Evaluation of a pilot second-opinion child telepsychiatry service

A second-opinion child psychiatry service was piloted for six months in the northern-most two-thirds of Queensland. It provided specialist expertise by telehealth to local multidisciplinary teams of mental health staff. During the study period, 28 videoconferences were performed by the service: nine for administrative purposes, two for educational purposes, and 17 for direct and indirect clinical applications. The mean time between a referral being made and a consultation being performed was 4.7 days (range 1-13). A survey administered to referring and non-referring mental health workers showed that the major barriers to service implementation included the limited allied health applications that were offered, a perceived lack of communication during the implementation phase of the service, and the creation of a new referral network that did not conform to traditional referral patterns in the north of Queensland.     

Evaluation of a telepsychiatry pilot project.

We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist (C$610 per consultation); with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.     

The successes and challenges of developing a prison telepsychiatry service

Prisoners are not typical of the general population with regard to their health needs, as they have a disproportionately high incidence of mental health problems and drug misuse. Health-care delivery in prison faces a significant number of challenges not experienced by other health-care organizations. Telepsychiatry is one strategy to improve the accessibility and quality of mental health-care in the prison setting. Despite some initial challenges, a telepsychiatry service was successfully established between a medium-secure unit in Fareham, Hampshire, and a category B training prison on the Isle of Wight. A low-cost, PC-based videoconferencing system was used, connected by ISDN lines at 128 kbit/s. A valuable lesson that was learnt was the importance of having the support of key individuals in a prison setting.     

Economic evaluation of a tertiary telepsychiatry service to an island

The island of Jersey is located 160 km south of Britain and 23 km from northwest France. The island has well-established primary and secondary mental health services, but tertiary services have to be purchased from UK mainland service providers. A pilot study of telepsychiatry was conducted, using videoconferencing to access tertiary mental health services from the UK. During a six-month study period, five patient consultations and six specialist presentations were carried out. The total cost of using videoconferencing to deliver tertiary mental health services not ordinarily available in Jersey was 3483.06 pounds. The costs of using the traditional model instead would have been 12,975.00 pounds. The threshold at which videoconferencing became cheaper than travel was between five and six telemedicine episodes per year; the actual workload during the pilot study was 22 episodes per year. The study suggests that telemedicine is cost-effective for providing tertiary mental health services not ordinarily available in Jersey.     

A prospective satisfaction study and cost analysis of a pilot child telepsychiatry service in Newfoundland

We evaluated user satisfaction with a PC-based videoconferencing system used for child psychiatry assessments and performed a cost analysis. Thirty patients (aged 5-16 years), accompanied by a parent, completed a psychiatric assessment using the videoconferencing system. One of five child psychiatrists was randomly assigned to each assessment. Satisfaction questionnaires were completed after each assessment by the psychiatrist, patient and parent. Parents also completed a cost questionnaire. The telecommunications bandwidth was 336 kbit/s. The psychiatrists stated that they were either 'very satisfied' or 'satisfied' with the telepsychiatry assessments. On a five-point Likert scale (1 = lowest, 5 = highest), 28 of the 30 parents (93%) rated their satisfaction level as 5; the other two rated it 4. All 30 parents (100%) stated that they 'liked' the telepsychiatry assessment and would use the system again. Twenty-nine parents (97%) indicated that they would prefer to use the telepsychiatry system to travelling to see a child psychiatrist in person. Eleven children (aged 5-12) participated and all (100%) said they 'liked' using the telepsychiatry system. Five out of nine children (56%) stated they liked the 'television doctor' better than the 'real' doctor; four said they had no preference. Nineteen adolescents (aged 13-16 years) participated and most were very satisfied or satisfied with the system. Seventeen of the 19 adolescents (89%) said they would prefer to see the psychiatrist on the videoconferencing system to travelling for an assessment, and the same number said that they would use telepsychiatry again. The estimated total travel cost for the 30 patients was $12,849, an average of $428 per patient. The total cost of the telepsychiatry service for the three-month pilot was $12,575, or $419 per patient.     

Emergency telepsychiatry

Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or man-made disaster.     

Clinical outcomes in a prison telepsychiatry clinic

The effectiveness of a prison telepsychiatry service was evaluated from a user perspective. Forty-five inmates (41 male, 4 female) completed the Symptom Rating Checklist-90-Revised (SCL-90-R) on three occasions, once before the teleconsultation and twice during treatment. The psychiatrist completed the Clinical Global Impression Scale--Severity Index (CGI) after each teleconsultation. Forty-nine per cent of inmates were aged under 30 years, 24% were aged between 30 and 39 years, while 27% were aged over 40 years. The inmates' mean SCL-90-R scores decreased over time, indicating less psychiatric distress. The psychiatrist reported patient improvement over time as assessed by the CGI. Telepsychiatry is an effective means of delivering mental health services to the prison population.     

International telepsychiatry: a study of patient acceptability

An international telepsychiatry service was established between Denmark and Sweden for cross-cultural patient groups, such as asylum seekers, refugees and migrants. Over an 18-month period starting in mid 2006, 30 patients were treated by telepsychiatry (21 men and 9 women). The patients received mental health care by videoconferencing from providers who spoke the patients' own language, i.e. without the assistance of interpreters. The total number of telepsychiatry sessions was 203 (range 1-22; average 6.8 sessions per patient). Patients completed a satisfaction questionnaire at the end of treatment. Seven patients (23%) were not able to complete a questionnaire, due to illiteracy and/or a psychotic condition. The rest of the patients (n=23) reported a high level of acceptance and satisfaction with telepsychiatry, as well as a willingness to use it again or recommend it to others. Any disadvantages of telemedicine were compensated by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references. Mentally ill asylum seekers, refugees and migrants are under-served in their mother tongue and telepsychiatry can improve access to scarce health-care resources.     

Cultural aspects of telepsychiatry

Telepsychiatry may involve working with clinicians, patients and systems of care that are both geographically and culturally distinct. In this context, culturally appropriate care is an important component of telepsychiatry. The outline for cultural formulation from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides general principles for addressing these issues. Two components of the outline are particularly relevant in telepsychiatry: (1) how the cultural background of patients (i.e. their cultural identity) influences their comfort with technology; and (2) the effect of cultural differences on the patient-provider relationship. Cultural differences between patient and provider are often highlighted in telepsychiatry by the patient and provider location (e.g. rural versus urban differences). Familiarity with the rural community and regular contact and feedback are important. Future research should examine the effect of telepsychiatry on patient-provider relationships, patient attitudes towards care and, most importantly, patient outcomes.     

贵州省少数民族地区加强常规免疫服务效果评价

目的 评价贵州省少数民族地区加强常规免疫服务策略的实施效果.方法 采用队列研究,设计统一调查表,对剑河、台江、罗甸、长顺4个试点县,在实施加强常规免疫服务策略前后,通过询问儿童监护人并核对预防接种证和预防接种卡的方法调查儿童免疫规划疫苗基础免疫覆盖率,通过问卷调查儿章监护人预防接种知识、态度、行为(KAP).结果 2008年效果评估中,儿童建预防接种卡、证率,卡介苗(BCG)、口服脊髓灰质炎减毒活疫苗(OPV)、百白破联合疫苗(DPT)、麻疹减毒活疫苗(MV)、乙型肝炎疫苗(HepB)5种疫苗的基础免疫覆盖率,HepB首针(HepB1)及时接种率和卡疤率均比2006年基线调查结果有不同程度提高;儿童住院分娩比例、儿童监护人预防接种KAP知晓率较2006年也呈升高趋势.结论 对基层防保人员进行反复培训,对基层工作开展经常性检查指导,加强与相关部门合作,开展有针对性的宣传活动,是少数民族地区提高常规免疫服务质量的有效策略.     

Success and failure in a Michigan telepsychiatry programme

Telemedicine programmes are often complex undertakings that result in combinations of success and failure. Michigan State University and LifeWays received a grant for a four-phase telepsychiatry research project in 2000. We employed multiple data-collection techniques, including patient and provider surveys, in-depth interviews, observation, patient chart analyses, and organizational archival data analyses. Of the four phases in the project, two proved to be successful, one failed in its initial goal but succeeded with a redefined goal, and one failed completely. Issues that affected success or failure included human resource conflicts, organizational structure, inter-organizational relationships and allocated resources.     

Evaluation of a community-based health information service

The Heart Information Service is a community-based telephone information and referral service designed to provide accurate and current information about cardiovascular disease to the lay and professional publics. In its first two years of existence, trained volunteers responded to more than 11,500 inquiries. The use of the service was evaluated by retrospective analysis of 4,351 calls made over a 12-month period and by a prospective evaluation using mailed survey questionnaires and simulation calls. The data indicate that 78 percent of the callers took at least one positive action as a result of information received. The results suggest that paraprofessional volunteers can effectively provide telephone information about heart disease, its prevention and treatment, as well as offer limited psychosocial support to cardiac patients and their families.     

以健康体检为纽带的浙江农村两地卫生服务的调研

浙江省推出以农民健康体检为纽带的基层卫生服务策略,并取得了一定成效.为进一步评估该策略取得的成效和存在的问题,探讨农村卫生的可持续发展,我们选择嘉兴平湖和台州仙居两地进行调研.调查结果表明,以农民健康体检为纽带的基层卫生服务策略在改善医患关系、促进农民健康理念、控制慢性病等方面起到了明显作用,对基层卫生机构和卫生人员服务观念与方法产生了较大影响.同时也存在一些问题,需要政府支持、项目改进、资源优化来保证农村卫生服务的可持续发展.

Abstract：

Zhejiang province takes an innovative approach in its rural health service strategy featuring routine health examination,which proved an initial success.Intending to assess the effect and dilemma of such a system,and seek sustainable development in future,we made investigations in Pinhu and Xianju in Zhejiang province.Overall,rural health service strategy based on rural health routine examination,to some extent, improved patient-physician relationship,changed and strengthened their rural health concepts,and upgraded non-communicable disease control. Furthermore,the practice has economically and socially influenced rural health service institutions and rural physicians in terms of their concepts and methodology.There are also setbacks and problems in need of govemment support,programme improvement and resource optimization for further sustainability.     

The status of telepsychiatry services in Canada: a national survey

A survey of Canadian telepsychiatry programmes was undertaken to provide information for future health services. Fourteen programmes were identified. They used a variety of service models and administrative arrangements. The average number of clinical consultations per programme per year was 238, which corresponds to 107 psychiatric teleconsultations per million persons served by the programmes. The rate for children's telepsychiatry services was higher, at 194 per million. Comparison with some telepsychiatry programmes in the USA revealed similar patterns of activity. While the development of telepsychiatry services in Canada is promising, there is nevertheless concern regarding the viability and activity levels of these programmes over the long term. This survey demonstrates that programmes from across a large country can respond to a standardized questionnaire and provide comparable information.     

Evaluation of a comprehensive adolescent health care service

The authors evaluate the Adolescent Health Clinic in the Emaús community in Belém, Pará, Brazil with regard to coverage, adequacy, accessibility, and utilization for the period 1994 to 1996. Coverage was calculated on the basis of clinical records and information collected from the target population. Adequacy was analyzed by comparing the service performance with goals established by PAHO/WHO for this kind of institution. Accessibility and utilization patterns were evaluated from information obtained by a population-based survey among adolescents living in the area. Results showed: a good degree of program adequacy vis-à-vis the final purpose, although some adjustments are needed, especially in human resources; lack of barriers to user access; reasonable coverage, despite the low proportion of consultations by adolescents; and utilization pattern compatible with the service provision profile, mainly directed towards curative and individual care. Recommendations are made to revise the hegemonic health care model to emphasize preventive, collective, and educational activities.     

Designing a framework for the evaluation of paediatric telepsychiatry: a participatory approach

While there is a great deal of interest in evaluating participants' experiences of teleconsultation programmes, specific frameworks for such evaluations are scarce. We have conducted a multi-stage consultation to develop a framework for the study of a paediatric telepsychiatry programme. Emphasis was placed on ensuring the participation of stakeholders in the design and response stage of the evaluation. A three-part approach was taken that comprised an opinion scan, focus groups and individual interviews. This resulted in the identification of specific areas of enquiry for the evaluation. One of the key points to emerge was that attending to context is vital. In the case of telepsychiatry, it is critical to understand the nuances of the local community for whom consultations are being provided. This involves considering the 'social ecology' of each evaluation site. The evaluation should take the form of a dialogue between the evaluators and those being evaluated, in order to maximize the uptake and integration of its findings. The framework we have developed should be viewed as a guide that is general enough to be used in the design of many different types of telepsychiatry programme.     

Home assessments in geriatrics revisited: an audit of a routine home visiting service.

Routine home visiting is a luxury not afforded to other medical specialties. The practice of routine home assessment visiting in geriatric medicine was evaluated in a prospective study of 110 consecutive referrals to determine whether; the response to general practitioners referrals could be predicted from the information given at the time of referral and; to identify where home visiting identified additional information of value in directing services more appropriately. Requests for admission were accurately predicted in 86-96% of cases by the visiting and a control doctor respectively. Additional information of value in directing services and patient management was gained from the home visit in 30% of admissions, 58% of day hospital cases and 80% of outpatients. It is possible to predict the outcome of home visits although implementation of such predictions without direct communication with general practitioners would result in a small number of unnecessary admissions and referrals to day hospital services.