Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence

Abstract

Objective: A review of systematic reviews of the effectiveness and feasibility of videoconference-based telepsychiatry services for resource constrained environments was conducted. Specifically with the aim of producing an evidence-based review of the effectiveness and feasibility of videoconference-based telepsychiatry services in resource constrained countries like South Africa. Methods: Eight key questions on telepsychiatry effectiveness and feasibility were identified and inclusion and exclusion criteria were developed. Review of citations from 2000-2011 from CINAHL, Medline, Pubmed, PsycInfo, EBSCOhost, SABINET, Cochrane Database of Systematic Reviews (CCTR), Cochrane Controlled Trial Registry (CCTR), Database of Abstracts of Reviews of Effectiveness (DARE), unpublished abstracts through NEXUS and internet search engines (Google/Google scholar) was conducted. Results: Ten systematic reviews were included for review. Despite the methodological limitations and heterogeneity of the systematic reviews, there appears to be good evidence of effectiveness (reliability and improved outcomes) and feasibility (use, satisfaction, acceptability and cost) for videoconference-based telepsychiatry internationally. The application of this evidence in lower middle income countries is dependent on the integration of telepsychiatry into local health system contexts. Conclusion: Based on the evidence, resource constrained countries such as South Africa should be encouraged to develop telepsychiatry programs along with rigorous evaluation methods.

A telepsychiatry model to support psychiatric outreach in the public sector in South Africa

“…Findings: Despite the methodological limitations and heterogeneity of the reviewed studies, there appears to be reasonable evidence of effectiveness to provide a rigorous Grade B evidence based recommendation of moderate support. (b): Telepsychiatry Effectiveness and Feasibility 21 A systematic review of the effectiveness and feasibility of videoconference-based clinical consultation for psychiatry was conducted. Findings: There is reasonable confidence that telepsychiatry is equivalent to face to face consultation for assessment, diagnosis and treatment with reported satisfaction from users.…”

“…Systematic reviews suggest that there is reasonable, good quality, international evidence that telepsychiatry is effective and feasible. 21 A model for successful implementation should aim to integrate telepsychiatry into the local South African context taking into account local health systems including human, technical and organizational factors, and prevalent local mental health conditions. 22 …”

Versorgungsbezogene E-Health-Anwendungen und Lebensqualität: Empirische Befunde und konzeptuelle Perspektiven

“…In einem Meta-Review [18] konnte lediglich in einem von insgesamt 10 eingeschlossenen Reviews Angaben zur Lebensqualität identifiziert werden, dagegen berichten 6 der 10 Reviews über die Patientenzufriedenheit. Nach diesem Review wirken sich die telepsychiatrischen Anwendungen positiv auf die Lebensqualität der Patienten aus, signifikante Unterschiede gegenüber konventionellen psychiatrischen Angeboten konnten jedoch nicht identifiziert werden [19].…”

Novas tecnologias de telecomunicação na prestação de serviços em saúde mental: atendimento psiquiátrico por webconferência

“…Quanto a estado de saúde mental, a satisfação com o tratamento, a relação terapêutica, a adesão ao tratamento, e a adesão à medicação não foram encontradas diferenças significantes entre os grupos. Contudo, depois de 6 meses, o número de abandonos foi significativamente maior no grupo controle (18,5 vs. 5,7%, p < 0,05). A satisfação com o acompanhamento por webconferência foi alta tanto para os pacientes como para os psiquiatras.…”

“…Alguns estudos apontam uma equivalência do atendimento telepsiquiátrico com o presencial para alguns serviços específicos, como avaliações psiquiátricas, gestão de medicamentos ou terapias comportamentais cognitivas (37), e existem resultados sugerindo a eficácia do tratamento e acompanhamento de vários transtornos psiquiátricos por VC (18).…”