Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.
Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
JMIR Public Health Surveill. 2021 Jul 22;7(7):e25836. doi: 10.2196/25836.
Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities.
The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services.
We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program.
During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions.
The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation.
受儿童保护服务监督的儿童和青少年有复杂的心理健康护理需求。智利专门的心理健康团队的稀缺和分布不均可能会限制为这一弱势群体提供和护理的质量。远程精神病学可以解决这些健康不平等问题。
本研究的目的是评估为受儿童保护服务监督的儿童和青少年提供初级保健（PHC）治疗的远程精神病学咨询计划的可行性。
我们为位于智利中部（瓦尔帕莱索地区）的两个农村 PHC 诊所开发了一个远程精神病学咨询计划，并使用混合方法研究设计评估其实施情况。该计划包括由智利圣地亚哥的儿童和青少年精神病学家安排的每月两次（每次 90 分钟）的视频会议心理健康咨询会议，为期 6 个月。我们描述了心理健康咨询会议的次数、参与者特征、感知的有用性和可接受性，以及远程精神病学咨询计划的经验。
在 6 个月的研究期间，进行了 15 次视频会议心理健康咨询。远程精神病学咨询计划帮助 PHC 临床医生对 11 名有复杂护理需求的未成年人进行了最合适的诊断，并在药物治疗和/或心理治疗方面做出了治疗决策。PHC 临床医生认为该干预措施有助于提高对该患者群体治疗的解决能力。在大多数会议中，连接问题等限制因素得到了解决。
远程精神病学咨询计划是可行的，并且对于支持 PHC 临床医生管理复杂心理社会护理需求的机构化儿童和青少年可能是有用的，这些儿童和青少年生活在资源匮乏的环境中。更大规模的试验应评估该患者群体的临床结果。需要为这种服务模式制定法规和资源，以促进可持续性和大规模实施。
