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Treatment of Opioid Dependence via Home-Based Telepsychiatry
... Telemedicine services have a diverse potential with wideranging benefits for individuals who are able to utilize these opportunities. [14][15][16] However, there are challenges that can arise in their implementation and hinder some of the benefits of telemedicine. Ikelheimer and Stowe et al. discuss these obstacles, including shortcomings with technology, userbased concerns, as well as organizational obstacles. ...
... Ikelheimer and Stowe et al. discuss these obstacles, including shortcomings with technology, userbased concerns, as well as organizational obstacles. 14,15,17 In the realm of technology, a lack of infrastructure, dwindling equipment supply, minimal Information Technology support, and privacy protection are a few barriers that can arise. 14,16,17 On a larger scale, institutional obstacles are wide-ranging and include a lack of support and advocacy from policymakers in the realm of reimbursement policies and regulations to provide support via technology-based modalities. ...
... 14,15,17 In the realm of technology, a lack of infrastructure, dwindling equipment supply, minimal Information Technology support, and privacy protection are a few barriers that can arise. 14,16,17 On a larger scale, institutional obstacles are wide-ranging and include a lack of support and advocacy from policymakers in the realm of reimbursement policies and regulations to provide support via technology-based modalities. 6,11,18 ...
Background: A scoping review was conducted to examine the breadth of evidence related to telehealth innovations being utilized in the treatment of opioid use disorder (OUD) with buprenorphine and its effect on patient outcomes and health care delivery. Materials and Methods: The authors systematically searched seven databases and websites for peer-reviewed and gray literature related to telehealth solutions for buprenorphine treatment published between 2008 and March 18, 2021. Two reviewers screened titles and abstracts for articles that met the inclusion criteria, according to the scoping review study protocol. The authors included studies if they specifically examined telehealth interventions aimed at improving access to and usage of buprenorphine for OUD. Results: After screening 371 records, the authors selected 69 for full review. These studies examined the effect of telehealth on patient satisfaction, treatment retention rates, and buprenorphine accessibility and adherence. Conclusion: According to the reviewed literature, incorporation of telehealth technology with medication-assisted treatment for OUD is associated with higher patient satisfaction, comparable rates of retention, an overall reduction in health care costs, and an increase in both access to and usage of buprenorphine. This has been made possible through the expansion of telehealth technologies and a substantial push toward relaxed federal guidelines, both of which were quickly escalated in response to the COVID-19 pandemic. Future research is needed to fully quantify the effect of these factors; however, the results appear promising thus far and should urge policymakers to consider making these temporary policy changes permanent.
... Bireyin evinde ya da mahrem hissedebileceği başka bir ortamda bu hizmetten yararlanmasıdır (Ikelheimer 2008). Bir video kamera ve hızlı internet bağlantısının varlığı yeterlidir. ...
... Bununla birlikte, hareket kabiliyeti kısıtlanmış, yaşlı ve engelli nüfus bakımındanevde alınan telepsikiyatri hizmeti ideal sayılabilecek bir yöntemdir. Geri ödeme konusunda gerekli yasal düzenlemelerin hayata geçmesiyle yaygınlığının artacağı öngörülmektedir (Ikelheimer 2008). ...
Telepsychiatry is an application brought out by modern day health system, and beneficial both to the patient and clinician. In recent years, growing usage of portable computers and development of secure communication systems has paved the way for telepsychiatry undertaking in desired place and time. The acceleration of telepsychiatry will increase in proportion to the development of adequate technology, making of legal arrangements, and ensuring the satisfaction of patients, psychiatrists and third companies. Taking into account the experiences acquired thus far, changing economical and social parameters, as well as expectations of growing health care system; clinicians are well advised to prepare for an adaptive platform designed for telepsychiatry in near future.
... There are no prospective studies considering treatment adherence, but a single retrospective study of office-based telepsychiatric visits showed significant benefits in adherence (10). Few published studies have examined home-based telepsychiatry, and those that have examined this intervention involved retrospective survey data (11), case reports (12), and psychotherapeutic interventions (13,14). ...
Objective:
This study examined whether patients who had been nonadherent with outpatient appointments and who were randomly assigned to receive treatment through a telepsychiatry intervention (home-based video teleconferencing) would show improvement in adherence to appointments, compared with a treatment-as-usual group.
Methods:
Participants (N=22) were randomly assigned to home-based video teleconferencing or to outpatient treatment as usual during a six-month study. The primary outcome measure was improvement in visit adherence, which was analyzed using a two-sample t test.
Results:
Percentage improvement in visit adherence did not differ significantly between the telepsychiatry and treatment-as-usual groups (14%, compared with 15%). A greater number of participants in the telepsychiatry group reported less subjective difficulty in keeping appointments.
Conclusions:
A small number of participants, short study period, selection bias, and the Hawthorne effect may have limited measured impact in this study. The findings implied that visit nonadherence among frequently nonadherent individuals is largely unrelated to inconvenience.
... Literature addressing substance abuse treatment by a telehealth addictions counselor was only represented by two original articles 103,104 , both of which demonstrated positive results. It is understood that many patients treated by telemental health for other mental disorders also have co-morbid substance abuse issues and illnesses. ...
This document was prepared in response to the needs and requests of providers, organizations, and the ATA membership interested in or engaged in TMH activities, for the development of evidence-based TMH guidelines. The broad nature of the mental health field along with an unlimited number of ways to use technology in mental health services led the committee to limit this evidence-based document to interactive video conferencing applications. Appreciating the broad range of providers and settings involved in TMH, recommendations are organized by patient age, types of treatment, treatment setting, and provider specialty. The coding system was developed to encourage more specific descriptions of the technology being used in TMH interactive videoconferencing research and methods publication. It provides recommendations based on clinical confidence derived from the published literature, committee members, and expert reviewers. The committee hopes that the users of this document will benefit from the recommendations, literature references, and the development of a clinical/technical coding system. The document structure and headings were selected in anticipation that users will note the clinical applications that are in most need of additional evidence-based research and perhaps select these areas as a focus of future research.
Web-based videoconferencing technologies hold far-reaching potential to increase and improve delivery of evidence-based substance abuse treatment interventions. A review of the literature reveals very few reports on the efficacy of web-based videoconferencing intervention strategies for treating substance use disorder, and many of those have been descriptive reports that do not meet the requirements of establishing effective and replicable evidence-based care. Comparatively more studies have reported on the use of computer-administered pre-programmed treatment and education modules. These approaches can be very helpful, but do not expand the availability of flexible and professional counseling services for patients in long-term therapy relationships that can be realized with web-based videoconferencing. One of the next important advances in the substance abuse treatment continuum is to evaluate how web-based videoconferencing can help engage patients with serious and chronic problems in the long-term outpatient treatment process. Patients requiring long-term treatment often require responsive and flexible levels of counseling to manage symptoms that fluctuate greatly in scope and intensity over time. Unfortunately, the overall effectiveness of long-term therapy is often seriously hindered by treatment demands to on-site scheduled counseling and psychosocial services that often continue for many years. These demands reduce utilization of therapy services with resulting negative impacts on treatment outcome. Web-based videoconferencing service delivery provides a remarkable opportunity to reduce some of the inconvenience of counseling and so facilitate the long-term treatment process while at the same time allowing pursuit of other responsibilities (e.g., child care) or treatment goals (e.g., employment) essential to rehabilitation. A recent study by our research group demonstrated both increased satisfaction and improved attendance in patients receiving long-term substance abuse treatment who were assigned to web-based counseling versus on-site counseling, with no differences in treatment outcomes. However, much more work is needed to establish how best to use this technology since the great majority of published studies have focused on individuals with mild to moderate problems and/or on brief interventions. Using web-based videoconferencing to expand the continuum of care holds great promise to improve treatment satisfaction, adherence and retention for the many patients with chronic substance use problems requiring longterm outpatient substance abuse treatment.
Innovative technologies are increasingly utilized in order to address gaps in access to mental health care. Videoteleconferencing (VTC) is one technological modality in which mental health-care services, including psychotherapy, can be delivered. The authors discuss current issues related to delivering psychotherapy over VTC including why this modality is necessary for delivery, how psychotherapy is delivered, who can deliver psychotherapy over VTC, and what kinds of psychotherapy have been delivered over VTC. Additionally, the authors briefly address emerging technologies related to psychotherapy.
The science fiction author Arthur C. Clarke wrote “The only way of discovering the limits of the possible is to venture a little way past them into the impossible…and any sufficiently advanced technology is indistinguishable from magic.” Mr. Clarke’s laws of prediction capture the romance of e-mental health. More concretely, telemedicine (direct patient care) and telehealth (medical records, preventive medicine training) both describe the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status, generally via the Internet or telephony.
Televideo bridges the gap between high need for behavioral services in rural and other underserved areas and limited access to professionals trained in evidence-based strategies such as cognitive-behavioral therapy (CBT). The authors first summarize the current literature concerning CBT using televideo, including therapeutic rapport as well as condition-specific considerations related to depressive symptoms and suicidality; anxiety and obsessive-compulsive disorders; eating disorders; alcohol and substance abuse; and behavioral medicine. They then address establishing and sustaining a televideo practice, including concerns related to clients/families, therapists, telemedicine site coordinators, and broader community participants. They conclude with a case example highlighting ethical considerations related to CBT services over televideo.
Voice over the Internet Protocol (VoIP) systems such as Adobe ConnectNow, Skype, ooVoo, etc. may include the use of software applications for telerehabilitation (TR) therapy that can provide voice and video teleconferencing between patients and therapists. Privacy and security applications as well as HIPAA compliance within these protocols have been questioned by information technologists, providers of care, and other health care entities. This paper develops a privacy and security checklist that can be used within a VoIP system to determine if it meets privacy and security procedures and whether it is HIPAA compliant. Based on this analysis, specific HIPAA criteria that therapists and health care facilities should follow are outlined and discussed, and therapists must weigh the risks and benefits when deciding to use VoIP software for TR.
1. Patient participants viewed seclusion as a form of punishment that maintains physical, and at times, psychological control over the secluded person. 2. A seclusion episode should serve a greater function than simply containment or preserving safety. During this period of crisis for the patient, they felt an even greater need for a therapeutic intervention. 3. Environmental, procedural, and attitudinal changes were emphasized by the patients in this study as a means to enhance the therapeutic potential of seclusion.
The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
Diagnosis-specific, proven efficacious treatments are a major recent advance in psychiatry. Appropriate use of such treatments presupposes patients who meet the diagnostic criteria and clinicians who have accurately diagnosed the target disorder and comorbid conditions. Since little is known about whether these prerequisites are commonly met, the authors conducted a study at two community treatment sites to determine the frequency of various axis I diagnoses and the concordance between the diagnoses recorded in patient charts and those obtained by a structured interview. Given that a DSM diagnosis may not be sufficient to understand a patient's problems, the authors also obtained ratings of interpersonal functioning.
The subjects were 164 nonpsychotic patients who were seen at a rural (N=114) or urban (N=50) community treatment facility. Raters trained to reliably use the Structured Clinical Interview for DSM-IV (SCID) conducted diagnostic interviews. Clinical charts were reviewed to obtain clinical diagnoses. Patients completed questionnaires regarding interpersonal functioning.
Most (N=145, 88%) of the patients met the SCID criteria for a current axis I diagnosis, and 53% (N=87) met the criteria for two or more disorders. Clinical and SCID diagnoses had poor agreement. Evidence was found for interpersonal dysfunction.
Most patients met the diagnostic criteria for conditions for which there are proven treatments; however, inaccurate diagnosis proved common. This barrier to optimal treatment could be ameliorated with the use of structured interviews for common diagnoses. Scores on social/interpersonal measures support the premise that DSM symptoms provide only part of the relevant information about patients' conditions.
Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of delusions and hallucinations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.
Seclusion continues to be widely used in the management of disturbed behaviour in hospitalized patients. While early research on the topic highlighted significant differences in staff and patient perceptions, there are few recent data to indicate if these differences still exist.
This paper reports a study exploring the perceptions of both nursing staff and patients towards the reasons for seclusion; its effects; patients' feelings during seclusion; and possible changes to the practice.
Sixty nursing staff and 29 patients who had experienced seclusion at three inpatient units in Queensland, Australia completed Heyman's Attitudes to Seclusion Survey.
The findings indicate that the two groups differed significantly on a number of the dimensions assessed. Nurses believed seclusion to be very necessary, not very punitive and a highly therapeutic practice that assisted patients to calm down and feel better. Patients, on the other hand, believed that seclusion was used frequently for minor disturbances and as a means of staff exerting power and control. Patients also believed that seclusion resulted in them feeling punished, and had little therapeutic value.
The disagreement between staff and patients highlights the need for greater dialogue between these groups. While nursing staff require greater understanding of how patients feel about seclusion, patients require information on why and how seclusion is implemented.
Recent studies show a high prevalence of trauma symptoms among people with serious mental illness who are treated in public-sector mental health systems. Unfortunately, growing evidence suggests that many consumers have had traumatic or harmful experiences while being treated in various psychiatric settings. This study explores consumers' perceptions of such harmful inpatient experiences, events that the authors place under the rubric of "sanctuary harm."
The authors conducted semistructured qualitative interviews with 27 randomly selected mental health consumers to hear their descriptions of adverse events that they experienced while receiving psychiatric care. Our analysis of interview transcriptions focused on understanding consumers' narratives of harmful experiences-events that would not meet DSM-IV criteria for trauma but that nevertheless resulted in significant distress.
Eighteen of 27 interviewees described harmful incidents that they had witnessed or experienced directly, many of which evoked strong emotional responses by consumers during their narration. Nearly all incidents described were hospital based and were clustered around two sets of themes. The first set related to the hospital setting, including the fear of physical violence and the arbitrary nature of the rules. The second set related to the narrators' interactions with clinical staff, including depersonalization, lack of fairness, and disrespect.
The findings suggest that many mental health consumers have had a lifetime sanctuary experience that they perceived as harmful. They also offered suggestions for how the mental health service delivery system might reduce the potential for sanctuary harm experiences.
This study examined patients' preferences for coercive measures in case of emergency situations on acute psychiatric wards.
From November 2004 until January 2006, 104 adult patients completed a questionnaire after they underwent seclusion, nonconsensual medication, or both on one of three acute psychiatric wards in the Netherlands.
Equal numbers of patients preferred seclusion and medication, and both measures were equal in perceived aversiveness and perceived efficacy. Men more often than women expressed a preference for seclusion. Patients who understood why the measure was necessary and acquiesced to it retrospectively held more positive views of the efficacy of the measure.
Many patients on acute psychiatric wards have a clear preference between seclusion and medication. Patients appreciated receiving explanations of the reasons for the use of a restrictive measure and discussing their preferences with staff.