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Skala J, Chavez JX, Anderson K, Gulrajani C. Examiners' perceptions of forensic mental health assessments conducted via videoconferencing. BEHAVIORAL SCIENCES & THE LAW 2023; 41:292-309. [PMID: 36965143 DOI: 10.1002/bsl.2621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic led to an acceleration in the adoption of videoconferencing (VC) for conducting forensic mental health evaluations (forensic mental health assessments [FMHA]). Two years into the COVID-19 pandemic, we administered a survey to 71 Minnesota-licensed forensic evaluators. Approximately two-thirds (65.7%) had started using VC for FMHA only after the pandemic, though a combined 84.5% reported performing FMHA via VC frequently at present. A striking 43.7% of respondents preferred VC for FMHA over in-person evaluation, and another 22.5% expressed no preference between modalities. Further, nearly 70% of respondents denied there were any populations for which they would never use VC to complete an FMHA. We conclude that the widespread adoption of VC for FMHA with the advent of the COVID-19 pandemic has induced a lasting change in the practice of FMHA. We postulate that with further advancements in technology and the development of testing instruments that can be administered online, the use of VC for FMHA will become standard practice.
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Affiliation(s)
- Josie Skala
- Department of Psychiatry and Behavioral Sciences, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Jacob X Chavez
- Minnesota Direct Care and Treatment - Forensic Services, Forensic Mental Health Program, St. Peter, Minnesota, USA
| | - Katelin Anderson
- Office of Information Technology, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Chinmoy Gulrajani
- Department of Psychiatry and Behavioral Sciences, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
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Nawaz FA, Bilal W, Khan HA, Duvuru R, Derby H, Pereira-Sanchez V. The scope of metaverse in enhancing telepsychiatry training and digital literacy among psychiatrists. Digit Health 2023; 9:20552076231191040. [PMID: 37529538 PMCID: PMC10387674 DOI: 10.1177/20552076231191040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- Faisal A Nawaz
- Al Amal Psychiatric hospital, Emirates Health Services, Dubai, United Arab Emirates
| | - Wajeeha Bilal
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hira Anas Khan
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ruthwik Duvuru
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hanan Derby
- Mental Health Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, Amoud University School of Medicine and School of Public Health, Borama, Somaliland
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Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
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Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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Abstract
The utilization of telemedicine and telepsychiatry (TP) services in the outpatient department (OPD) has been increasing in recent years. The information about the technological, administrative, and clinical challenges is being addressed by the telemedicine and TP guidelines published by several individual nations. TP aims to address the treatment gaps, barriers for utilization, accessibility, diagnostic validity, financial implications, and individual client preferences. Utilization of TP in the OPD varies from country to country depending upon their healthcare delivery systems. It also varies in populations utilizing the TP services-urban, rural, child and adolescent, geriatric, and differently abled. TP services in the OPDs are being incorporated differentially by government organizations, insurance recognized psychiatric healthcare organizations, private psychiatric group practice deliverers, and individual, standalone psychiatric healthcare deliverers. TP may not replace the traditional in-person consultations completely. Covid-19 pandemic has hastened its utilization across several healthcare delivery systems. Healthcare organizations, clinicians, other healthcare deliverers, and end users are in the process of adapting to the new scenario. Incorporation of the big data, machine learning, artificial intelligence, virtual reality, and other technological advances in the psychiatric healthcare delivery systems into TP services in the OPDs would significantly contribute to the overall quality and efficacy of the psychiatric healthcare delivery systems in the future.
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Affiliation(s)
| | | | - Amala Emani
- Columbus Hospital, Hyderabad, Telangana, India
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Roncero C, Remon D, Casado-Espada NM, Aguilar L, Gamonal-Limcaoco S, Gallego MT, Bote B, Montejo AL, Buch B. Perception and satisfaction in telemedicine on Mental Health among professionals during the COVID outbreak. A real-world experience in telepsychiatry. (Preprint). JMIR Form Res 2020. [DOI: 10.2196/22224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Santesteban-Echarri O, Piskulic D, Nyman RK, Addington J. Telehealth interventions for schizophrenia-spectrum disorders and clinical high-risk for psychosis individuals: A scoping review. J Telemed Telecare 2020; 26:14-20. [PMID: 30134781 DOI: 10.1177/1357633x18794100] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite its increased use in mental health, both health care provision by telehealth and research are in the early stages. Videoconferencing, a telehealth subfield, has been mainly used for the medication management and delivery of psychological treatments for mood, adjustment and anxiety disorders, and to a lesser extent for psychotic disorders. OBJECTIVES The focus of this scoping review is on studies using videoconferencing for intervention for individuals with a diagnosis of schizophrenia-spectrum disorder and those who may be considered to be in the very early stages of psychosis (clinical high risk). The aim of this review is to assess the feasibility, acceptability and clinical benefits of videoconferencing interventions and compare them with face-to-face interventions for this population. METHODS A scoping review of peer-reviewed original research on the use of videoconferencing for intervention purposes in individuals with a schizophrenia-spectrum disorder or at clinical high risk. RESULTS Out of 13,750 citations, 60 articles were retrieved for detailed evaluation, resulting in 14 eligible studies (N = 439 individuals). There was no study reporting on videoconferencing interventions for individuals at clinical high risk. All the studies reported that videoconferencing implementation was feasible, and most of them described high acceptance by individuals with a schizophrenia-spectrum disorder. However, selection bias of studies was high, and overall methodological quality was poor. CONCLUSION Videoconferencing interventions seem feasible for participants with schizophrenia-spectrum disorder who showed high acceptance of this intervention modality.
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Affiliation(s)
| | - Danijela Piskulic
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Rowen K Nyman
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Canada
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Jones RM, Leonard S, Birmingham L. Setting up a telepsychiatry service. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.12.464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Telepsychiatry is the delivery of healthcare and the exchange of healthcare information for purposes of providing psychiatric services across distances (Yellowlees et al, 2003). In practice, this most often means an interaction between a patient and clinician who are in different sites, through the use of transmitted live sound and video images. The term telepsychiatry was first used by Dwyer in 1973 who described the use of closed-circuit television at Massachusetts General Hospital for consultations between psychiatrists and patients. However, telemedicine was pioneered at the Nebraska Psychiatric Institute nearly 20 years earlier (Wittson & Dutton, 1956).
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Abstract
With new developments in image generation and transmission, researchers have studied the feasibility of using comunications technology for remote diagnosis and care delivery. The term ‘telepsychiatry’ has been used to describe the application of telemedicine and telecare to mental health. This article reviews the development of telepsychiatry and key research findings. Results suggest that service users are more comfortable with mediated services than are professsonals. Most work has been done in areas of low population density, where accessibility to conventional services is limited by economics and geography. In urban settings, with distributed community services, telepsychiatry can improve communication between primary and secondary sectors and within secondary services.
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Stein DJ. Psychiatry on the Internet: survey of an OCD mailing list. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.21.2.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Professionals and consumers have joined psychiatric support groups on the Internet. This paper reports on a survey of members of an obsessive-compulsive disorder (OCD) mailing list (OCD-L). Members, who were primarily patients with OCD, but included family members and professionals, were generally positive about the benefits of the list, finding it a useful source of information about treatment, and a helpful source of support. It is concluded that a useful component of the management of OCD may include Joining OCD–L or a similar Internet support group, as benefits seem to outweigh possible problems. Further study of other Internet psychiatric support groups, which may differ significantly from OCD–L, seems warranted.
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Barrera-Valencia C, Benito-Devia AV, Vélez-Álvarez C, Figueroa-Barrera M, Franco-Idárraga SM. [Cost-effectiveness of Synchronous vs. Asynchronous Telepsychiatry in Prison Inmates With Depression]. ACTA ACUST UNITED AC 2016; 46:65-73. [PMID: 28483175 DOI: 10.1016/j.rcp.2016.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/10/2015] [Accepted: 04/15/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Telepsychiatry is defined as the use of information and communication technology (ICT) in providing remote psychiatric services. Telepsychiatry is applied using two types of communication: synchronous (real time) and asynchronous (store and forward). OBJECTIVE To determine the cost-effectiveness of a synchronous and an asynchronous telepsychiatric model in prison inmate patients with symptoms of depression. METHODS A cost-effectiveness study was performed on a population consisting of 157 patients from the Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. The sample was determined by applying Zung self-administered surveys for depression (1965) and the Hamilton Depression Rating Scale (HDRS), the latter being the tool used for the comparison. RESULTS Initial Hamilton score, arrival time, duration of system downtime, and clinical effectiveness variables had normal distributions (P>.05). There were significant differences (P<.001) between care costs for the different models, showing that the mean cost of the asynchronous model is less than synchronous model, and making the asynchronous model more cost-effective. CONCLUSIONS The asynchronous model is the most cost-effective model of telepsychiatry care for patients with depression admitted to a detention centre, according to the results of clinical effectiveness, cost measurement, and patient satisfaction.
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Affiliation(s)
- Camilo Barrera-Valencia
- Grupo Telesalud, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia.
| | | | - Consuelo Vélez-Álvarez
- Departamento de Salud Pública, Grupo de Investigación, Promoción de Salud y Prevención de la Enfermedad, Universidad de Caldas, Manizales, Colombia
| | - Mario Figueroa-Barrera
- Departamento de Salud Mental, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia
| | - Sandra Milena Franco-Idárraga
- Departamento de Salud Pública, Grupo de Investigación, Promoción de Salud y Prevención de la Enfermedad, Universidad de Caldas, Manizales, Colombia
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Bashiri M, Greenfield LJ, Oliveto A. Telemedicine Interest for Routine Follow-Up Care Among Neurology Patients in Arkansas. Telemed J E Health 2015; 22:514-8. [PMID: 26684500 DOI: 10.1089/tmj.2015.0112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Teleneurology in Arkansas has been used primarily for management of acute stroke with a state-funded hub-and-spoke model allowing physicians at rural hospitals to access vascular neurologists in time to facilitate tissue plasminogen activator administration. Routine neurologic care has been provided only in small pilot studies. We wished to determine patient interest in participating in teleneurology for routine follow-up visits as well as demographic and medical factors associated with interest. MATERIALS AND METHODS New and established patients of the Neurology Outpatient Clinic at the University of Arkansas for Medical Sciences (UAMS) were surveyed between March 2011 and December 2012 to assess their interest in participating in teleneurology as well as potential factors associated with their interest. RESULTS Of 1,441 respondents, 52.4% were interested in telemedicine. Of those interested versus uninterested in telemedicine, respectively, 68.9% versus 36.32% traveled more than 1 h to the clinic, 64.7% versus 35.3% had difficulty secondary to neurological conditions, 22.6% versus 6.8% had missed medical appointments due to travel problems, and 43.1% versus 9.4% had travel-imposed financial hardship. CONCLUSIONS Telemedicine interest for routine follow-up visits was strong among patients at the UAMS Neurology Outpatient Clinic. Factors positively associated with interest included long travel distances, travel expenses, and transportation difficulties. These results suggest that implementing a telemedicine program for follow-up visits would be acceptable to neurology patients for routine ongoing care.
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Affiliation(s)
- Maryam Bashiri
- 1 Interdisciplinary Biomedical Sciences Graduate Program, Clinical and Translational Sciences Track, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - L John Greenfield
- 2 Department of Neurology, University of Arkansas for Medical Sciences , Little Rock, Arkansas
| | - Alison Oliveto
- 3 Department of Psychiatry, University of Arkansas for Medical Sciences , Little Rock, Arkansas
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Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry 2015; 5:286-304. [PMID: 26425443 PMCID: PMC4582305 DOI: 10.5498/wjp.v5.i3.286] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 02/05/2023] Open
Abstract
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
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Heckman BD, Lovejoy TI, Heckman TG, Anderson T, Grimes T, Sutton M, Bianco JA. The moderating role of sexual identity in group teletherapy for adults aging with HIV. Behav Med 2015; 40:134-42. [PMID: 25090366 DOI: 10.1080/08964289.2014.925417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV.
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Supportive-expressive and coping group teletherapies for HIV-infected older adults: a randomized clinical trial. AIDS Behav 2013; 17:3034-44. [PMID: 23474642 DOI: 10.1007/s10461-013-0441-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This clinical trial tested whether telephone-administered supportive-expressive group therapy or coping effectiveness training reduce depressive symptoms in HIV-infected older adults. Participants from 24 states (N = 361) completed the Geriatric Depression Scale at pre-intervention, post-intervention, and 4- and 8-month follow-up and were randomized to one of three study arms: (1) 12 weekly sessions of telephone-administered, supportive-expressive group therapy (tele-SEGT; n = 122); (2) 12 weekly sessions of telephone-administered, coping effectiveness training (tele-CET; n = 118); or (3) a standard of care (SOC) control group (n = 121). Tele-SEGT participants reported fewer depressive symptoms than SOC controls at post-intervention (MSEGT = 11.9, MSOC = 14.3) and 4- (MSEGT = 12.5, MSOC = 14.4) and 8-month follow-up (MSEGT = 12.7, MSOC = 14.5) and fewer depressive symptoms than tele-CET participants at post-intervention (MSEGT = 12.4, MCET = 13.6) and 8-month follow-up (MSEGT = 12.7, MCET = 14.1). Tele-CET participants reported no statistically significant differences from SOC controls in GDS values at any assessment period. Tele-SEGT constitutes an efficacious treatment to reduce depressive symptoms in HIV-infected older adults.
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Trajković G, Starčević V, Latas M, Leštarević M, Ille T, Bukumirić Z, Marinković J. Reliability of the Hamilton Rating Scale for Depression: a meta-analysis over a period of 49 years. Psychiatry Res 2011; 189:1-9. [PMID: 21276619 DOI: 10.1016/j.psychres.2010.12.007] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 11/24/2010] [Accepted: 12/05/2010] [Indexed: 11/30/2022]
Abstract
The aim of this study was to provide a comprehensive meta-analytic review of the reliability of the Hamilton Rating Scale for Depression (HRSD) for the period 1960-2008, taking into consideration all three types of reliability: internal consistency, inter-rater, and test-retest reliability. This is the first such meta-analytic study of a clinician-administered psychiatric scale. A thorough literature search was conducted using MEDLINE and PsycINFO. The total number of collected articles was 5548, of which 409 reported one or more reliability coefficients. The effect size was obtained by the z-transformation of reliability coefficients. The meta-analysis was performed separately for internal consistency, inter-rater and test-retest reliability. A pooled mean for alpha coefficient in random effects model was 0.789 (95%CI 0.766-0.810). The meta-regression analysis revealed that higher alpha coefficients were associated with higher variability of the HRSD total scores. With regard to inter-rater reliability, pooled means in random effects model were 0.937 (95%CI 0.914-0.954) for the intraclass correlation coefficient, 0.81 (95%CI 0.72-0.88) for the kappa coefficient, 0.94 (95%CI 0.90-0.97) for the Pearson correlation coefficient, and 0.91 (95%CI 0.78-0.96) for the Spearman rank correlation coefficient. A meta-regression analysis showed positive association between inter-rater reliability and publication year. Test-retest reliability of HRSD ranged between 0.65 and 0.98 and generally decreased with extending the interval between two measurements (Spearman r between the duration of interval and test-retest reliability figures=-0.74). Results suggest that HRSD provides a reliable assessment of depression. Figures indicate good overall levels of internal consistency, inter-rater and test-retest reliability, but some HRSD items (e.g., "loss of insight") do not appear to possess a satisfactory reliability.
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Affiliation(s)
- Goran Trajković
- Institute of Medical Statistics and Informatics, University of Belgrade, School of Medicine, Dr Subotica 15, Belgrade, Serbia.
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Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
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Rosenheck RA, Krystal JH, Lew R, Barnett PG, Thwin SS, Fiore L, Valley D, Huang GD, Neal C, Vertrees JE, Liang MH. Challenges in the design and conduct of controlled clinical effectiveness trials in schizophrenia. Clin Trials 2011; 8:196-204. [PMID: 21270143 DOI: 10.1177/1740774510392931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The introduction of antipsychotic medication has been a major advance in the treatment of schizophrenia and allows millions of people to live outside of institutions. It is generally believed that long-acting intramuscular antipsychotic medication is the most effective approach to increasing medication adherence and thereby reduce relapse in high-risk patients with schizophrenia, but the data are scant. PURPOSE To report the design of a study to assess the effect of long-acting injectable risperidone in unstable patients and under more realistic conditions than previously studied and to evaluate the effect of this medication on psychiatric inpatient hospitalization, schizophrenia symptoms, quality of life, medication adherence, side effects, and health care costs. METHODS The trial was an open randomized clinical comparative effectiveness trial in patients with schizophrenia or schizo-affective disorders in which parenteral risperidone was compared to an oral antipsychotic regimen selected by each control patient's psychiatrist. Participants had unstable psychiatric disease defined by recent hospitalization or exhibition of unusual need for psychiatric services. The primary endpoint was hospitalization for psychiatric indications; the secondary endpoint was psychiatric symptoms. RESULTS Overall, 382 patients were randomized. Determination of a persons' competency to understand the elements of informed consent was addressed. The use of a closed-circuit TV interview for psychosocial measures provided an economical, high quality, reliable means of collecting data. A unique method for insuring that usual care was optimal was incorporated in the follow-up of all subjects. LIMITATIONS Patients with schizophrenia or schizo-affective disorders and with the common co-morbid illnesses seen in the VA are a challenging group of subjects to study in long-term trials. Some techniques unique in the VA and found useful may not be generalizable or applicable in other research or treatment settings. CONCLUSIONS The trial tested a new antipsychotic medication early in its adoption in the Veterans Health Administration. The VA has a unique electronic medical record and database which can be used to identify the endpoint, that is, first hospitalization due to a psychiatric problem, with complete ascertainment. Several methodologic solutions addressed competency to understand elements of consent, the costs and reliability of collecting interview data gathering, and insuring usual care.
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Affiliation(s)
- Robert A Rosenheck
- Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT, USA.
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Abstracts from CyberTherapy 14. Designing the Future of Healthcare. June 21-23, 2009. Lago Maggiore, Verbania, Italy. CYBERPSYCHOLOGY & BEHAVIOR : THE IMPACT OF THE INTERNET, MULTIMEDIA AND VIRTUAL REALITY ON BEHAVIOR AND SOCIETY 2009; 12:581-673. [PMID: 19817570 DOI: 10.1089/cpb.2009.9991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:323-338. [PMID: 20161010 PMCID: PMC2758653 DOI: 10.1111/j.1468-2850.2009.01170.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Affiliation(s)
| | | | - Anouk L. Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY : A PUBLICATION OF THE DIVISION OF CLINICAL PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2009. [PMID: 20161010 DOI: 10.1111/j.1468‐2850.2009.01170.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Porcari CE, Amdur RL, Koch EI, Richard DCS, Favorite T, Martis B, Liberzon I. Assessment of post-traumatic stress disorder in veterans by videoconferencing and by face-to-face methods. J Telemed Telecare 2009; 15:89-94. [PMID: 19246609 DOI: 10.1258/jtt.2008.080612] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We compared videoconferencing and face-to-face (FTF) assessments for veterans seeking a mental health evaluation for post-traumatic stress disorder (PTSD). The Clinician-Administered PTSD Scale (CAPS) interview was used in 20 male veterans. There were significant correlations (ranging from 0.74 to 0.92) between the CAPS administered FTF and by videoconferencing on all three subscales, as well as on the total severity score. The confidence intervals for the CAPS scores indicated statistical equivalence between administration FTF and by videoconferencing. The sensitivity of videoconferencing was 0.94 and the specificity was 0.33, compared with FTF assessment. The total and subscale scores suggested that there was a moderate working alliance with both methods. The patients indicated general satisfaction with the videoconferencing method. Most of them indicated that they would prefer to see a clinician FTF, but would utilize videoconferencing if there were distance barriers to services. Overall, the results of the present study support the use of videoconferencing in the assessment of PTSD.
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Affiliation(s)
- Carole E Porcari
- Research Service (151), Washington DC VA Medical Center, 50 Irving Street NW, Washington, DC 20422, USA
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Rationale and design: telepsychology service delivery for depressed elderly veterans. Trials 2009; 10:22. [PMID: 19379517 PMCID: PMC2681467 DOI: 10.1186/1745-6215-10-22] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/20/2009] [Indexed: 01/17/2023] Open
Abstract
Background Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas. Methods We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use). Discussion Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services. Trial registration National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).
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Antonacci DJ, Bloch RM, Saeed SA, Yildirim Y, Talley J. Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: implications for forensic and correctional psychiatry. BEHAVIORAL SCIENCES & THE LAW 2008; 26:253-69. [PMID: 18548519 DOI: 10.1002/bsl.812] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A growing body of literature now suggests that use of telepsychiatry to provide mental health services has the potential to solve the workforce shortage problem that directly affects access to care, especially in remote and underserved areas. Live interactive two-way audio-video communication-videoconferencing-is the modality most applicable to psychiatry and has become synonymous with telepsychiatry involving patient care, distance education, and administration. This article reviews empirical evidence on the use and effectiveness of videoconferencing in providing diagnostic and treatment services in mental health settings that serve child, adolescent, and adult populations. Descriptive reports, case studies, research articles, and randomized controlled trials related to clinical outcomes were identified and reviewed independently by two authors. Articles related to cost-effectiveness, technological issues, or legal or ethical aspects of telepsychiatry were excluded. The review of the evidence broadly covers mental health service provision in all settings, including forensic settings. Given the sparse literature on telepsychiatry in forensic settings, we discuss implications for mental health care across settings and populations and comment on future directions and potential uses in forensic or correctional psychiatry.
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Affiliation(s)
- Diana J Antonacci
- Department of Psychiatric Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
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Williams JBW, Ellis A, Middleton A, Kobak KA. Primary care patients in psychiatric clinical trials: a pilot study using videoconferencing. Ann Gen Psychiatry 2007; 6:24. [PMID: 17916254 PMCID: PMC2093932 DOI: 10.1186/1744-859x-6-24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 10/04/2007] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND While primary care physicians play a pivotal role in the treatment of depression, collaboration between primary care and psychiatry in clinical research has been limited. Primary care settings provide unique opportunities to improve the methodology of psychiatric clinical trials, by providing more generalizable and less treatment-resistant patients. We examined the feasibility of identifying, recruiting, screening and assessing primary care patients for psychiatric clinical trials using high-quality videoconferencing in a mock clinical trial. METHODS 1329 patients at two primary care clinics completed a self-report questionnaire. Those screening positive for major depression, panic, or generalized anxiety were given a diagnostic interview via videoconference. Those eligible were provided treatment as usual by their primary care physician, and had 6 weekly assessments by the off-site clinician via videoconferencing. RESULTS 45 patients were enrolled over 22 weeks, with 36 (80%) completing the six-week study with no more than two missed appointments. All diagnostic groups improved significantly; 94% reported they would participate again, 87% would recommend participation to others, 96% felt comfortable communicating via videoconference, and 94% were able to satisfactorily communicate their feelings via video. CONCLUSION Results showed that primary care patients will enroll, participate in and complete psychiatric research protocols using remote interviews conducted via videoconference.
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Affiliation(s)
- Janet BW Williams
- MedAvante, Inc., MedAvante Research Institute, Hamilton, NJ, USA
- Columbia University, Dept. of Psychiatry, New York, NY, USA
| | - Amy Ellis
- MedAvante, Inc., MedAvante Research Institute, Hamilton, NJ, USA
| | | | - Kenneth A Kobak
- MedAvante, Inc., MedAvante Research Institute, Hamilton, NJ, USA
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Biederman J, Ball SW, Mick E, Monuteaux MC, Kaiser R, Bristol E, Faraone SV. Informativeness of maternal reports on the diagnosis of ADHD: an analysis of mother and youth reports. J Atten Disord 2007; 10:410-7. [PMID: 17449840 DOI: 10.1177/1087054706295656] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We evaluated correlates of the diagnosis of ADHD in youth by informant source. METHOD Ninety-four pairs of mother reports and youth self-reports on ADHD were independently assessed, using diagnostic interviews from a large study of youth of both genders with and without ADHD. Comparisons were made on measures of interpersonal, school, and family functioning; treatment history; and parental psychopathology by informant source. RESULTS With the exception of higher rates of ADHD-associated impairment and higher frequency of treatment for ADHD in the combined youth-mother group. There were no other differences in any other clinical or familial correlates by informant source; both informant groups had higher levels of impairment in multiple nonoverlapping measures of dysfunction than controls. Males were overrepresented among the mother-only group. CONCLUSION Maternal reports of ADHD result in a meaningful diagnosis of ADHD with high levels of impairment, regardless of endorsement by the affected youth.
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Affiliation(s)
- Joseph Biederman
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Elliott J, Chapman J, Clark DJ. Videoconferencing for a Veteran’s Pain Management Follow-Up Clinic. Pain Manag Nurs 2007; 8:35-46. [PMID: 17336868 DOI: 10.1016/j.pmn.2006.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The under treatment of pain has been well documented. Contributing to this is the limited availability of pain management specialists in many geographic areas. The use of technology to provide care to underserved areas is gaining momentum. We chose to study whether stable patients and staff in chronic pain clinic were satified with the use of a videoconferencing format in care delivery. Our goals were to determine whether patients and staff could successfully operate the extant videoconferencing equipment, was the equipment dependably functional, was the use of a videoconferencing format an acceptable method of healthcare delivery for both patients and staff, whether patients and staff were satisfied with the process, and whether this was a cost-effective mode of care delivery. Thirty-six patients were enrolled over 29 months. Questionnaires were administered to staff and patients. Routine pain clinic patient assessment tools were administered. Results showed the use of videoconferencing for this group of patients is useable and satisfactory for both patients and staff, that the patients save time and money, and that for a system where videoconferencing equipment is already in use, it is also cost effective. Staff were able to identify new patient problems. Some patients would prefer to be seen in person but find that the savings in time and money override this preference. Hearing impaired patients have difficulty using this medium. Dependable equipment and phone connections are needed. A videoconferencing clinic format is a clinically acceptable and cost effective method for follow-up of stable patients with chronic pain.
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Abstract
This article analyzes telemedicine, the use of distant communication technologies within the context of clinical health care, and the effects it has on health communication. The main effect is that telemedicine has the capacity to substantially transform health care in both positive and negative ways and to radically modify personal face-to-face communication (Turner, 2003). This has tremendous implications for health communication scholars in that they can extend the telemedicine debate by integrating fresh insights into more acceptable approaches that will refine and humanize mediated channels of health communication. There are several key areas of telemedicine that need to be discussed (i.e., e-health services, clinical encounters, etc.), all of which are identified in this article. In addition to describing the past and current applications of telemedicine, this article provides a better understanding of unique needs, resources, problems, and opportunities germane to telemedicine services.
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Affiliation(s)
- Jonathan Matusitz
- Nicholson School of Communication, University of Central Florida, Orland, FL 32816, USA.
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Modai I, Jabarin M, Kurs R, Barak P, Hanan I, Kitain L. Cost effectiveness, safety, and satisfaction with video telepsychiatry versus face-to-face care in ambulatory settings. Telemed J E Health 2006; 12:515-20. [PMID: 17042703 DOI: 10.1089/tmj.2006.12.515] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Videoconference telepsychiatry provides an alternative for the psychiatric treatment of mental health patients who reside in remote communities. The objective of this study was to compare institutional ambulatory and hospitalization costs, treatment adherence, patient and physician satisfaction, and treatment safety between mental healthcare via videoconferencing and care provided in person. Data collected for 1 year of telepsychiatry treatment was compared to that of the preceding year and a matched comparison group. Twenty-nine patients from Or Akiva and 20 patients from Reut Hostel in Hadera who met the inclusion criteria agreed to participate; 24 and 15 patients, respectively, completed the study. Forty-two matched patients, who continued face-to-face interviews, comprised the comparison group. Drop-out patients and those who did not consent to telepsychiatry treatment were not involved. During the year of telepsychiatry treatment, patients and physicians were satisfied and treatment was safe. However, 1 hour of telepsychiatry treatment was more expensive than face-to-face care, and a tendency of increased hospitalizations was noted. Adherence ratios before and during telepsychiatry treatment were similar, but were twice as high versus the comparison group. The limited sample size precludes the drawing of definite conclusions, and further studies involving a larger study population and longer duration of investigation is warranted.
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Affiliation(s)
- Ilan Modai
- Shaar-Menashe Mental Health Center, Mobile Post Hefer, Israel.
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Himle JA, Fischer DJ, Muroff JR, Van Etten ML, Lokers LM, Abelson JL, Hanna GL. Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder. Behav Res Ther 2006; 44:1821-9. [PMID: 16466688 DOI: 10.1016/j.brat.2005.12.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Revised: 12/12/2005] [Accepted: 12/20/2005] [Indexed: 10/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.
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Affiliation(s)
- Joseph A Himle
- The University of Michigan Department of Psychiatry, 2101 Commonwealth Ave, Ann Arbor, MI 48105, USA.
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Nelson EL, Palsbo S. Challenges in telemedicine equivalence studies. EVALUATION AND PROGRAM PLANNING 2006; 29:419-425. [PMID: 17950871 DOI: 10.1016/j.evalprogplan.2006.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Revised: 04/01/2005] [Accepted: 02/01/2006] [Indexed: 05/25/2023]
Abstract
As the number of telemedicine programs continues to grow, the accuracy of diagnosis over interactive televideo is a central concern. Although investigators have begun to address diagnostic equivalency in telehealth clinics, few published studies reflect strong research design. The two presented telehealth programs completed randomized controlled trials in real-world clinical settings that addressed some of the methodologic shortcomings of prior studies. Diagnostic equivalency studies were completed across five telehealth specialty clinics: physical therapy, speech therapy, ambulatory pediatrics, child psychiatry, and developmental disabilities services. The two research teams encountered similar decision points in designing and implementing the equivalency protocols. This article addresses methodologic issues in choosing design, participants, technology, and evaluation measures. Although the paper focuses on interactive televideo, the issues raised are pertinent across telehealth technologies.
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Affiliation(s)
- Eve-Lynn Nelson
- Kansas University Medical Center, 2012 Wahl Annex, MS 1048, 3901 Rainbow Blvd. Kansas City, KS 66160, USA
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Grady BJ, Melcer T. A Retrospective Evaluation of TeleMental Healthcare Services for Remote Military Populations. Telemed J E Health 2005; 11:551-8. [PMID: 16250818 DOI: 10.1089/tmj.2005.11.551] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The objective of this study was to compare specific treatment and outcome variables between mental health care via videoconferencing to care provided in person. The study was a retrospective record review of service members and their adult civilian family members seen at two remotely located military bases. One group was seen via video conferencing (telemental health care [TMHC]) while a second group was seen face-to-face care (FTFC) and served as a control group. Chi-square tests were used to test for significance associations between therapy format and secondary variables. The Global Assessment of Functioning was unexpectedly and significantly more improved for the TMHC group than the FTFC care group. Mean change in Global Assessment of Functioning for FTFC (8.4) was significantly less than mean change for TMHC (15.3). There were no significant differences between the groups in the number of laboratories or studies ordered, self-help recommendations made, selected mental status elements, or number of patients prescribed two or more psychotropic medications. The rate of full compliance with the medication plan and follow-up appointments was significantly better for TMHC. Providers using TMHC told more patients to return for follow-up appointments in 30 days or less. Improved compliance, the unique interpersonal processes of care via TMH, and slightly shorter times to next follow-up appointment were the chief contributors. Alterations in the process of communication may have implications in the business, political, and military sectors.
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Affiliation(s)
- Brian J Grady
- Sheppard Pratt Health System, TeleBehavioral Services, Baltimore, Maryland, USA.
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Hyler SE, Gangure DP, Batchelder ST. Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies. CNS Spectr 2005; 10:403-13. [PMID: 15858458 DOI: 10.1017/s109285290002277x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The authors conducted a review and meta-analysis of the literature comparing telepsychiatry with "in-person" psychiatric assessments. METHOD Approximately 380 studies on telepsychiatry published between 1956 and 2002 were identified using MEDLINE, PsycINFO, and cross-referenced bibliographies. Of these, 14 studies with an N > 10 compared telepsychiatry with in-person psychiatry (I-P) using objective assessment instruments or satisfaction instruments. Three of these studies compared high bandwidth (HB) with low bandwidth (LB) telepsychiatry. RESULTS Fourteen studies of 500 patients met inclusion criteria and were included in the meta-analysis. Telepsychiatry was found to be similar to I-P for the studies using objective assessments. Effect sizes were on average quite small, suggesting no difference between telepsychiatry and I-P. Bandwidth was found to be a significant moderator. Three moderators were tested, effect sizes remained largely heterogeneous, and further analyses are needed to determine the direction of effect. There was no difference between I-P and telepsychiatry between the HB and LB groups, although there are anecdotal data suggesting that HB was slightly superior for assessments requiring detailed observation of subjects. CONCLUSION Out of a large telepsychiatry literature published over the past 40+ years, only a handful of studies have attempted to compare telepsychiatry with I-P directly using standardized assessment instruments that permit meaningful comparisons. However, in those studies, the current meta-analysis concludes there is no difference in accuracy or satisfaction between the two modalities. Over the next few years, we expect telepsychiatry to replace I-P in certain research and clinical situations.
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Affiliation(s)
- Steven E Hyler
- Department of Psychiatry, Columbia University, New York, NY, USA.
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Abstract
OBJECTIVE To evaluate a telepsychiatry clinical service to Wagga Wagga in rural New South Wales, comprising a face-to-face interview with a psychiatrist followed by a telepsychiatry interview with a Sydney-based psychiatrist. METHODS Thirty-one patients were referred to a specialist mood disorder clinic in a rural setting for consultation and assessment. A retrospective evaluation was made to determine the acceptance of the teleconferenced psychiatry and face-to-face psychiatry, as well as the overall patient response. RESULTS Twenty participants completed all evaluation components. Their results indicated a satisfaction level of 95% with the consultation process as a whole, with 80% happy to use telepsychiatry again and 60% preferring telepsychiatry over travelling to a larger centre for face-to-face consultation. The face-to-face component was satisfactory for 85% of patients while the telepsychiatry component was satisfactory for 72%. CONCLUSIONS Although face-to-face psychiatry was preferred by this sample, the telepsychiatry component was highly rated and preferred over travel to larger centres for face-to-face consultation, by residents of rural and remote locations. Certain issues are of more concern in telepsychiatry than face-to-face psychiatry, including confidentiality, rapport, explanation and education.
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Affiliation(s)
- James Greenwood
- School of Rural Health, University of New South Wales, Sydney, NSW, Australia.
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Cruz M, Cruz RF, Krupinski EA, Lopez AM, McNeeley RM, Weinstein RS. Effect of camera resolution and bandwidth on facial affect recognition. Telemed J E Health 2005; 10:392-402. [PMID: 15650536 DOI: 10.1089/tmj.2004.10.392] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This preliminary study explored the effect of camera resolution and bandwidth on facial affect recognition, an important process and clinical variable in mental health service delivery. Sixty medical students and mental health-care professionals were recruited and randomized to four different combinations of commonly used teleconferencing camera resolutions and bandwidths: (1) one chip charged coupling device (CCD) camera, commonly used for VHSgrade taping and in teleconferencing systems costing less than $4,000 with a resolution of 280 lines, and 128 kilobytes per second bandwidth (kbps); (2) VHS and 768 kbps; (3) three-chip CCD camera, commonly used for Betacam (Beta) grade taping and in teleconferencing systems costing more than $4,000 with a resolution of 480 lines, and 128 kbps; and (4) Betacam and 768 kbps. The subjects were asked to identify four facial affects dynamically presented on videotape by an actor and actress presented via a video monitor at 30 frames per second. Two-way analysis of variance (ANOVA) revealed a significant interaction effect for camera resolution and bandwidth (p = 0.02) and a significant main effect for camera resolution (p = 0.006), but no main effect for bandwidth was detected. Post hoc testing of interaction means, using the Tukey Honestly Significant Difference (HSD) test and the critical difference (CD) at the 0.05 alpha level = 1.71, revealed subjects in the VHS/768 kbps (M = 7.133) and VHS/128 kbps (M = 6.533) were significantly better at recognizing the displayed facial affects than those in the Betacam/768 kbps (M = 4.733) or Betacam/128 kbps (M = 6.333) conditions. Camera resolution and bandwidth combinations differ in their capacity to influence facial affect recognition. For service providers, this study's results support the use of VHS cameras with either 768 kbps or 128 kbps bandwidths for facial affect recognition compared to Betacam cameras. The authors argue that the results of this study are a consequence of the VHS camera resolution/bandwidth combinations' ability to improve signal detection (i.e., facial affect recognition) by subjects in comparison to Betacam camera resolution/bandwidth combinations.
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Affiliation(s)
- Mario Cruz
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA.
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Nelson EL, Zaylor C, Cook D. A Comparison of Psychiatrist Evaluation and Patient Symptom Report in a Jail Telepsychiatry Clinic. Telemed J E Health 2004. [DOI: 10.1089/tmj.2004.10.s-54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
OBJECTIVE To evaluate a telepsychiatry clinical service to Wagga Wagga in rural New South Wales, comprising a face-to-face interview with a psychiatrist followed by a telepsychiatry interview with a Sydney-based psychiatrist. METHODS Thirty-one patients were referred to a specialist mood disorder clinic in a rural setting for consultation and assessment. A retrospective evaluation was made to determine the acceptance of the teleconferenced psychiatry and face-to-face psychiatry, as well as the overall patient response. RESULTS Twenty participants completed all evaluation components. Their results indicated a satisfaction level of 95% with the consultation process as a whole, with 80% happy to use telepsychiatry again and 60% preferring telepsychiatry over travelling to a larger centre for face-to-face consultation. The face-to-face component was satisfactory for 85% of patients while the telepsychiatry component was satisfactory for 72%. CONCLUSIONS Although face-to-face psychiatry was preferred by this sample, the telepsychiatry component was highly rated and preferred over travel to larger centres for face-to-face consultation, by residents of rural and remote locations. Certain issues are of more concern in telepsychiatry than face-to-face psychiatry, including confidentiality, rapport, explanation and education.
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Affiliation(s)
- James Greenwood
- School of Rural Health, University of New South Wales, Sydney, NSW, Australia.
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Myers KM, Sulzbacher S, Melzer SM. Telepsychiatry with Children and Adolescents: Are Patients Comparable to Those Evaluated in Usual Outpatient Care? Telemed J E Health 2004; 10:278-85. [PMID: 15650522 DOI: 10.1089/tmj.2004.10.278] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Several studies have described successful applications of telepsychiatry with children and adolescents. However, there has been little examination of the populations served by telepsychiatry and the ability to evaluate youth accurately through this medium. In this article, we examined whether telepsychiatry patients are representative of those in usual outpatient care. Participants included 369 patients 3-19 years old evaluated at two clinics. A new telepsychiatry clinic (TPC) developed to provide services to under-served communities, and a child and adolescent psychiatric outpatient clinic (CAPOC) that served youth from predominantly metropolitan areas were included in the study. The telepsychiatry sites were linked using ISDN lines at 384 KB/sec. We examined these two samples regarding demographics, payor status, and diagnostic profiles. Results indicated that youth evaluated through the TPC were broadly comparable to youth evaluated in the CAPOC. Therefore, telepsychiatry appears to serve youth that are representative of those seeking psychiatric care, and it is not restricted to youth with no medical insurance or with selected diagnoses. The similarity of diagnoses further suggests that telepsychiatry provides adequate technical resolution and doctor-patient rapport to detect psychopathology of youths. These findings suggest the need for further systematic investigation of telepsychiatry as a tool for providing psychiatric care to young people.
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Affiliation(s)
- Kathleen M Myers
- Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
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Wegge J, Bipp T. Videokonferenzen in Organisationen: Chancen, Risiken und personalpsychologisch relevante Anwendungsfelder. ACTA ACUST UNITED AC 2004. [DOI: 10.1026/1617-6391.3.3.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Zusammenfassung. Arbeit mit verschiedenen Formen von Videokonferenzsystemen nimmt stetig zu. Neben der Teilnahme an Konferenzen ermöglichen insbesondere pc-basierte Systeme vielfältige Interaktionsprozesse (z. B. Beratung, Befragung, Anweisung, Datentransfer), die sowohl zwischen organisationsinternen (Vorgesetzte, Mitarbeiter, Teleheimarbeiter etc.) als auch zwischen organisationsexternen Akteuren wie z. B. Kunden, Klienten, Bewerbern oder Patienten stattfinden können. Weil Videokonferenzen (VK) im Vergleich zu herkömmlichen Kommunikationssituationen (z. B. Brief, Telefon, E-Mail) komplexere Interaktionsformen unterstützen und mit multimedialen VK nachhaltigere Wirkungen erzielt werden können, ergeben sich für die Personalpsychologie interessante neue Anwendungsmöglichkeiten. In diesem Übersichtsartikel wird zusammengefasst, was man über die aktuelle Verbreitung und allgemeinen Wirkungen (Chancen, Risiken) von VK weiß. Ferner wird bilanziert, welche Erkenntnisse mit Blick auf vier personalpsychologisch relevante Anwendungsgebiete - Mitarbeiterführung, Beratung, Personalentwicklung und Personalmarketing - heute vorliegen. Wenngleich der schon häufig vorhergesagte Boom von VK in der organisationalen Praxis noch auf sich warten lässt, ist es Zeit, die besonderen Probleme und Chancen dieser neuen Technik in der personalpsychologischen Arbeit mehr zu beachten.
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Hilty DM, Marks SL, Urness D, Yellowlees PM, Nesbitt TS. Clinical and educational telepsychiatry applications: a review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:12-23. [PMID: 14763673 DOI: 10.1177/070674370404900103] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Telepsychiatry in the form of videoconferencing brings enormous opportunities for clinical care, education, research, and administration. Focusing on videoconferencing, we reviewed the telepsychiatry literature and compared telepsychiatry with services delivered in person or through other technologies. METHODS We conducted a comprehensive review of telepsychiatry literature from January 1, 1965, to July 31, 2003, using the terms telepsychiatry, telemedicine, videoconferencing, effectiveness, efficacy, access, outcomes, satisfaction, quality of care, education, empowerment, and costs. We selected studies for review if they discussed videoconferencing for clinical and educational applications. RESULTS Telepsychiatry is successfully used for various clinical services and educational initiatives. Telepsychiatry is feasible, increases access to care, enables specialty consultation, yields positive outcomes, allows reliable evaluation, has few negative aspects in terms of communication, generally satisfies patients and providers, facilitates education, and empowers parties using it. Data are limited with regard to clinical outcomes and cost-effectiveness. CONCLUSIONS Telepsychiatry is effective. More short- and long-term quantitative and qualitative research is warranted on clinical outcomes, predictors of satisfaction, costs, and educational outcomes.
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Abstract
Four case studies were conducted in Georgia, Pennsylvania, Ohio, and Wisconsin to uncover factors that played key roles in state telemedicine initiatives. Factors that affect the success of state telemedicine initiatives include telecommunications infrastructure, correctional facilities, need for a champion, user buy-in, competition in the healthcare market, timing of the government's action, and financial support for the initiatives. How these factors affect state telemedicine networks, the level of importance of the various factors, and potential state actions to leverage or dampen the effects of the various factors are reviewed.
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Mitchell JE, Myers T, Swan-Kremeier L, Wonderlich S. Psychotherapy for bulimia nervosa delivered via telemedicine. EUROPEAN EATING DISORDERS REVIEW 2003. [DOI: 10.1002/erv.517] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
Telepsychiatry, in the form of videoconferencing and other modalities, brings enormous opportunities for clinical care, education, research and administration to the field of medicine. A comprehensive review of the literature related to telepsychiatry - specifically videoconferencing - was conducted using the MEDLINE, Embase, Science Citation Index, Social Sciences Citation Index and Telemedicine Information Exchange databases (1965 to June 2001). The keywords used were telepsychiatry, telemedicine, videoconferencing, Internet, primary care, education, personal digital assistant and handheld computers. Studies were selected for review if they discussed videoconferencing for patient care, satisfaction, outcomes, education and costs, and provided models of facilitating clinical service delivery. Literature on other technologies was also assessed and compared with telepsychiatry to provide an idea of future applications of technology. Published data indicate that telepsychiatry is successfully used for a variety of clinical services and educational initiatives. Telepsychiatry is generally feasible, offers a number of models of care and consultation, in general satisfies patients and providers, and has positive and negative effects on interpersonal behaviour. More quantitative and qualitative research is warranted with regard to the use of telepsychiatry in clinical and educational programmes and interventions.
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Affiliation(s)
- Donald M Hilty
- University of California-Davis, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.
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Rost K, Fortney J, Fischer E, Smith J. Use, quality, and outcomes of care for mental health: the rural perspective. Med Care Res Rev 2002; 59:231-65; discussion 266-71. [PMID: 12205828 DOI: 10.1177/1077558702059003001] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review synthesizes empirical research in rural mental health services to identify current research priorities to improve the mental health of rural Americans. Using a conceptual framework of the multiple determinants of use, quality, and outcomes, the authors address (1) how key constructs are operationalized, (2) their theoretical influence on the care process, (3) reported differences for nonmetropolitan and metropolitan individuals or within nonmetropolitan individuals, (4) salient issues rural advocates have raised, and (5) key research questions. While the authors recognize that rurality is a useful political umbrella to organize advocacy efforts, they propose that investigators no longer employ any of the multiple definitions of the term in the literature as even intrarural comparisons have not provided compelling evidence about the underlying causes of observed outcomes differences. Until these underlying causes have been identified, it is difficult to determine which components of the nonmetropolitan service system need to be improved.
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Thurmond VA, Boyle DK. An Integrative Review of Patients' Perceptions Regarding Telehealth used in their Health Care. Worldviews Evid Based Nurs 2002. [DOI: 10.1111/j.1524-475x.2002.00012.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Simpson S. The provision of a telepsychology service to Shetland: client and therapist satisfaction and the ability to develop a therapeutic alliance. J Telemed Telecare 2002; 7 Suppl 1:34-6. [PMID: 11576484 DOI: 10.1177/1357633x010070s114] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a pilot study to assess the feasibility and acceptability of videoconferencing as a means of providing a clinical psychology service in the Shetland Islands. A general practitioner was equipped with a desktop PC-based system connected to a mainland hospital videoconferencing system by ISDN at 128 kbit/s. Qualitative methods were used to assess user satisfaction, the ability to form a therapeutic relationship and client improvement. Over one year, 10 patients (eight female, two male) participated in the videoconferencing therapy sessions. The psychologist and all but one of the clients were highly satisfied with the videoconferencing therapy sessions. The clients were able to develop a positive therapeutic relationship with the psychologist and all reported some improvement from therapy. The results showed that videoconferencing is a feasible and acceptable means of providing therapy to patients in remote areas.
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Affiliation(s)
- S Simpson
- Psychology Department, Royal Cornhill Hospital, Aberdeen, UK.
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Bakke B, Mitchell J, Wonderlich S, Erickson R. Administering cognitive-behavioral therapy for bulimia nervosa via telemedicine in rural settings. Int J Eat Disord 2001; 30:454-7. [PMID: 11746307 DOI: 10.1002/eat.1107] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This report describes the therapy of 2 women with bulimia nervosa who were treated using cognitive-behavioral therapy delivered via telemedicine. METHOD The telecommunication link was established using a 128-Kbps ISDN switchable data line. RESULTS Both cases were treated successfully and were doing well at 1-month follow-up. DISCUSSION These cases illustrate that this methodology may make it possible to deliver manual-based psychotherapies to patients with eating disorders in remote areas.
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Affiliation(s)
- B Bakke
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
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Jones BN, Johnston D, Reboussin B, McCall WV. Reliability of telepsychiatry assessments: subjective versus observational ratings. J Geriatr Psychiatry Neurol 2001; 14:66-71. [PMID: 11419569 DOI: 10.1177/089198870101400204] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geriatric patients in underserved areas could benefit from the use of telecommunications to expand access to mental health services. It is important to determine the clinical limitations of using videoconferencing for psychiatric assessments, particularly in the elderly. The goal of this study was to test the hypothesis that videoconferencing ratings based on visual observations of behavior would be less reliable than ratings based on patients' verbal reports of symptoms. Videoconferencing assessments of 30 geriatric patients using low-bandwidth (ISDN) equipment were compared to gold standard face-to-face assessments. The Brief Psychiatric Rating Scale (BPRS) was dichotomized into subjective items based on patients' verbal reports and observational items based on visual ratings of behavior. Reliability of the BPRS subjective items was consistently higher than for the observational items. Future studies should emphasize the accuracy of telemedicine ratings that require visual observation of behavior, which is crucial to clinical assessment of psychogeriatric conditions.
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Affiliation(s)
- B N Jones
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Grob P, Weintraub D, Sayles D, Raskin A, Ruskin P. Psychiatric assessment of a nursing home population using audiovisual telecommunication. J Geriatr Psychiatry Neurol 2001; 14:63-5. [PMID: 11419568 DOI: 10.1177/089198870101400203] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to demonstrate that psychiatric assessment of nursing home residents could be reliably carried out remotely via telecommunications. Twenty-seven nursing home residents each had two interviews consisting of the following three rating scales: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Brief Psychiatric Rating Scale (BPRS). The interviews were conducted by three trained psychiatrists, each of whom interviewed two-thirds of the subjects. Subjects were sequentially assigned to have either two in-person interviews (in-person group) or one in-person and one remote interview via telecommunication (remote group). Inter-rater reliability was calculated separately for each condition (in-person vs remote group) for each of the three rating scales. Intraclass correlations on the MMSE were .95 for the remote group and .83 for the in-person group. On the GDS, they were .82 for the remote group and .86 for the in-person group. Finally, on the BPRS, they were .81 for the remote group and .49 for the in-person group. There were no statistically significant differences in intraclass correlation on any of the three scales for the remote group compared with the in-person group, indicating that nursing home residents can be reliably assessed remotely via telecommunication.
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Affiliation(s)
- P Grob
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
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Alessi N. Geriatric telepsychiatry: no matter the population, the questions remain the same--a commentary. J Geriatr Psychiatry Neurol 2001; 14:88-90. [PMID: 11419573 DOI: 10.1177/089198870101400208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- N Alessi
- Department of Psychiatry, University of Michigan, Ann Arbor, 48109, USA
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Abstract
The quality of care provided by telemedicine and its acceptability to persons who live in rural areas is largely undetermined. In this study, service satisfaction and functional status in persons using telemedicine was compared to those receiving face-to-face services at two rural sites over a 2-year study period. Similar ratings of satisfaction and clinical status were observed in twelve patients who received services under both modalities. Although there are many obstacles to successful program implementation, telepsychiatry appears to offer an acceptable and adequate alternative mode of service delivery to persons who live in rural areas.
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Affiliation(s)
- B M Rohland
- Department of Health Services Research and Management, Texas Tech Health Sciences Center, Lubbock 79430, USA.
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