Painter Jon, Turner James, Procter Paula
Department of Nursing and Midwifery, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S1 1WB, UK.
Healthcare (Basel). 2021 Apr 29;9(5):517. doi: 10.3390/healthcare9050517.
COVID-19 has placed additional challenges on mental health services. Video consultations (VCs) have provided a short-term solution to lockdown restrictions but could also increase long-term capacity to meet the anticipated rising demand. A total of 7752 VCs were conducted over six weeks. Thematic analysis of 474 online survey responses identified twenty patient attributes that influenced staffs' decisions to offer VCs. Their opinions were diverse, at times contradictory, and not always evidence based. There was reasonable consensus (and published evidence to support) of the probable suitability of VC for patients who: are IT savvy and suitably equipped; are teenagers; live in remote/rural locations; have caring responsibilities; have anxiety disorders or express a preference. No consensus was reached regarding eight attributes and there was a corresponding paucity of evidence, indicating the need for further research. Conversely, old age; paranoia, sensory impairment/communication difficulties; high risk and trauma/PTSD (posttraumatic stress disorder) were generally seen as contraindicated by staff, despite published evidence of success elsewhere. It may be possible to overcome staff's reticence to offer these groups VCs. As staff are effectively the gatekeepers to VC interventions, it is important to understand and support them to overcome reservations that are contrary to the empirical evidence base. This will ensure that their initial anxieties do not become unnecessary barriers to services for those most in need. As with all mental healthcare, such decisions should be made collaboratively, and on an individual basis.
新冠疫情给心理健康服务带来了更多挑战。视频咨询（VCs）为应对封锁限制提供了短期解决方案，但也可能提高长期应对预期增长需求的能力。在六周内共进行了7752次视频咨询。对474份在线调查回复进行的主题分析确定了20个影响工作人员提供视频咨询决定的患者属性。他们的意见各不相同，有时相互矛盾，且并非总是基于证据。对于具备信息技术能力且设备合适、青少年、居住在偏远/农村地区、有护理责任、患有焦虑症或表示有偏好的患者，视频咨询可能具有适用性，对此存在合理共识（并有已发表的证据支持）。对于八个属性未达成共识，且相应的证据不足，这表明需要进一步研究。相反，尽管其他地方有成功的证据发表，但工作人员普遍认为老年人、偏执、感官障碍/沟通困难、高风险以及创伤/创伤后应激障碍（PTSD）患者不适合视频咨询。有可能克服工作人员对为这些群体提供视频咨询的抵触情绪。由于工作人员实际上是视频咨询干预的把关人，了解并支持他们克服与实证证据相悖的保留意见非常重要。这将确保他们最初的焦虑不会成为最需要服务的人群获得服务的不必要障碍。与所有心理保健一样，此类决定应在个体基础上共同做出。
