Use of Tele–Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models

Uscher‐Pines, Lori; Raja, Pushpa; Qureshi, Nabeel; Huskamp, Haiden A.; Busch, Alisa B.; Mehrotra, Ateev

doi:10.1176/appi.ps.201900386

Cited by 25 publications

(32 citation statements)

References 15 publications

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“…Although patients and providers are largely satisfied with TMH as it improves access to care [ 14 ], reduces wait and travel times and costs [ 18 ], providers report a combination of system, policy and administrative concerns and are often seen as the clinical gatekeepers for implementation and sustainability of these services [ 9 , 19 , 20 ]. Despite advances in videoconferencing software programs, technical issues appear to be the most prevalent [ 21 ], and providers have noted video, audio and latency issues, and an inflexible video camera as barriers to patient care [ 19 , 22 – 25 ]. For example, providers are often troubled if a technical issue occurs when a patient is discussing an emotional and sensitive topic [ 23 ], and have difficulty not accidently interrupting the patient during audio lags [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…In one study [ 22 ], providers indicate that all mental health patients can be treated via TMH, and identify patients with anger management issues and agoraphobia as those who best respond to TMH. In addition, some psychiatrists believe that shy or socially anxious patients may be well treated through TMH [ 15 , 25 ]. Conversely, other providers believe that patients who are emotionally unstable, impulsive or have poor coping skills, and those suffering from dementia, paranoia, visual and/or hearing deficits are not suitable for TMH [ 10 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec

Shang

Arnaert

Hindle

et al. 2021

BMC Health Serv Res

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Background Due to regional, professional, and resource limitations, access to mental health care for Canada’s Indigenous peoples can be difficult. Telemental health (TMH) offers the opportunity to provide care across vast distances and has been proven to be as effective as face-to-face services. To our knowledge, there has been no qualitative study exploring the experiences of TMH staff serving the Indigenous peoples in Northern Quebec, Canada; which is the purpose of this study. Methods Using a qualitative descriptive design, the entire staff of a TMH clinic was recruited, comprising of four psychiatrists and four support staff. Individual semi-structured interviews were conducted through videoconferencing, and results were thematically analyzed. Results To address the mental health gap in Northern communities, all psychiatrists believe in the necessity of in-person care and note the synergistic effect of combining in-person care and TMH services. This approach to care allows psychiatrists to maintain both an insider and outsider identity. However, if a patient’s condition requires hospitalization, then the TMH staff face a new set of information sharing and communication challenges with the inpatient staff. TMH staff believe that the provision of culturally sensitive care to Northern patients at the inpatient unit is progressing; however, more work needs to be done. Despite the strong collegial atmosphere within the clinic and collective efforts to provide quality TMH services, all participants express a sense of frustration with the paper-based and scattered documentation system. Conclusion The TMH team works in cohesion to offer TMH services to Indigenous peoples; yet, automatization is needed to improve the workflow efficiency within the clinic and collaboration with the Northern clinics. More research is needed on the functioning of TMH teams and the separate but important roles of each team member.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec

Shang

Arnaert

Hindle

et al. 2021

BMC Health Serv Res

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“…Previously, there were several studies on the application of telecounseling during the COVID-19 pandemic, some of which indicated that telecounseling was able to overcome the negative emotions of the people (Ghazanfarpour et al, 2020;Uscher-Pines et al, 2020;Zhou et al, 2020). By continuing to interrupt the spread of infection, telecounseling also makes it easier for individuals to receive counseling (Uscher-Pines et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Why Can Other People Live Normally While I Cannot?: An Application of Telecounseling Due to COVID-19

Darmayanti¹,

Winata²,

Anggraini³

2020

Makara Hubs-Asia

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“…Despite advances in videoconferencing software programs, technical issues appear to be the most prevalent (19), and providers have noted video, audio and latency issues, and an in exible video camera as barriers to patient care (17,(20)(21)(22)(23). For example, providers are often troubled if a technical issue occurs when a patient is discussing an emotional and sensitive topic (21), and have di culty not accidently interrupting the patient during audio lags (22).…”

Section: Introductionmentioning

confidence: 99%

“…One study (20) indicates that all mental health patients can be treated via TMH, and identi es patients with anger management issues and agoraphobia as those who best respond to TMH. In addition, psychiatrists believe that shy or socially anxious patients may be well treated through TMH (23,24). Conversely, evidence exists that seniors and patients who are emotionally unstable, impulsive or have poor coping skills, and those suffering from dementia, paranoia or have visual and/or hearing di culties are not suitable for TMH (10,15).…”

Section: Introductionmentioning

confidence: 99%

Experiences of Telemental Health Providers and Support Staff Serving Indigenous Patients of Northern Canada

Shang¹,

Arnaert²,

Hindle³

et al. 2020

Preprint

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Background: It is known that there is a high mental health burden among Indigenous communities in Northern Quebec. The use of telemental health (TMH) may be a potential solution in addressing this burden, but its use in the Northern Quebec context has never been studied. Methods: A purposive sample of eight healthcare providers and support staff comprising of an entire TMH clinic serving Indigenous patients in Northern Quebec was recruited. A qualitative descriptive approach was adopted, and semi-structured interviews were conducted, concurrent with thematic data analysis.Results: Overall, the TMH staff have a very strong sense of communication, which allows them to diligently serve the Indigenous communities, and reflect upon their own practice. On the other hand, Northern patient care at the inpatient unit is seen as a work in progress, as there exists further potential for culturally sensitive Indigenous patient care. Both the TMH clinic and the inpatient unit address the mental health gap in Northern Quebec, where local staff turnover is adversely affecting patient care. As for the delivery of the mental health care, the in-person and videoconferencing consultations have a synergistic effect, since they allow for the TMH psychiatrists to maintain both an insider and outsider identity. Finally, a comprehensive electronic medical record and further administrative reforms are desperately needed, which would increase the efficiency of all components of the TMH clinic. Conclusions: TMH is an indispensable component of Northern patient care, but there is room for further improvements, especially with regards to the inpatient unit and documentation methods. This study may have implications towards the development and improvement of telemental health in Northern Quebec.

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Use of Tele–Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models

Cited by 25 publications

References 15 publications

Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec

Experiences of psychiatrists and support staff providing telemental health services to Indigenous peoples of Northern Quebec

Why Can Other People Live Normally While I Cannot?: An Application of Telecounseling Due to COVID-19

Experiences of Telemental Health Providers and Support Staff Serving Indigenous Patients of Northern Canada

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