Can Telepsychiatry Replace In-Person Psychiatric Assessments? A Review and Meta-Analysis of Comparison Studies

Abstract

Objective: The authors conducted a review and meta-analysis of the literature comparing telepsychiatry with “in-person” psychiatric assessments.Method: Approximately 380 studies on telepsychiatry published between 1956 and 2002 were identified using MEDLINE, PsycINFO, and cross-referenced bibliographies. Of these, 14 studies with an N>10 compared telepsychiatry with in-person psychiatry (I-P) using objective assessment instruments or satisfaction instruments. Three of these studies compared high bandwidth (HB) with low bandwidth (LB) telepsychiatry.Results: Fourteen studies of 500 patients met inclusion criteria and were included in the meta-analysis. Telepsychiatry was found to be similar to I-P for the studies using objective assessments. Effect sizes were on average quite small, suggesting no difference between telepsychiatry and I-P. Bandwidth was found to be a significant moderator. Three moderators were tested, effect sizes remained largely heterogeneous, and further analyses are needed to determine the direction of effect. There was no difference between I-P and telepsychiatry between the HB and LB groups, although there are anecdotal data suggesting that H B was slightly superior for assessments requiring detailed observation of subjects.Conclusion: Out of a large telepsychiatry literature published over the past 40+ years, only a handful of studies have attempted to compare telepsychiatry with I-P directly using standardized assessment instruments that permit meaningful comparisons. However, in those studies, the current meta-analysis concludes there is no difference in accuracy or satisfaction between the two modalities. Over the next few years, we expect telepsychiatry to replace I-P in certain research and clinical situations.

Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence

“…[48][49]51 Ten systematic reviews were selected (QS ≥22) for detailed extraction of findings and evidence based recommendations (Table IV). 23,[26][27][28][38][39][54][55][56][57] One of these was a policy document which provided detailed grading of evidence-based recommendations. 38 Two of these systematic reviews were non-effectiveness reviews included to provide synthesised information on utilization and cost.…”

“…The recommendations extracted from the different studies in the systematic reviews were subjected to evidence and video application grading based on the clinical coding methodology developed by the American Telemedicine Association cited in Grady (2011) (Table II). 38 As Hyler (2005) found that bandwidth was a confounder in evaluation studies 39 , bandwidth was included in the video application classification and each study used in a review was classified by letters (HD -LB) according to bandwidth and resolution. The recommendations from the studies were assigned evidence grading by numbers (1-3), equivalent to standard recommendations ratings A-C, for research quality confidence.…”

Developing telepsychiatry services in KwaZulu-Natal – an action research study

“…Latency is reduced at higher bandwidths. Even though there is evidence that suggests that there is a slight superiority of Internet Protocol (IP) connectivity over ISDN connectivity 29 , there is acceptance that 128Kbps is adequate for some clinical applications. 30 Planning Most hospitals in the province connect at 128Kbps for videoconferencing using ISDN lines.…”

Internet y psicología clínica : revisión de las ciber-terapias

“…Entre ellos se destacan trabajos: (a) que demuestran la satisfacción del terapeuta y del usuario con la nueva tecnología (Giles, 2001;Skinner y Latchford, 2006;Urness, Wass, Gordon, Tian, y Bulger, 2006); (b) que comparan la efectividad de estas herramientas respecto a listas de espera e intervenciones tradicionales (Andersson, 2009); análisis de costos (O'Reilly, et al, 2007); y (c) de meta-análisis o revisión (Hyler, Gangure, y Batchelder, 2005;Pelechano, 2007;Spek, et supervisiones (Kaltenthaler, Parry, y Beverley, 2004). La ciber-terapia también suele ser denominada e-terapia, consulta online, cyber-terapia, terapia virtual, terapia online, consejo web, tele-salud conductual, tele-psiquiatría, consejería a distancia, o e-terapia conductual (Caldwell y Gottesman, 1990;Carlbring y Andersson, 2006;Giles, 2001;Grohol, 1999;Kaltenthaler, et al, 2004;Valero, 2003), defi niciones que expresan su divergencia conceptual ya que cada una de ellas aporta pequeños matices.…”