Department of Psychiatry, Brigham and Women's Hospital.
Department of Psychiatry, Harvard Medical School.
Psychol Serv. 2023;20(Suppl 2):11-19. doi: 10.1037/ser0000625. Epub 2022 Feb 24.
After years of slow and fragmented implementation of telemental health (TMH), the coronavirus disease (COVID-19) pandemic necessitated widespread adoption. With the initial state of public health emergency behind us, we are at a decision point on whether to continue with TMH or return to a largely in-person care model. In this qualitative study, we investigated clinicians' perspectives on advantages and disadvantages of TMH in outpatient mental healthcare as well as considerations for future implementation. We conducted 29 semistructured interviews with outpatient mental health providers. Data were analyzed using rapid qualitative analysis methodology. Advantages included increased utilization of services, improved therapeutic processes, and improved provider wellbeing. Providers, however, also noted that TMH has some disadvantages in terms of therapeutic processes and provider wellbeing, and they reported technology issues as an additional disadvantage. Overall providers reported they can provide high quality care via TMH, but indicated some patient populations and appointment types are a better fit for in-person services. Most providers preferred a hybrid model of care moving forward with reimbursement discrepancies and out-of-state licensure restrictions as barriers. They indicated that, as TMH becomes a mainstay in psychiatric care, training and professional guidelines will be important. Continued implementation of TMH alongside in-person care is likely to offer improved access and enhanced service quality when applied to the right patient populations and appointment types. Effective implementation may require policy and systems level support on equitable reimbursement rates, out-of-state licensure restrictions and professional guidelines for delivering TMH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
在精神科远程医疗(TMH)缓慢且零散实施多年后,冠状病毒病(COVID-19)大流行迫使它得到广泛采用。随着公共卫生紧急状态的初始阶段过去,我们现在处于是否继续使用 TMH 或回归以面询为主的护理模式的决策点。在这项定性研究中,我们调查了临床医生对 TMH 在门诊精神卫生保健中的优缺点的看法,以及对未来实施的考虑。我们对 29 名门诊精神卫生提供者进行了半结构化访谈。使用快速定性分析方法进行数据分析。TMH 的优点包括增加了服务利用率、改善了治疗过程和提高了提供者的幸福感。然而,提供者也注意到 TMH 在治疗过程和提供者幸福感方面存在一些缺点,并报告技术问题是另一个缺点。总体而言,提供者表示他们可以通过 TMH 提供高质量的护理,但表示一些患者群体和预约类型更适合面询服务。大多数提供者更倾向于在未来采用混合护理模式,但由于报销差异和州外执照限制等障碍,他们表示这将是一个挑战。他们表示,随着 TMH 成为精神科护理的主要手段,培训和专业指南将变得重要。当将 TMH 应用于合适的患者群体和预约类型时,继续实施 TMH 与面询护理相结合可能会提供更好的可及性和增强的服务质量。有效的实施可能需要在公平的报销率、州外执照限制和提供 TMH 的专业指南方面在政策和系统层面上提供支持。
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