1 Division of Child and Adolescent Psychiatry, Department of Psychiatry, Queen's University Canada , Kingston, Ontario, Canada .
2 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .
Telemed J E Health. 2017 Oct;23(10):842-846. doi: 10.1089/tmj.2016.0269. Epub 2017 Apr 20.
The significant gap between children and adolescents presenting for emergency mental healthcare and the shortage of child and adolescent psychiatrists constitutes a major barrier to timely access for psychiatric assessment for rural and remote areas. Unlike remote areas, urban emergency departments have in-house psychiatric consultation. Telepsychiatry may be a solution to ensure the same service for remote areas. However, there is a paucity of studies on the use of telepsychiatry for child and adolescent emergency consults. Thus, the aim of our study was to (1) assess patient satisfaction with telepsychiatry and (2) compare clinical characteristics and outcome of telepsychiatry with face-to-face emergency child and adolescent assessments.
This is a prospective study of telepsychiatry emergency assessments of children and adolescents referred by emergency physicians. The comparison group was age- and gender-matched patients seen for face-to-face urgent assessments. Data were gathered on demographic and clinical variables. Telepsychiatry satisfaction was assessed using a questionnaire. Descriptive statistics and chi-square tests were used to assess group differences for each variable. Logistic regression was used to assess impact of the variables on outcome after the consult. A p value <0.05 was used to determine statistical significance.
Sixty (n = 60) assessments were conducted through telepsychiatry in 12 months. Among the telepsychiatry group, Aboriginal patients were over-represented (50% vs. 6.7%, p < 0.001), a higher proportion received a diagnosis of adjustment disorder (22% vs. 8.3%, p = 0.004) or no diagnosis (27% vs. 6.7%, p = 0.004) compared with controls. There was no statistically significant difference between groups on other clinical variables. Patients reported a high degree of satisfaction with telepsychiatry.
Telepsychiatry is acceptable to patients and families for safe emergency assessment and follow-up, reducing unnecessary travel to urban centers. Longer time outcomes are needed to establish validity of telepsychiatry for emergency assessments.
儿童和青少年在寻求紧急心理健康护理方面存在显著差距，而儿童和青少年精神科医生的短缺，构成了农村和偏远地区获得精神病评估的主要障碍。与偏远地区不同，城市急诊部门有内部精神科会诊。远程精神病学可能是确保偏远地区获得相同服务的一种解决方案。然而，对于儿童和青少年急诊咨询的远程精神病学使用，研究甚少。因此，我们的研究目的是：（1）评估远程精神病学的患者满意度，（2）比较远程精神病学与面对面急诊儿童和青少年评估的临床特征和结果。
这是一项对通过急诊医生转介的儿童和青少年进行远程精神病学急诊评估的前瞻性研究。对照组为接受面对面紧急评估的年龄和性别匹配患者。收集人口统计学和临床变量的数据。使用问卷评估远程精神病学满意度。使用描述性统计和卡方检验评估每个变量的组间差异。使用逻辑回归评估变量对咨询后结果的影响。p 值<0.05 用于确定统计学意义。
在 12 个月内通过远程精神病学进行了 60 次评估。在远程精神病学组中，原住民患者的比例过高（50%比 6.7%，p<0.001），与对照组相比，更多的患者被诊断为适应障碍（22%比 8.3%，p=0.004）或无诊断（27%比 6.7%，p=0.004）。两组在其他临床变量上无统计学显著差异。患者报告对远程精神病学非常满意。
远程精神病学可被患者及其家属接受，用于安全的急诊评估和随访，减少了前往城市中心的不必要旅行。需要进行更长时间的结局研究，以确立远程精神病学在急诊评估中的有效性。
