Home-based clinical video teleconferencing care: Clinical considerations and future directions

Abstract

Clinical video teleconferencing (CVT) is a treatment delivery modality that can be used to provide services to clinical populations that experience barriers to accessing mental health care. Recently, home-based CVT (HBCVT) has been developed in order to deliver treatment via CVT to patients in their homes. A number of clinical considerations, including the appropriate clinical population and individual patient factors, need to be taken into account when delivering CVT. Particular challenges can exist when setting up the home environment for HBCVT. Concerns about maintaining patient privacy while living in shared spaces, ensuring adequate CVT technology in the patient's home, and conducting risk management remotely are important to consider when delivering treatment via CVT. Since treatments delivered via CVT are often conducted across state lines, novel ethical and legal issues such as privacy laws, licensing of providers, prescribing practices, and insurance reimbursements need to be addressed when conducting services via these modalities. Future research on HBCVT will provide researchers and clinicians with information regarding which patients are most appropriate for treatment delivered via this modality and help further develop evidence for the cost-effectiveness of CVT and HBCVT clinical practice guidelines.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…11,16,20,33,35,38,41,42,44,45,62,63 Unfamiliarity with technology may also play a role in patients' comfort and willingness to try telepsychiatry. 11,33,44,62,[64][65][66][67] However, clinicians rate patients' comfort and satisfaction with telepsychiatry encounters less highly than do patients 45 and they rate patients' levels of comfort as lower than their own. 39 In one such study, patients assessed videoconference meetings as being more meaningful than therapists did, and patients evaluated the therapists more positively than the therapists did themselves.…”

“…68,71,[73][74][75][76] COMMUNITY/CULTURAL Telepsychiatry practice often involves challenging culture gaps 16,77 and differences in values. 16,33,38,45,62,67,69,77,78 Psychiatrists from elsewhere may be unfamiliar with local resources and make recommendations for services that are scarce. 79 Collaborating with local clinicians provides knowledge of local resources and culture, 9,78 provides connection to the community, 33,34,77 and may mitigate feelings of loss of control that local clinicians may feel from remote expert consultations.…”

“…6,9,11,20,33,44,51,52,59,67,77,[83][84][85][86][87] They worry about others accessing telepsychiatry sessions 84 or protected health information. 27 Of particular concern are network security 59 and encryption, 67 and equipment situated outside the traditional clinical areas that could increase the risk of intercepting telemental health interactions, especially as teleconference technology becomes ever more mobile. 11,20,27,77,83,87 Although technically possible to videoconference over mobile devices, lack of information security on these devices may not meet clinical standards.…”

Telemental health training in the Veterans Administration Puget Sound Health Care System

“…For the patient with VA receiving CVT-to-home (CVTHM), VAPSHCS psychologists have noticed that we can gain novel information about patient hygiene or the home environment through observing the patient in their own home. Therapeutic rapport is enhanced when patients share their home environment with providers (e.g., introducing them to pets and household members; Morland, Poizner, Williams, Masino, & Thorp, 2015).…”

“…T A B L E 1 (Continued) Barrier Solution VA Puget Sound Health Care System (VAPSHCS) actions more flexible scheduling, less time away from work or home, and greater access to specialty services that may not be available locally (DeWeger et al, 2013;Morland et al, 2015).…”