Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Hensel, J., Graham, R., Corinne, I., Ahmed, N., Jitender, S., & Bolton, J. (2020). A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation, The Canadian Journal of Psychiatry, 65(8). DOI: 101177/0706743719900465. NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

The authors distributed a survey to staff in an emergency room to explain telepsychiatry that planned for implementation for Manitoba and Winnipeg area hospitals (Hensel et al., 2020). The survey’s purpose was to determine what barriers perceived by staff for each site to adjust the implementation accordingly (2020). The survey (N=111) experienced little to no telepsychiatry exposure in the past, yet a more significant number were receptive to use for emergency needs (2020). Three areas identified as potential barriers: ready, technical, i.e., logistical and clinical (2020). The risk of the barriers got addressed, and implementation of the program began (2020). In one year, 243 telepsychiatry evaluations took place, resulting in 65% of patients avoiding transfer to the hospital (2020).

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The survey’s use to identify and address the clinicians’ concerns about what barriers were a concern enabled program administrators to plan and prepare a prevention plan facilitating the program (2020). The lack of on-site psychiatric providers in Manitoba and Winnipeg area hospitals contributed to the clinicians’ openness to providing telepsychiatry (2020). The study with the use of the survey served the purpose of striving to implement a telepsychiatry program successfully first of all (2020). Second to provide services direly needed in the surrounding vicinities that relied on the hospital identified (2020). Lastly, the program successfully averted 65% of transfer to hospitalization for the 243 patients evaluated due to a psychiatric crisis (2020). NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Hubley, S., Lynch, S. B., Scheck, C., Thomas, M., & Shore, J. (2016). Review of key telepsychiatry outcomes, World Journal of Psychiatry, 6(2). DOI: 10.5498/wjp.v6.i2.269.

This systematic research review encompassed a randomized controlled trial design of telepsychiatry treatment outcomes versus face-to-face (FTF) psychiatric appointments (Lynch et al., 2016). The method was to identify research reviews through the database published from the year 2000 (2016). The researchers chose 1976 studies initially with 452 that met the criteria to be included (2016). The categories had legal issues, cost-effectiveness, implementation outcomes, treatment outcomes, reliability, and satisfaction (2016). There were no studies found identifying legal matters related to telepsychiatry (2016). Keeping in mind the need for cybersecurity within all healthcare entities tasked explicitly with the role to implement the utmost security tools available, the lack of reports of a breach of security is not altogether surprising than it is with medical health records (2016). The use of studies using basic and highly advanced tools to assess the cost-effectiveness reveals telepsychiatry does not cost more than the face-to-face distribution of mental health services (2016). The bulk of telepsychiatry studies indeed demonstrated more cost-effective services than face-to-face, eventually, if not immediately (2016). Reliability was deemed equal if not better than face-to-face for telepsychiatry, as evidenced by evaluations through non- inferiority designs when correctly applied for initial assessment and treatment outcomes (2016). This study’s conclusive evidence massively confirms that telepsychiatry is an effective vehicle to provide mental health services. Further NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

research to investigate ideal approaches in providing telepsychiatry is suggested (2016).

Hungerbuehler, I., Valiengo, L., Loch, A. A., Rossler, W., & Gattaz, W. F. (2016). Home-Based  Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial, JMIR Mental Health 3(3). Doi: 10.2196/mental.5675: 10.2196/mental.5675

The research study aims to determine the validity and usability of telepsychiatry through videoconferencing patients who have mild depression from home (Hungerbuehler et al., 2016). The method was a randomized controlled study of adults with mild depression with a six and then 12-month follow-up (2016). Fifty-three patients were in the video conferencing group, and fifty-four were in the face-to-face (F2F) group (2016). The patients in the two groups were at baseline, similar in demographics (2016). The F2F group was seen for appointments monthly, as were the videoconferencing patients by a psychiatrist (2016). Assessment of depression severity, mental health status, medication compliance, response, and relapses compliance with appointment attendance, dropouts, therapeutic relationship, and satisfaction with treatment (2016). NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Patients with a significant degree of depression severity decreased throughout the 12

months for both groups (Hungerbuehler et al., 2016). The difference between groups

in treatment outcomes during treatment was that the video conferencing group had

better results (2016). There was one relapse in the videoconferencing group

and 4 in the F2F group (2016). There were no meaningful differences between

groups in medication compliance, adherence to treatment, therapeutic relationship,

treatment satisfaction or status of mental health (2016). The rate of dropouts was

higher substantially for the F2F group with 5.7% for the videoconferencing and

18.5% for F2F group (2016). NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Videoconferencing by the research study was as useful as F2F and possibly more

advantageous (2016). The benefits cover adherence to medication compliance and

treatment, the therapeutic relationship, patient satisfaction, and clinical outcomes of

depressed patients (2016). The study contributes to confirmation of telepsychiatry’s

practical use through videoconferencing for underserved patient populations in

remote locations (2016).

Mazhari, S., Nejad, A. G., Mofakhami, Q., Raaii, F., & Bahaadinbeiggy, K. (2019). Evaluating

 the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A

 Preliminary Study, Iranian Journal of Psychiatry 3.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778603/

Iran is a developing country where generally telepsychiatry is not investigated.

(Mazhari et al., 2019). Barriers include lack of infrastructure, financial where with

all, poor internet, and connectivity (2019). The research study consisted of 40

inpatients over 18 years of age (2019). Psychiatric residents chose the patients through

an interview to make sure there was a lack of adverse agitation, mental retardation,

impairments in language, communication abilities, and absence of disorganization

that would prevent the ability to engage in videoconferencing (2016). Patients were on

psychotropic medications (2016).  Patients were seen face-to-face initially by two

psychiatric clinical staff and then through videoconferencing (2016). The computers

got supervised by the Information Technology (IT) department of the hospital

(2019). Upon completion of the telepsychiatry appointment, the patient

completed a Patient Satisfaction Questionnaire with 9-items, which determined

attitude about the telepsychiatry visit (2019). The additional questions assessed the

patients’ attitudes about the future, preferable choice, confidentiality, technology, and

information (2019). Forty patients participated in the study (2019). The participants

were of an average of 35.2 years with a means of education of 8.8 years with an

(SD=3.6) (2019). The two interviewers’ agreement of diagnostics was 75%

(Mazhari et al., 2019). Furthermore, telepsychiatry follow-up visits were preferable by

the patients at 85% (2019). Eighty-two percent plus of patients reported they would

recommend telepsychiatry (2019). However, 95% of the patients experienced some

degree of discomfort while engaged in telepsychiatry (2019).

The purpose of this literature review is to identify telepsychiatry’s advantages to improve

treatment availability for those who would otherwise lack services. Those who are non-

compliant due to distance rendering treatment unobtainable or ineffective due to the hardship

entailed identified as beneficiaries. Increased access by the ease of obtaining mental health NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

services through telepsychiatry is shown through rigorous evidence-based research studies

reviewed. Due to the empiric rationale for the ongoing development of telepsychiatry routinely

provided in clinical settings, further studies would be advantageous to provide increased

knowledge of best practices.

In conclusion, the research studies reviewed all demonstrated the prosperity of

telepsychiatry’s use concerning the patients’ ability to access mental health care from the comfort

of their homes. The benefits include compliance with medication management, compliance in

attending mental health appointments, and most patients’ satisfaction with the process. The

use of the technology, which has been in existence for three decades plus has advanced in

function exponentially (McGonigle & Mastrian, 2017). The expansion of the use of

telepsychiatry is evident in the research conducted. The research studies focus on patient

satisfaction, medication compliance, treatment, and therapeutic

relationship quality. These dependent variables are determinates of the outcomes of using

the technological tool of telepsychiatry in need to be conducted expanded at the time the research

studies. Telepsychiatry is incredibly researched in the literature reviews to show

evidence of this technology’s essential and valuable use.

References

Hensel, J., Graham, R., Corinne, I., Ahmed, N., Jitender, S., & Bolton, J. (2020). A Novel

Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and

Addressing Perceived Barriers for Successful Implementation, The Canadian Journal of

Psychiatry, 65(8). DOI: 101177/0706743719900465.

Hubley, S., Lynch, S. B., Scheck, C., Thomas, M., & Shore, J. (2016). Review of key

telepsychiatry outcomes, World Journal of Psychiatry, 6(2). DOI: 10.5498/wjp.v6.i2.269.

Hungerbuehler, I., Valiengo, L., Loch, A. A., Rossler, W., & Gattaz, W. F. (2016). Home-Based

Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized

Controlled Follow-Up Trial, JMIR Mental Health 3(3). Doi: 10.2196/mental.5675:

10.2196/mental.5675

Mazhari, S., Nejad, A. G., Mofakhami, Q., Raaii, F., & Bahaadinbeiggy, K. (2019). Evaluating

the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A

Preliminary Study, Iranian Journal of Psychiatry 3.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778603/

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge

(4^th ed.). Burlington, MA: Jones & Bartlett Learning. NURS – 6051N Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies