Subho Chakrabarti, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
World J Psychiatry. 2015 Sep 22;5(3):286-304. doi: 10.5498/wjp.v5.i3.286.
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
远程精神病学，即利用信息和通信技术从远处提供精神科服务，已经存在了半个多世纪。在此期间的研究表明，基于视频会议的远程精神病学是一种赋权和赋能的服务提供形式，它促进了平等的获得服务的机会，并提高了患者的满意度。基于视频会议的远程精神病学提供的服务范围、潜在用户和服务提供点在理论上是无限的。远程精神病学具有临床实用性和非临床用途，如行政、学习和研究应用。大量积累的证据表明，基于视频会议的远程精神病学评估是可靠的，远程精神病学干预的临床结果与不同患者群体、年龄和诊断组以及广泛的措施中的传统治疗相当。然而，在许多有效性方面，证据基础仍然相对有限，并且经常受到方法学问题的影响。特别是缺乏成本效益数据，这是一个主要障碍，对远程精神病学服务的持续可行性提出了质疑。此外，还有技术的不确定性、临床医生的负面看法、提供者的接受度低以及一些法律、伦理和行政障碍。这些都阻碍了远程精神病学的广泛实施及其与常规护理的整合。尽管预计技术和研究的进一步进步将解决许多这些问题，但前进的方向将是将远程精神病学作为传统护理的辅助手段，并开发混合模式，将传统和远程精神病学形式的精神保健结合起来。
