Department of Psychiatry, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont 05401, USA.
Telemed J E Health. 2010 Jan-Feb;16(1):34-40. doi: 10.1089/tmj.2009.0088.
Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.
精神科护理对于养老院居民来说很难获得，尤其是在农村地区，这种不足可能导致严重的发病率或死亡率。通过视频会议提供这项服务可能是一种有帮助的、具有成本效益的、可接受的替代面对面治疗的方法。我们分析了 106 名养老院居民的 278 次远程精神病学治疗的数据，以估计与面对面护理相比，这种模式的潜在成本和时间节省。如果 278 次就诊分别进行，与面对面咨询相比，总共可节省 278 次就诊中的每一次就诊 843.5 小时（105.4 个 8 小时工作日）的旅行时间。如果每次旅行可以进行四次居民就诊，节省的时间将减少到 26.4 个工作日。节省的旅行距离为 43,000 英里；如果每次旅行进行四次访问，则节省 10,750 英里。如果进行 278 次单独的访问，将花费超过 3,700 美元用于汽油；如果每次往返旅行进行四次访问，则减少到 925 美元。人员成本节省估计从 33,739 美元到 67,477 美元不等。与 278 次就诊相关的额外旅行时间相关的医生费用从 84,347 美元到 253,040 美元不等，或者从每次就诊四次的 21,087 美元到 63,260 美元不等。远程精神病学方法几乎受到所有居民、家属和养老院工作人员的热烈欢迎，并导致成功的患者管理。通过视频会议为农村养老院居民提供精神科护理具有成本效益，并且似乎是替代面对面护理的一种可接受的医疗方法。此外，这种方法将使许多养老院能够提供否则无法获得的基本护理。
