RESEARCH

"Dilema" telepsihiatriei

 The telepsychiatry “dilemma”

First published: 30 septembrie 2021

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Psih.65.2.2021.5376

Abstract

Is telepsychiatry writing history, or is it just a transition? Telehealth is here to stay in all aspects, but generally because all mental disorders that were already here or were accentuated by the pandemic need it. Depression, anxiety, insomnia and all mental disorders accentuated or triggered by the COVID-19 pandemic brought us a highly increased prevalence of mental disorders. The rising incidence in all mental health problems is expected to boost the online platforms for treatment and diagnosis and drive the telemedicine market. Telemedicine meets the precise needs of patients, and we treat patients in several ways, with significant advantages involved in the process. I don’t intend to put telemedicine on a pedestal, but here are some main advantages: giving genuine quality care directly in the patients’s homes; reducing/fighting the considerable stigma; no spending time in traffic and waiting rooms; minimizing all the delays in care; improving the continuity in care and follow-up; reducing at minimum the “time waste” (time off from work, the time spent in traffic in big cities and the time to get to a mental health specialist, if they are far away from the big cities). Want to have a view into the future? We go and see the revenue. “It seems to show an increase of 21% (CAGR) from the shocking year 2020 ‘till late 2026.” Take your objective angle and remember: with all this being said, I consider that telemedicine in general, in this domain, will be the doctor’s most significant asset in the future years, with infinite possibilities of development and great individualized care for any type of disorder or patient.
 

Keywords
depression, telemedicine, anxiety, mental disorders, telehealth

Rezumat

Scrie telepsihiatria istorie sau este doar o perioadă de tranziţie? Cu certitudine, telemedicina este aici pentru a rămâne, sub toate aspectele. Depresia, anxietatea, insomnia şi celelalte tulburări mintale accentuate sau declanşate de pandemia de COVID-19 ne-au adus o creştere a prevalenţei tulburărilor mintale. Cei care suferă de aceste tulburări au nevoie de telemedicină, în măsura în care şi doctorii aveau nevoie de ea. Incidenţa în creştere a tuturor problemelor de sănătate mintală era de aşteptat să stimuleze abordarea online pentru tratament şi diagnostic şi să conducă piaţa telemedicinei spre viitor. Telemedicina satisface nevoile precise ale pacienţilor, cu avantaje semnificative implicate în proces. Nu intenţionez să pun telemedicina/telepsihiatria pe un piedestal, dar iată câteva avantaje principale: acordarea de îngrijire personalizată, de calitate, direct în casele pacienţilor; reducerea/combaterea considerabilă a stigmei; lipsa timpului pierdut în săli de aşteptare; minimizarea întârzierilor în îngrijire; îmbunătăţirea continuităţii în îngrijire şi monitorizarea ulterioară (mai ales în afecţiuni cronice); reducerea timpului irosit (timpul liber de la locul de muncă, timpul în trafic în oraşele mari şi timpul pentru a ajunge la un specialist în sănătate mintală dacă pacientul se află departe de oraşele mari). Vrei să ai o perspectivă asupra viitorului? Mergem şi vedem veniturile. „Se pare că arată o creştere de 21% (CAGR) de la anul «şocant» 2020 până la finele anului 2026.” Alegeţi unghiul din care priviţi obiectiv, fie ca pacient, fie ca medic, şi amintiţi-vă: telemedicina va fi cel mai important atu al medicului în anii următori, cu nenumărate posibilităţi de dezvoltare şi cu o abordare personalizată pentru orice tip de tulburare mintală sau tipologie de pacient.
 

Let’s say we were back in 2000. Would it ever cross your mind that telemedicine will make its way in such a manner, especially when we talk about psychiatry?

It is not the case of a comeback. Here we speak loudly about evolution, significant advantages, the miracle of technology serving medicine at its highest point. It also fits all the anguish and everyday worries of the patients. This is happening, no matter the language, country of origin or pathology. Does it also have its flaws? Of course, it has. Don’t we all?

Unfortunately, when we speak the language of psychiatry patients, we also talk about stigma. It’s included just like in a two-pack promotion commercial. People who permanently suffer from mental health issues feel the stigma at their workplace, sometimes in their families, and in society.

Instead of being seen in a doctor’s office, people have lately often preferred to access mental health care, and when I say recently, a say the last couple of years (not to forget the pandemic influence).

Telemedicine – “in and out”…COVID!
...and in again

How would we define it? Is telemedicine different from telehealth? Some put the difference based on online clinical or nonclinical services, but generally they are considered the same.

The American Psychological Association (APA) describes telemedicine as: “the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, and information across a distance, rather than face to face“(1).

The World Health Organization (WHO) has adopted the following description: “the delivery of health care services, where distance is a critical factor, by all healthcare professionals, using information and communication technologies for the exchange of valid information for the diagnosis, treatment and prevention of disease and injuries etc.”(2)

Back in November 2007, in the article “Telemedicine and E-Health”, there were like 104 perspectives over it(3). Wow!

What’s wrong with us after COVID?

Everything could go wrong. Exactly how it can go right is an old saying that can apply to health. Mental health instead must give us an urge to resolve things as far and fast as possible, but under a mandatory quality request. Under a continuous pressure in our lives, the body and mind and our well-being are suffering.

But after COVID…

Now we know that patients with severe conditions who reach the critical phase suffer after being discharged from the hospital from residual physical and mental symptoms. However, in order to speak of “post-COVID syndrome,” the symptoms should last at least six months and be relatively homogeneous and consistent. According to specialists, at the moment, one can speak only of a cluster of heterogeneous symptoms.

However, even patients who recover physically immediately may be at risk of suffering long-term mental health problems or experiencing a reduction in the quality of life.

Such complications do not occur only after an SDRA (“acute respiratory distress syndrome”), since many patients admitted to intensive care for other problems experience residual symptoms for a long time. All these are known as “intensive care syndrome” (PICS acronym in English).

So, who comes in handy and manages all the patients’ fears in need in a 360-degree manner? ATLAS (https://atlas.app/ro) provides a multidisciplinary approach to all physical and mental problems, regarding well-being, from personal to organizational and so on. Of course, we have niches like “long COVID”, but general health remains a priority in all aspects.

Anonymity, confidentiality and infinite possibilities

Here are the two main things that the patients suffering from psychiatric disorders wants and telemedicine can give them. Of course, telemedicine does not exclude seeing patients in person from time to time, for reevaluation. It has multiplied chronic illness benefits for patients and specialists also.

To emphasise some of David Mucic’s ideas in his book e-Mental-Health, in a domain like psychiatry, we never exclude physical interaction with our patients, so balance is the key to the “extraordinary change that technology brought us” (for both patients and doctors)(4).

Depression, anxiety, stress: Let’s go faster and easier for solutions?

This is not a game; our patient’s health is at stake. If telehealth is the easiest way, the standard of quality doesn’t have to decrease. Is it faster? OK, but efficiency needs to be at its highest level.

From depression to severe anxiety and stress, insomnia or schizophrenia, Alzheimer and all the clubs of long-term chronic mental diseases, we have the tools in the long run for all of them. If a physical approach is needed instead for the last one from the list, that is the way.

We find the limits of telemedicine in the severity of the cases or in the severity of the disease.

We fight as specialists all day long against these “characters” for the benefit of our patients.

The evaluation of telepsychiatry has gone through three phases. Firstly, it was found to be effective in terms of increasing access to care, acceptance and good educational outcomes. Secondly, it was noted to be valid and reliable as compared to in-person services. In addition to comparison (or “as good as”) studies, telepsychiatric outcomes are not inferior to in-person care.

Telecare also allows the clinicians to assess the patients’ living environment. In mental health, evaluating components such as lighting, household clutter and organization provide context on day-to-day well-being.

These eHealth innovations are used to augment the point-of-care medical practice and represent a significant area of opportunity in mental health management for all diseases.

Well-being and benefits

We love to think we bring a significant change in the quality of life of our clients. Well-being is not just a term in trend, it is the main focus for us, but also for organizations and people in general in the last few years. You should improve every single aspect of your health, especially mental health.

Telemedicine – advantages and disadvantages

Telemedicine meets the precise needs of patients, and we treat patients in several ways, with significant advantages involved in the process:

  • giving genuine quality care directly in their homes;
  • reducing/fighting the considerable stigma;
  • no spending time in traffic and waiting rooms;
  • minimizing all the delays in care (not only time-related);
  • improving continuity in care and follow-up;
  • reducing at minimum the “time waste” (the time off from work, the time in traffic in big cities and the time to get to a specialist in mental health if they are far away from the city).

Of course, from practice, we can see now clearly that a tiny percentage are reticent talking in front of a screen, most of them being very comfortable with it. People can interact easily from their office or their homes.

Let’s resume some inconvenience that a WHO study revealed clearly in 2020 (an another perspective to the story):

  • very severe conditions that are not manageable partially or totally through telemedicine (as I mentioned before);
  • poor internet access;
  • poor management of the technology involved in the process (poor video or audio quality, poor internet speed);
  • difficulty in expressing emotions;
  • low physician communication skills (improved by workshops and the training);
  • environmental obstruction impossible to handle by the specialist;
  • patients who require assistance etc.;
  • privacy etc. (legal issues)(5).

For us, the specialist, telehealth offers enormous time availability in treating more patients in distant locations, with no language, nationality or quality barrier. If back in 2014, for example, security of data and safety were some issues, now safety, security and privacy are what we also give them at a different level(6).

I am often asked what’s my motto, and I give the same answer: “Do the best you can with all you have, now”.

Because reduced care continuity can decrease life quality, consumer telemedicine providers must apply solutions to maintain appropriate and accessible patients’ records. As more healthcare providers adopt telehealth solutions to use with their own patients, care continuity will likely increase.

Telemedicine is here to stay

Why did I say this now? Well, give this a thought: the statistics showed that “approximately 13.5% of all hospital beds in the European Union in 2018 were psychiatric care beds”(7). Sounds scary? Add these to the 2021 issues.

Depression, anxiety, insomnia and all mental disorders accentuated or triggered by the COVID-19 brought us a highly increased prevalence of mental disorders. The rising incidence in all mental health problems is expected to boost the online platform for treatment and diagnosis and drive the telemedicine market.

So, what we need to do without postponing is taking all the advantages of telehealth, but keeping a close eye on all studies, on contrary opinions and deficiencies also, learn from them, and see forward.

Do you wonder about the revenue?

“It seems to show an increase of 21 per cent (CAGR) from the shocking year 2020 ‘till late 2026”(7).

How is this possible?

Well, the COVID-19 pandemic puts us all and tele­medicine on fast forward, and investing time and resources brings this estimate that motivates us going further as it does the intense attention and care for mental health.

Take your angle and remember: telemedicine in general, but telepsychiatry in particular, will be the doctor’s most significant asset in the future years. Definitely, patients will trust more, and we are on the edge of seeing trust and development like never before.  

Bibliografie

  1. APA (American Psychological Association). What are telehealth and Telepsychology. 2014, second edition, 2019,1-3.
  2. WHO. Developments Report on the second global survey on eHealth Global Observatory for eHealth series, Volume 2, T-Who Press, 2010.
  3. Liebert MA. Telemedicine and E-Health. Telepsychology. 2021 Sep; 26(5):571-3.
  4. Mucic D, Hilty DM. E-Mental Health – worldwide trends. Springer-Switzerland, 2020, 22-38.
  5. Almathami HKY, Win KT, Vlahu-Gjorgievska E. Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review. Journal of Medical Research. 2020 Feb 20;22(2):1-22.
  6. Hall JL, McGraw D. For telehealth to succeed, privacy and security risks must be identified and addressed. Health Aff (Millwood). 2014;33(2):216-221.
  7. Mordor Intelligence. Report – Europe Telemedicine Market forecast years 2021-2026. Mobile health, base year 2021, 5.1.3.

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