Shalev Ligat, Bistre Moises, Lubin Gadi, Avirame Keren, Raskin Sergey, Linkovski Omer, Eitan Renana, Rose Adam J
School of Public Health, Hebrew University, Jerusalem, Israel.
The Jerusalem Mental Health Center, Jerusalem, Israel.
JMIR Res Protoc. 2023 Oct 17;12:e49405. doi: 10.2196/49405.
Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission.
The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link.
This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation's viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records.
This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others.
Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation.
ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49405.
远程精神病学是利用虚拟通信（如视频链接）来提供心理健康评估、治疗和随访。以往研究表明，远程精神病学是可行的，与面对面诊疗相比准确无误，并且让精神科医生和患者都感到满意。远程精神病学还与缩短评估等待时间相关，在一些研究中，还与降低住院率有关。然而，以往大多数研究侧重于在社区环境中使用远程精神病学，而非非自愿住院治疗。
本研究旨在探讨使用视频链接对精神科急诊科（ED）非自愿住院患者进行评估的有效性和实施过程。
这项1型混合实施研究将通过比较远程精神病学组（n = 240）和在以色列5家精神科急诊科之前常规护理期间进行面对面评估的历史对照组（n = 240），来检验远程精神病学的有效性和实施过程。为了进行研究，已获得以色列卫生部对仅要求面对面评估的现行政策的临时豁免。在远程精神病学阶段，临床工作人员和患者将从急诊科加入视频通话，而主治医生将在其他地方登录。促进卫生服务研究实施行动（PARIHS）框架将指导对急诊科远程精神病学实施过程的评估。PARIHS有以下三个要素：（1）证据：工作人员对创新的可行性和实用性的看法、他们对其使用的满意度水平以及患者对这种变化的看法；（2）背景：急诊科对新策略的认可程度、决策过程以及临床团队沟通和协作的方式；（3）促进：利用倡导者报告评估促进工作的充分性。主要临床结局包括从病历中获取的急诊科住院时间和暴力事件。
本研究获得了阿巴巴内尔心理健康中心伦理委员会（174；2023年3月13日）、耶路撒冷心理健康中心（22 - 21；2022年11月6日）、列夫 - 哈沙龙心理健康医疗中心（LH12023；2023年2月12日）、特拉维夫医疗中心（TLV - 22 - 0656；2023年1月3日）和沙阿·梅纳什（1 - 4 - 23；2023年4月18日）的赫尔辛基批准。数据收集于2023年7月在2个研究地点开始，其他地点也将很快开始。
远程精神病学可能对精神科急诊科的患者有显著益处。除了确定在不同急诊环境中实施远程精神病学的促进因素和障碍外，研究其在急诊科的有效性将有助于就其实施做出更好的政策决策。
ClinicalTrials.gov NCT05771545；https://clinicaltrials.gov/study/NCT05771545。
国际注册报告识别号（IRRID）：DERR1 - 10.2196/49405。
