Amirsadri Alireza, Burns Jaclynne, Pizzuti Albert, Arfken Cynthia L
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, 3901 Chrysler Service Drive, Detroit, MI 48201, USA.
Case Rep Psychiatry. 2017;2017:6296423. doi: 10.1155/2017/6296423. Epub 2017 May 29.
Telepsychiatry expands access to psychiatric care. However, telepsychiatry for elderly adults is only reimbursed in the US if the patient is assessed while in a clinical setting. This case study presents a homebound older woman previously hospitalized for schizophrenia who had not seen a psychiatrist in over 20 years. Care was provided with hybrid telepsychiatry (team-based practice with social worker traveling to the home with electronic tablet for connection with psychiatrist). The intervention resulted in detecting unrecognized depression and complex trauma. The treatment plan included adding an antidepressant and therapy plan, eliminating one psychiatric medication, and reducing dosage of pain medication. The outcomes were improved function and quality of life. The patient and caregiver were both highly satisfied with the services. This hybrid telepsychiatry is a reasonable option for homebound elderly patients living in urban areas and less expensive than nursing home admission.
远程精神病学扩大了获得精神科护理的机会。然而，在美国，只有当老年患者在临床环境中接受评估时，老年远程精神病学服务才能得到报销。本案例研究介绍了一位因精神分裂症曾住院治疗的居家老年女性，她已有20多年未看过精神科医生。通过混合式远程精神病学服务（基于团队的实践，由社会工作者携带电子平板电脑前往患者家中与精神科医生进行连线）为其提供护理。该干预措施发现了未被识别的抑郁症和复杂创伤。治疗计划包括添加一种抗抑郁药和治疗方案、停用一种精神科药物以及减少止痛药剂量。结果是功能和生活质量得到改善。患者和护理人员对服务都非常满意。这种混合式远程精神病学对于居住在城市地区的居家老年患者来说是一个合理的选择，而且比入住养老院成本更低。
