•  The Evidence Base
•  Donald M. Hilty, M.D.

Telepsychiatry’s evidence base is substantial and satisfaction is extremely high among patients, psychiatrists and other professionals.

Its effectiveness is comparable to in-person care in terms of therapeutic engagement, quality of care, validity/reliability of assessment, and clinical outcomes. There are two types of study design: head-to-head comparison or non-inferiority (i.e., as good as).

• The evidence base is formidable for children, adolescents and adults regarding assessment (diagnostic, cognitive, other) and treatment (medication, therapy).
• Preliminary studies in geriatric patients and across cultures are positive. Indeed, it may facilitate cultural, ethnic and language matching between patients and providers.
• The experience other mental health clinicians using telemedicine (i.e., telemental health), is consistent with, and further substantiates the diagnostic, therapeutic and outcome evidence base.
• Care models that have good evidence include direct care, consultation to primary care and collaborative care. It is being studied specifically, now, as a way to leverage psychiatric expertise in stepped and integrated care models, too.

There are a few populations in which it may be preferable to in-person care (e.g., autism spectrum, severe anxiety disorders, geriatric patients with physical limitations, those with significant geographical obstacles).

Telepsychiatrists adjust clinical care in a few ways to make it as personal as in-person care. First, they may project a little more in terms of gestures, just as if one is giving a presentation to a large group. Second, it helps to check-in to see how the patient is experiencing it. Third, verbal communication may replace handshakes, handing a tissue box and such. Finally, if a particular examination item is less facile at a distance, another staff or accompanying person can help.

References

• Hilty DM, Ferrer DC, Parish MB, et al. The Effectiveness of telemental health: A 2013 review. Telemed J E Health 2013;(19):444-454.
• Myers K, vander Stoep A, Zhou C, et al. Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: results of a community-based randomized controlled trial. J Amer Asso Child Adolesc Psychiatry 2015;54(4):263-74.
• Hilty DM, Yellowlees PM, Parish MB, et al. Telepsychiatry: Effective, evidence-based and at a tipping point in healthcare delivery. Psych Clin N Amer 2015;38(3):559-592.
• Yellowlees PM, Hilty DM, Mucic D: “Global/World Wide Telehealth: International Perspectives of Telepsychiatry and the Future.” In Key Issues in e-Mental Health. Eds Mucic D, Hilty DM, Springer Publishing, pp. 233-250, 2015