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Telepsychiatry, future implications in mental health services

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Telepsychiatry, future implications in mental health services

  1. 1. Telepsychiatry, future implications in mental health services Dr. Ahmed Albehairy, M.D Psychiatry Consultant
  2. 2. History and Background : • Telemedicine : has been defined as the intervention of a telecommunication device in the diagnosis and the overall care of patients that are separated from providers by a distance.
  3. 3. History and Background : • The use of videoconferencing in psychiatry began during the 1950s. • In 1959, Norfolk, the Nebraska Psychiatric Institute was using early videoconferencing to provide group therapy, long-term therapy, consultation-liasion psychiatry, and medical student training. • By the 2000s, outcome studies provided a platform for practice guidelines ( e.g. the American Telemedicine Association). APA and ATA have helped to disseminate information of guidelines in USA organization.
  4. 4. TELEMEDICINE
  5. 5. Modes, Scope, and Applications of Telepsychiatry
  6. 6. Modes of Communications • Synchronous ( mimic face to face ), or asynchronous(non real time, store and forward). • Through , telephone, cell phone messages, two way closed circuit television, E-mail, online chat , website & blogs, and virtual chat rooms. • Sets of communications :******** - Patient at home ± family with Physician at office ±team work. - Physician with Physician. - Patient in remote office ± family with Physician at office ±team work.
  7. 7. Scope of Telepsychiatry • Studies showed significant results as regard telepsychiatry validity and reliability of clinical assessments, clinical outcomes, outcomes in terms of acceptability and satisfaction of patients and clinicians, quality of life, and cost-effectiveness. • Direct clinical case management, education, and consultation–supervision. • Adults, children, adolescents, elderly, and in special populations such as in prison inmates and veterans.
  8. 8. Applications of Telepsychiatry • Depression disorders. • Panic disorder, agoraphobia, social phobia, and generalised anxiety disorders. • PTSD. • A.N & B.N. • Schizophrenia. • Emergency department. • Liasion consultation. • Consultation care model in 1ry care services. • CBT, Crisis intervention, and counseling. • Geriatric population, and Video link consultation and psychotherapeutic management of children and adolescents, (ADHD). • Forensic clinic .
  9. 9. Paramaters in Assessing Telepsychiatry Services Outcome • Quality of care (83% of patients were correctly diagnosed by DSM-IV through telepsychiatry ). • Access ( increased to the patients with locked apply care, rural areas, collage student, prisoners). • Cost ( reducing cost by more than 70% , but may cost more than face to face / hour ). • Technology ( standards, covered by insurance , problem in transmission speed sp. In rural areas as there s no fiber optics) • Licensure ( may appear if cover inter-counrties services). • Legal and ethical issues: Safety, security, and confidentiality ( compromised with self harm and suicide, filing , recordings, documentations). • Constraints ( billing and reimbursement, covering medical insurance ).
  10. 10. GUIDELINES OF TELEPSYCHIATRY . Clinical Guidelines of Telepsychiatry, APA . • . Guidelines for Telepsychiatry , Emergency Management. • Guidelines of Telepsychiatry Technology Standards.
  11. 11. Clinical Guidelines of Telepsychiatry, APA
  12. 12. Include: • General clinic procedures (schedule, documentation, records keeping, and rule of support staff ). • Physical environment. • Site and check in procedures. • Emergency procedures. • Patient enrollment and informed consent . • Role of interdisciplinary team. • Care between telepsychiatry sessions. • Doctor orders, lab and treatment. • Confidentiality, and privacy of information, approval for session. • Quality review. • Training review. • Billing guidelines. • Technology standards.
  13. 13. Guidelines for Telepsychiatry Emergency Management
  14. 14. • Administrative Issues : Perform a remote site assessment . Obtain information of local regulations and resources. Identify local collaborators, Create emergency protocols with clear delineations of roles and responsibilities, Decide the “tipping point” for psychiatric emergencies when other staff and resources are brought to bare, and Determine after hours emergency coverage procedures. • Legal/Ethical Issues: Know local civil commitment and duty to warn regulations, and Arrange with local staff to initiate/assist with civil commitments. • General Clinical Issues. • Rural Issues.
  15. 15. Guidelines of Telepsychiatry Technology Standards
  16. 16. • Hardware : camera/webcam, speakers, headphones, monitor, and microphone. • Software: videoconferencing, encryption, and codec. • Network : ISDN, T1, Satellite, microwave , and IP , internet protocol network. • Others, speed , quality, encryption algorithm, and bandwidth.
  17. 17. Pros and Cons of Telepsychiatry Advantages : • Sense of freedom and avoid confrontation in shy patients. • Better follow up and case managements. • Less costs. • Special population , rural areas services and, Community care services . • Reliable and valid in most of mental services. Disadvantages: • Increased cost/hr. • Reimbursements and billing. • Interoperability problems. • Suicide and self harm lacks care.
  18. 18. Conclusion : • Telepsychiatry could help in covering the current and future demands of mental health services in KSA . • Legal and ethical issues needs special care with activating the clinical guidelines for telepsychiatry services. • To activate the services in KSA, we need to include the telepsychiatry services mainly in governmental mental hospitals and primary care services in rural areas , prisons , military or remote areas. • Non- governmental and private sections need a special guidelines for legal and ethical issues and for collaborating teams specially in emergency .
  19. 19. REFERENCES: • WHO, mental health psychiatrists and nurses working in mental health services, 2014. • American Telemedicine Association., Practice Guidelines for Video-Based Online Mental Health Services, MAY 2013. • Telepsychiatry: Promise, potential, and challenges, Savita Malhotra, Subho Chakrabarti, and Ruchita Shah, Indian J Psychiatry. 2013 Jan-Mar; 55(1): 3–11. • Telepsychiatry in the 21st Century: Transforming Healthcare with Technology, Stacie Deslich, , Bruce Stec, , Shane Tomblin, , and Alberto Coustasse, Perspect Health Inf Manag. 2013 Summer; 10(Summer): 1f. • Telepsychiatry in Commonwealth Africa a first step, Commonwealth Health Partnerships 2013. • National Survey of Prevalence of Mental Disorders in Egypt: preliminary survey M. Ghanem, M. Gadallah, F.A. Meky,S. Mourad and G. El-Kholy: Eastern Mediterranean Health Journal, Vol. 15, No. 1, 2009 65. • Emergency Management Guidelines for Telepsychiatry, Jay H. Shore, MPH,corresponding author Donald M. Hilty, and Peter Yellowlees, MBBS : Gen Hosp Psychiatry. Author manuscript; available in PMC 2008 May 1. • American psychiatric association guidelines,: psychiatryonline.org/guidlines

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