand how academic primary care clinics provide continuity to patients requesting same-day access and identify factors that may affect site-level success. We conducted qualitative interviews from December 2013–October 2014 with primary care leadership involved with residency programs at 19 Veterans Health Administration academically-affiliated medical centers. Interview recordings were transcribed verbatim. To analyze the data, we created comprehensive, structured transcript summaries for each site. Site summaries were then entered into NVivo 10 software and coded by main categories to facilitate within-case and cross-case analyses. Themes and patterns across sites were identified using matrix analysis.
Results
Interviewees found it challenging to provide continuity for same-day in-person visits. Most sites took a team-based approach to ensure continuity and provide coverage for same-day access, notably using NPs, PAs, and RNs in their coverage algorithms. Further, they reported several adaptations that increased multiple types of continuity for walk-in patients, urgent care between in-person visits, and follow-up care. While this study focused on longitudinal continuity, both by individual PCPs or by a team of professionals, informational continuity and continuity of supervision, as well as, to a lesser extent, relational and management continuity, were also addressed in our interviews. Finally, most interviewees reported clinic intention to provide patient-centered, team-based care and a robust educational experience for trainees, and endeavored to structure their clinics in ways that align these two missions.
Conclusions
In contending with the tension between providing continuity and educating new clinicians, clinics have re-conceptualized continuity as team-based, creating alternative strategies to same-day visits with a usual provider, coupled with communication strategies. Understanding the effect of these strategies on different types of continuity as well as patient experience and outcomes are key next steps in the further development and dissemination of effective models for improving continuity and the transition to team-based care in the academic clinic setting.
Electronic supplementary material
The online version of this article (10.1186/s12913-019-3943-2) contains supplementary material, which is available to authorized users.
Background
It is challenging to conduct and quickly disseminate findings from in-depth qualitative analyses, which can impede timely implementation of interventions because of its time-consuming methods. To better understand tradeoffs between the need for actionable results and scientific rigor, we present our method for conducting a framework-guided rapid analysis (RA) and a comparison of these findings to an in-depth analysis of interview transcripts.
Methods
Set within the context of an evaluation of a successful academic detailing (AD) program for opioid prescribing in the Veterans Health Administration, we developed interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and interviewed 10 academic detailers (clinical pharmacists) and 20 primary care providers to elicit detail about successful features of the program. For the RA, verbatim transcripts were summarized using a structured template (based on CFIR); summaries were subsequently consolidated into matrices by participant type to identify aspects of the program that worked well and ways to facilitate implementation elsewhere. For comparison purposes, we later conducted an in-depth analysis of the transcripts. We described our RA approach and qualitatively compared the RA and deductive in-depth analysis with respect to consistency of themes and resource intensity.
Results
Integrating the CFIR throughout the RA and in-depth analysis was helpful for providing structure and consistency across both analyses. Findings from the two analyses were consistent. The most frequently coded constructs from the in-depth analysis aligned well with themes from the RA, and the latter methods were sufficient and appropriate for addressing the primary evaluation goals. Our approach to RA was less resource-intensive than the in-depth analysis, allowing for timely dissemination of findings to our operations partner that could be integrated into ongoing implementation.
Conclusions
In-depth analyses can be resource-intensive. If consistent with project needs (e.g., to quickly produce information to inform ongoing implementation or to comply with a policy mandate), it is reasonable to consider using RA, especially when faced with resource constraints. Our RA provided valid findings in a short timeframe, enabling identification of actionable suggestions for our operations partner.
Electronic supplementary material
The online version of this article (10.1186/s13012-019-0853-y) contains supplementary material, which is available to authorized users.
Objectives
This study compares rapid and traditional analyses of a UK health service evaluation dataset to explore differences in researcher time and consistency of outputs.
Design
Mixed methods study, quantitatively and qualitatively comparing qualitative methods.
Setting
Data from a home birth service evaluation study in a hospital in the English National Health Service, which took place between October and December 2014. Two research teams independently analysed focus group and interview transcript data: one team used a thematic analysis approach using the framework method, and the second used rapid analysis.
Participants
Home birth midwives (6), midwifery support workers (4), commissioners (4), managers (6), and community midwives (12) and a patient representative (1) participated in the original study.
Primary outcome measures
Time taken to complete analysis in person hours; analysis findings and recommendations matched, partially matched or not matched across the two teams.
Results
Rapid analysis data management took less time than thematic analysis (43 hours vs 116.5 hours). Rapid analysis took 100 hours, and thematic analysis took 126.5 hours in total, with interpretation and write up taking much longer in the rapid analysis (52 hours vs 8 hours). Rapid analysis findings overlapped with 79% of thematic analysis findings, and thematic analysis overlapped with 63% of the rapid analysis findings. Rapid analysis recommendations overlapped with 55% of those from the thematic analysis, and thematic analysis overlapped with 59% of the rapid analysis recommendations.
Conclusions
Rapid analysis delivered a modest time saving. Excessive time to interpret data in rapid analysis in this study may be due to differences between research teams. There was overlap in outputs between approaches, more in findings than recommendations. Rapid analysis may have the potential to deliver valid, timely findings while taking less time. We recommend further comparisons using additional data sets with more similar research teams.
Background:
The use of inappropriate elective Percutaneous Coronary Intervention (PCI) has decreased over time, but hospital-level variation in the use of inappropriate PCI persists. Understanding the barriers and facilitators to the implementation of Appropriate Use Criteria (AUC) guidelines may inform efforts to improve elective PCI appropriateness.
Methods:
All hospitals performing PCI in Washington State were categorized by their use of inappropriate elective PCI in 2010 to 2013. Semi-structured, qualitative telephone interviews were then conducted with 17 individual interviews at 13 sites in Washington State to identify barriers and facilitators to the implementation of the AUC guidelines. An inductive and deductive, team-based analytical approach, drawing primarily on Matrix analysis was performed to identify factors affecting implementation of the AUC.
Results:
Specific facilitators were identified that supported successful implementation of the AUC. These included collaborative catheterization laboratory environments that allow all staff to participate with questions and opinions; ongoing AUC education with catheterization laboratory teams and referring providers; internal AUC peer review processes; interventional cardiologist be directly involved with the pre-procedural review process; checklist-based algorithms for pre-procedural documentation; systems redesign to include insurance companies; and AUC educational information with patients. Barriers to implementation of the AUC included external pressures, such as competition for patients, and the lack of shared medical records with sites that referred patients for coronary angiography.
Conclusions:
The identified facilitators enabled sites to successfully implement the AUC. Catheterization laboratories struggling to successfully implement the AUC may consider utilizing these strategies to improve their processes to improve patient selection for elective PCI.
Purpose of review:
Participatory medicine and the availability of commercial technologies have given patients more options to view and track their health information and to communicate with their providers. This shift in the clinical process may be of particular importance in mental healthcare where rapport plays a significant role in the therapeutic process.
Recent findings:
In this review, we examined literature related to the impact of technology on the clinical workflow and patient-provider rapport in the mental health field between January 2014 and June 2017. Thirty three relevant articles, of 226 identified articles, were summarized. The use of technology clinically has evolved from making care more accessible and efficient to leveraging technology to improve care, communication, and patient-provider rapport. Evidence exists demonstrating that information and communication technologies may improve care by better connecting patients and providers and by improving patient-provider rapport, although further research is needed.
Introduction:
The effectiveness of any new technology is typically measured in order to determine whether it successfully achieves equal or superior objectives over what is currently offered. Research in telemental health-in this article mainly referring to telepsychiatry and psychological services-has advanced rapidly since 2003, and a new effectiveness review is needed.
Materials and methods:
The authors reviewed the published literature to synthesize information on what is and what is not effective related to telemental health. Terms for the search included, but were not limited to, telepsychiatry, effectiveness, mental health, e-health, videoconferencing, telemedicine, cost, access, and international.
Results:
Telemental health is effective for diagnosis and assessment across many populations (adult, child, geriatric, and ethnic) and for disorders in many settings (emergency, home health) and appears to be comparable to in-person care. In addition, this review has identified new models of care (i.e., collaborative care, asynchronous, mobile) with equally positive outcomes.
Conclusions:
Telemental health is effective and increases access to care. Future directions suggest the need for more research on service models, specific disorders, the issues relevant to culture and language, and cost.
In the current health care environment, researchers are asked to share meaningful results with interdisciplinary professional audiences, concerned community members, students, policy makers, planners, and financial officers. Emphasis is placed on effective health care outcomes and evidence, especially for underserved and vulnerable populations. Any research strategy that facilitates the clear, accurate communication of findings and voices will likely benefit groups targeted for intervention with scarce resources. In this example, matrix analysis contributes to the display, interpretation, pragmatic evaluation, and dissemination of findings in a study of rural elders. The author proposes matrix analysis as a strategy to advance knowledge and enhance the development of evidence in qualitative research.
Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.
Individuals in many regions of the United States experience inadequate availability of specialty mental health care.¹ Telemental health, the use of video visits between a patient and a remote mental health specialist, may address these access barriers. Telemental health has grown rapidly but unevenly across the nation.² Little is known about the characteristics of psychiatrists associated with the use of this technology. Research has examined characteristics of physicians who adopt other technologies such as electronic health records and diagnostic or therapeutic procedures; in general, such physicians are younger, male, US medical school graduates, and work in larger practices.³,4 Among psychiatrists who care for Medicare beneficiaries, we compared the characteristics of psychiatrists who do and do not use telemental health.
Despite the staggering physical, economic, and societal costs of mental health conditions in the United States, there continues to be a significant gap in mental health service, as access lags behind the demand for them. The uneven distribution of mental health service providers contributes to this gap, making it necessary to incorporate novel approaches to the delivery of mental health services. Telepsychiatry has proven to be one of the more innovative approaches for improving access to mental health services. This article focuses on six challenges that have historically impeded larger-scale adoption of telepsychiatry: limited training, limitations of existing research, security and technology issues, clinical practice challenges, licensure, and reimbursement restrictions. The article discusses recent developments, ongoing advances, and future directions to overcoming these barriers.
Telemedicine may improve access to specialty care, particularly in underserved, rural areas.¹ To promote telemedicine adoption, “parity” laws, which mandate coverage and reimbursement for telemedicine, have passed in 32 US states (64%) as of 2016.² However, little is known about telemedicine adoption nationally among the commercially insured. To address this gap, we examined trends in telemedicine use and its association with regional factors (parity legislation and physician supply) within a large commercial health plan.
Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analyzed Medicare fee-for-service claims for the period 2004-14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. There was notable variation across states: In 2014 nine had more than twenty-five visits per 100 beneficiaries with serious mental illness, while four states and the District of Columbia had none. Compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than sixty-five, be eligible for Medicare because of disability, and live in a relatively poor community. States with a telemedicine parity law and a pro-telemental health regulatory environment had significantly higher rates of telemental health use than those that did not. © 2017 Project HOPE-The People-to-People Health Foundation, Inc.
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Telemedicine is essential amid the covid-19 crisis and after it
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