Background
Methods
Study design
Study sample
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To assess the pattern of utilization, the sample included consecutive patients, 65 years and over, with mental health problems, resident in rural and remote South Australia, referred to the service for a tele-psychiatry assessment from January 2010–December 2011.
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To assess acceptance and satisfaction, feedback about the tele-psychiatry consultation was sought prospectively from patients, referring nurse/clinician and psychiatrist involved in the tele-psychiatry consultation from April to November 2012. The feedback was voluntary and anonymous. Return of the feedback forms was accepted as consent.
Telepsychiatry setup and process of consultation
Data collection
Data analysis
Acceptance and satisfaction
Results
Profile of older adult seen via telepsychiatry in 2010–2011
Consumer profile | Jan 2010 to Dec 2011 (N = 134) |
---|---|
Mean Age (SD) | 75.89 (SD 7.55) |
Female (n, %) | 81 (60.4%) |
Place of residence (n, %) | |
Private own/rental, Independent house | 96 (71.6%) |
Residential Age Care Facility (RACF) | 25 (18.7%) |
Hospital | 7 (5.2%) |
Not stated | 6 (4.5%) |
Physical disability (n, %) | |
No disability | 90 (67.2%) |
Visual/hearing impaired | 21 (15.7%) |
Unsteady gait/ restricted mobility | 17 (12.7%) |
Not stated | 6 (4.5%) |
Difficult Speech/aphasia | 2 (1.5%) |
Medical Illnesses (eg: hypertension, diabetes, infections, renal impairment, cancers) (n, %) | |
2 or more medical conditions | 96 (71.6%) |
Single medical condition | 16 (11.9%) |
No medical illness | 17 (12.7%) |
Not stated | 5 (3.7%) |
Standard Mini Mental State Examination (SMMSE) | |
Mean score (SD) | 24.44 (SD 4.98) |
Not mentioned (n, %) | 61 (45.5%) |
Reason for referral (n, %) | |
Depression/anxiety | 58 (43.3%) |
Difficult-behaviors (odd/confused/paranoid/manic/aggression/uncooperative) | 26 (19.4%) |
Not specified | 28 (20.9%) |
Self-harm ideation/attempt | 16 (11.9%) |
Others (alcohol use, medication side effects, capacity) | 6 (4.5%) |
Person accompanying the patient (n, %) | |
Member of the Community Mental Health Team (CMHT) /clinician | 69 (51.5%) |
Clinical nurse (RACF/hospital/practice) | 56 (41.8%) |
Family (spouse/son/daughter) | 53 (39.6%) |
Not stated | 9 (6.3%) |
GP | 5 (3.7%) |
DSM IV diagnosis (n, %) | |
Major Depressive Disorder | 51 (38.1%) |
Bipolar Disorder | 20 (14.9%) |
Dementia | 18 (13.4%) |
Schizophrenia/Schizo-affective disorder/Delusional Disorder/Psychotic Disorder NOS | 14 (10.5%) |
Anxiety disorders (PTSD, Panic Disorder, NOS) | 11 (8.2%) |
Adjustment Disorder | 11 (8.2%) |
Delirium | 9 (6.7%) |
Medication side effects | 7 (5.2%) |
No axis 1 diagnosis | 3 (2.2%) |
Substance dependence/abuse | 2 (1.5%) |
Recommendations provided (n, %) | |
Medication recommendation only | 55 (41.0%) |
Medication recommendation + psychosocial supports and services | 32 (23.9%) |
Recommended further medical evaluation/inpatient admission+/− medication recommendation | 34 (25.4%) |
No further changes | 13 (9.7%) |
Prospective feedback from patients, clinicians, and psychiatrists for telepsychiatry consultations
Total (N=98) | Feedback received (N = 51) | Feedback not received (N = 47) | Statistical significance | |
---|---|---|---|---|
Mean age in years (SD) | 75.68 (6.39) | 75.94 (6.45) | 75.40 (6.39) | t = 0.414, p = 0.860a |
Gender | ||||
Females (N, %) | 64 (65.3% | 34 (66.7%) | 30 (63.8%) | χ2 = 0.087 p = 0.833b |
Males (N,%) | 34 (34.7%) | 17 (33.3%) | 17 (36.2%) | |
Prior tele-psychiatry contact with the service (N, %) | χ2 = 1.791 p = 0.216b | |||
Yes | 38 (38.8%) | 23 (45.1%) | 15 (31.9%) | |
No | 60 (61.2%) | 28 (54.9%) | 32 (68.1%) | |
Primary Psychiatry Diagnosis made at the assessment (N, %) | ||||
Depression or anxiety | 51 (52.0%) | 30 (58.8%) | 21 (44.7%) | χ2 = 9.107 p = 0.168b |
Mania | 10 (10.2%) | 5 (9.8%) | 5 (10.6%) | |
Psychotic illness | 21 (21.4%) | 12 (23.5%) | 9 (19.1%) | |
Delirium | 6 (6.1%) | 1 (2.0%) | 5 (10.6%) | |
Organic mood disorder | 2 (2.0%) | 1 (2.0%) | 1 (2.1%) | |
Dementia | 7 (7.1%) | 1 (2.0%) | 6 (12.8%) | |
Unclear | 1 (1%) | 1 (2.0%) | 0 (0.0%) | |
Living Situation (N, %) | ||||
Independent living (Home or Retirement home) | 82 (83.7%) | 41 (80.4%) | 41 (87.2%) | χ2 = 1.229 p = 0.420b |
Nursing Home | 16 (16.3%) | 10 (19.6%) | 6 (12.8%) | |
Status at consultation (N, %) | ||||
Inpatient (admitted in community hospital) | 37 (37.8%) | 14 (27.5%) | 23 (48.9%) | χ2 = 0.838
p = 0.037*
b
|
Outpatient | 61 (62.2%) | 37 (72.5%) | 24 (51.1%) |
Feedback from patients
Feedback Question | Mean ± SD | Percentage satisfieda (n) | Percentage unsurea (n) | Percentage dissatisfieda (n) |
---|---|---|---|---|
1. The waiting period for the consultation was satisfactory (i.e The time interval between making contact with the service and appointment for consultation) | 4.14 ± 0.94 | 84.4 (43) | 7.8 (4) | 7.8 (4) |
2. Sufficient explanation was provided regarding the process | 4.18 ± 0.71 | 86.2 (44) | 11.8 (6) | 2.0 (1) |
3. My privacy and confidentiality was respected | 4.41 ± 0.61 | 98.0 (50) | 0 (0) | 2.0 (1) |
4. I was able to see clearly | 4.24 ± 0.79 | 92.2 (47) | 3.9 (2) | 3.9 (2) |
5. I was able to hear clearly | 4.00 ± 1.00 | 80.4 (41) | 7.8 (4) | 11.8 (6) |
6. I was able to express myself adequately using this mode of assessment | 4.20 ± 0.78 | 86.3 (44) | 9.8 (5) | 3.9 (2) |
7. I felt comfortable discussing my problems using this mode of assessment | 4.22 ± 0.78 | 90.2 (46) | 3.9 (2) | 5.9 (3) |
8. The assessment addressed my needs | 3.90 ± 0.83 | 68.6 (35) | 27.5 (14) | 3.9 (2) |
9. The recommendations made were useful | 3.88 ± 0.77 | 72.5 (37) | 23.5 (12) | 3.9 (2) |
10. I am satisfied with the consultation | 4.14 ± 0.75 | 86.3 (44) | 9.8 (5) | 3.9 (2) |
11. I would prefer to use it again? | 4.02 ± 0.81 | 76.5 (39) | 19.6 (10) | 3.9 (2) |
12. I would recommend it to others? | 4.08 ± 0.85 | 86.3 (44) | 7.8 (4) | 5.9 (3) |
Questionsa | Prior telepsychiatry contact with the service | Gender | Living Situation | Status at the time of the assessment | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes = 23 Mean, SD | No = 28 Mean, SD | U, 2 tailed P value | Male= 17 Mean, SD | Female = 34 Mean, SD | U, 2 tailed P value | Independent living = 41 Mean, SD | Nursing Home = 10 Mean, SD | U, 2 tailed P value | Inpatient = 14 Mean, SD | Outpatient = 37 Mean, SD | U, 2 tailed P value | |
Q 1 | 4.30, 0.765 | 4.0, 1.054 | 275.5, 0.339 | 4.24, 0.831 | 4.09, 0.996 | 271.0, 0.696 | 4.15, 1.014 | 4.10, 0.568 | 174.5, 0.432 | 3.64, 1.324 | 4.32, 0.784 | 163.0, 0.028* |
Q 2 | 4.30, 0.765 | 4.07, 0.663 | 253.5, 0.150 | 4.12, 0.781 | 4.21, 0.687 | 270.0, 0.674 | 4.22, 0.759 | 4.00, 0.471 | 160.5, 0.242 | 4.07, 0.616 | 4.22, 0.750 | 222.0, 0.386 |
Q 3 | 4.43, 0.507 | 4.39, 0.685 | 319.0, 0.948 | 4.41, 0.507 | 4.41, 0.657 | 277.0, 0.783 | 4.41, 0.631 | 4.40, 0.516 | 195.0, 0.786 | 4.36, 0.497 | 4.43, 0.647 | 230.0, 0.483 |
Q 4 | 4.26, 0.689 | 4.21, 0.876 | 321.0, 0.983 | 4.06, 0.966 | 4.32, 0.684 | 246.5, 0.337 | 4.20, 0.843 | 4.40, 0.516 | 186.0, 0.612 | 3.71, 1.139 | 4.43, 0.502 | 160.5, 0.019* |
Q 5 | 3.83, 1.072 | 4.14, 0.932 | 269.0, 0.279 | 4.24, 0.664 | 3.88, 1.122 | 253.5, 0.444 | 4.07, 0.985 | 3.70, 1.059 | 160.0, 0.249 | 3.93, 1.141 | 4.03, 0.957 | 252.0, 0.873 |
Q 6 | 4.17, 0.937 | 4.21, 0.630 | 307.0, 0.755 | 4.29, 0.588 | 4.15, 0.857 | 274.0 0.742 | 4.27, 0.708 | 3.90, 0.994 | 162.5, 0.268 | 3.93, 0.829 | 4.30, 0.740 | 192.5, 0.123 |
Q 7 | 4.26, 0.752 | 4.18, 0.819 | 307.5, 0.759 | 4.18, 0.728 | 4.24, 0.819 | 268.0 0.639 | 4.22, 0.822 | 4.20, 0.632 | 189.5, 0.681 | 3.86, 0.949 | 4.35, 0.676 | 181.5, 0.067 |
Q 8 | 3.87, 0.869 | 3.93, 0.813 | 309.5, 0.801 | 3.88, 0.781 | 3.91, 0.866 | 276.5 0.790 | 3.93, 0.848 | 3.80, 0.789 | 183.0, 0.579 | 3.86, 0.770 | 3.92, 0.862 | 242.5, 0.711 |
Q 9 | 4.00, 0.798 | 3.79, 0.738 | 269.5, 0.276 | 3.82, 0.728 | 3.91, 0.793 | 261.5 0.547 | 3.90, 0.800 | 3.80, 0.632 | 185.0, 0.603 | 4.00, 0.679 | 3.84, 0.800 | 234.0, 0.563 |
Q 10 | 4.13, 0.757 | 4.14, 0.756 | 319.5, 0.958 | 4.24, 0.562 | 4.09, 0.830 | 272.0 0.705 | 4.17, 0.771 | 4.00, 0.667 | 171.0, 0.368 | 4.07, 0.616 | 4.16, 0.800 | 229.0, 0.480 |
Q 11 | 4.17, 0.650 | 3.89, 0.916 | 271.0, 0.299 | 4.00, 0.707 | 4.03, 0.870 | 273.5 0.739 | 4.05, 0.835 | 3.90, 0.738 | 178.0, 0.491 | 3.71, 0.681 | 4.14, 0.787 | 186.0, 0.097 |
Q 12 | 4.22, 0.600 | 3.96, 0.999 | 293.0, 0.537 | 4.00, 0.935 | 4.12, 0.808 | 271.5 0.694 | 4.10, 0.889 | 4.00, 0.667 | 176.0, 0.439 | 3.86, 0.770 | 4.16, 0.866 | 194.5, 0.126 |
Feedback data from clinician’s/ nurses
Clinicians/Nurses (N = 59) | Psychiatrist (N = 80) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Feedback Question | Mean ± SD | Satisfied a% (n) | Unsureb % (n) | Dissatisfiedc % (n) | Feedback Question | Mean ± SD | Satisfieda % (n) | Unsureb % (n) | Dissatisfiedc (n) |
The waiting period of the consultation was satisfactory (ie, from the time of referral to consultation) | 4.53 ± 0.68 | 93.2 (55) | 5.1 (3) | 1.7 (1) | I was able to fit the referral in my existing time schedule | 4.13 ± 0.88 | 86.7 (72) | 3.6 (3) | 9.6 (8) |
The process of referral was convenient | 4.36 ± 0.78 | 88.1 (52) | 8.5 (5) | 3.4 (2) | The referral had adequate information | 4.19 ± 0.96 | 83.1 (69) | 8.4 (7) | 8.4 (7) |
Adequate privacy and confidentiality was provided during the consultation | 4.58 ± 0.91 | 93.2 (55) | 1.7 (1) | 5.1 (3) | Adequate privacy and confidentiality was provided | 4.08 ± 0.94 | 81.9 (68) | 7.2 (6) | 10.8 (9) |
The video was clear | 4.56 ± 0.90 | 93.2 (55) | 1.7 (1) | 5.1 (3) | The video was clear | 4.24 ± 1.07 | 85.5 (71) | 3.6 (3) | 10.8 (9) |
The audio was clear | 4.71 ± 0.53 | 96.6 (57) | 3.4 (2) | 0 (0) | The audio was clear | 4.25 ± 1.03 | 72 (86.7) | 3.6 (3) | 9.6 (8) |
I felt comfortable participating in the Telemed assessment process | 4.68 ± 0.54 | 96.6 (57) | 3.4 (2) | 0 (0) | I felt comfortable participating in the Tele-med assessment process | 3.78 ± 1.12 | 66.2 (54) | 16.9 (14) | 16.9 (14) |
The assessment confirmed to our desired outcomes as mentioned on the referral | 4.54 ± 0.65 | 91.5 (54) | 8.5 (5) | 0 (0) | The time was sufficient to do the assessment and make recommendation | 4.36 ± 0.77 | 94.0 (78) | 3.6 (3) | 2.4 (2) |
The recommendation for management was useful | 4.51 ± .65 | 91.5 (54) | 8.5 (5) | 0 (0) | The recommendations can be followed up in the community | 4.04 ± 0.99 | 79.5 (66) | 10.8 (9) | 9.6 (8) |
I am satisfied with the consultation | 4.63 ± 0.52 | 98.3 (58) | 1.7 (1) | 0 (0) | It was a useful adjunct to my routine work | 4.25 ± 0.88 | 85.6 (71) | 10.8 (9) | 3.6 (3) |
I would use it again | 4.71 ± 0.46 | 100 (59) | 0 (0) | 0 (0) | I preferred it to face to face consultation | 3.67 ± 1.39 | 55.4 (46) | 15.7 (13) | 28.9 (24) |
I would recommend it to others | 4.73 ± 0.45 | 100 (59) | 0 (0) | 0 (0) | I Would encourage its use | 4.45 ± 0.80 | 92.7 (77) | 4.8 (4) | 2.4 (2) |
Feedback from the psychiatrists/sub-specialty trainee
Feedback comments
Themes | Patients | Nurses/Clinicians | Psychiatrist | |||
---|---|---|---|---|---|---|
Positive | Negative | Positive | Negative | Positive | Negative | |
Referral process/information | 0 | 0 | Referral process (2) | Referral information requirements (3) | 0 | Lack of adequate information (2); Difficulty accommodating the referral (2) |
Privacy (not sound proof/external noise/intrusions) | 0 | 0 | 0 | Background noise (2) | 0 | Background noise (5); Intrusions (1) |
Audio-visual | 0 | Audio visual issues (5) | 0 | Audio-visual issues (5) | 0 | Technical issues- audio-visual, (5) |
Comfort | Comfortable (3) | Daunting (1) | 0 | 0 | 0 | Cold/uncomfortable (3) |
Recommendations | Useful recommendations (1) | 0 | 0 | 0 | 0 | Deficient community resources (1) |
Global | Good/Helpful (14) | Unsure (1) | Helpful (4) | 0 | Useful (4); Suitable (2) | 0 |
Others | Saved time travelling (4); Staff helpful (2); Treated respectfully (1) | 0 | Educational (2); Supportive (2); Saved time (1) | Interruption by a Medical emergency (2) | Time saving (3) | Patient related issues-behaviour/cognition/hearing (10) |