Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Yale New Haven Health, Yale New Haven Psychiatric Hospital, Connecticut, USA.
J Am Med Inform Assoc. 2020 Jul 1;27(9):1420-1424. doi: 10.1093/jamia/ocaa138.
COVID-19 has demanded unprecedented actions in the delivery of outpatient psychiatric services, including the rapid shift of services from in-person to telehealth in response to public health physical distancing guidelines. One such shift was to convert group-level intensive outpatient psychiatric (IOP) interventions to telehealth. Historically, telehealth in psychiatric care has been studied in provider-patient interactions, but has not been as well studied for group telehealth service delivery. During the COVID-19 outbreak, providing group-based interventions was important in order to care for high-risk individuals who needed structured psychotherapy group support. However, the delivery of services via telehealth led to special challenges that were unable to be fully accommodated by the preexisting telehealth infrastructure. Rapid feasibility testing and adoption of technology was needed to support IOP services to minimize infectious spread while delivering group services to high-risk psychiatric patients. This article describes the processes and workflows for service delivery and early results of telehealth for IOP services in 2 adolescent treatment programs. In addition, the article highlights early observations around safety and quality and the role of telehealth policy and payment.
新冠疫情要求在提供门诊精神科服务方面采取前所未有的行动,包括根据公共卫生保持身体距离的指导方针,迅速将服务从面对面转为远程医疗。其中一项转变是将团体强化门诊精神科(IOP)干预措施转为远程医疗。从历史上看,远程医疗在精神科护理中的研究主要集中在医患互动方面,但对于团体远程医疗服务的研究还不够充分。在 COVID-19 爆发期间,提供基于团体的干预措施很重要,因为需要为需要结构化心理治疗团体支持的高风险个体提供服务。然而,通过远程医疗提供服务带来了特殊的挑战,这些挑战无法完全通过现有的远程医疗基础设施来解决。需要快速进行可行性测试并采用新技术来支持 IOP 服务,以最大程度地减少传染性传播,同时为高风险精神科患者提供团体服务。本文描述了在 2 个青少年治疗项目中为 IOP 服务提供服务和远程医疗的早期结果的流程和工作流程。此外,本文还重点介绍了围绕安全性和质量的早期观察结果,以及远程医疗政策和支付的作用。