Asynchronous Telepsychiatry in Maharashtra, India: Study of Feasibility and Referral Pattern

Abstract

Context:There is a paucity of published telepsychiatry results in India.Aims:This study was conducted to assess the feasibility of asynchronous telepsychiatry and to study the referral patterns.Settings and Design:This study was conducted in the telemedicine unit of a tertiary care center and design was retrospective analysis of 94 cases, which were diagnosed and treated by telepsychiatry.Materials and Methods:All 94 patients who were referred between January 2007 and August 2013 for telepsychiatry consultations were retrospectively analyzed to assess the referral pattern and feasibility.Statistical Analysis Used:Comparisons between demographic parameters and psychiatric diagnosis was done using Chi-square test.Results:In 89 out of 94 (95%) patients it was possible to make a definitive diagnosis and recommend appropriate treatment only on the basis of data received from the primary care physician by telepsychiatry. This indicates the feasibility of telepsychiatry. The most common problems for which referrals were made included schizophrenia and other psychotic disorders, mood disorders and substance related disorders.Conclusions:This study demonstrates the feasibility of Asynchronous telepsychiatry. Additional Indian studies should be conducted to build the evidence base for the best use of asynchronous telepsychiatry.

Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature

“…15 In Chile, an online platform facilitated collaborative care by giving primary care providers remote access to a psychiatrist, which contributed to improved outcomes for care of people with depression. 16 In one study, 17 primary care providers from district hospitals in India sent patient reports to consulting psychiatrists at a tertiary medical centre to obtain treatment recommendations, whereas in another study from Pakistan, 18 reports on children or adolescents with complex presentations of mental illness were sent to psychiatrists in the UK for clinical guidance and feedback. Use of email to seek remote consultation from specialists is referred to as asynchronous or so-called store-and-forward telepsychiatry, 17,18 however, this approach seems to be an extension of existing practices of sending paper copies to consultants rather than an application of technology with potential for population-level impact.…”

“…16 In one study, 17 primary care providers from district hospitals in India sent patient reports to consulting psychiatrists at a tertiary medical centre to obtain treatment recommendations, whereas in another study from Pakistan, 18 reports on children or adolescents with complex presentations of mental illness were sent to psychiatrists in the UK for clinical guidance and feedback. Use of email to seek remote consultation from specialists is referred to as asynchronous or so-called store-and-forward telepsychiatry, 17,18 however, this approach seems to be an extension of existing practices of sending paper copies to consultants rather than an application of technology with potential for population-level impact. Nonetheless, this method can afford benefit, as shown in a study from Colombia 19 in which asynchronous telepsychiatry was used to supplement primary care visits for depression treatment among prisoners.…”

Response to: Rethinking online mental health services in China during the COVID-19 epidemic

“…In India, both synchronous (Agarwal et al, 2019;Das et al, 2020;Gowda et al, 2018) and asynchronous mode of video consultation (Balasinorwala et al, 2014) are in place since the last two decades (Chellaiyan et al, 2019). However, the utility has remained minimal as there were no guidelines and laws about the use of telemedicine in clinical practice.…”

Use of digital technology in addiction disorders

“…Studies in Opioid dependence patients on medication assisted treatments have reported that there is no significant difference in the outcomes of patients treated with face to face consultations and through telepsychiatry, implying its potential role in the development of treatment services 39 . In India, asynchronous telepsychiatry had been seen as a feasible option 40 . Even though there has been expertise developed as well as research conducted in telepsychiatry in the area of general psychiatry, its applicability in addiction mental health has not been studied.…”