Telemedicine-assisted stepwise approach of service delivery for substance use disorders in India

Ghosh, Abhishek; Mahintamani, Tathagata; Subodh, BN; Pillai, Renjith R; Mattoo, Surendra Kumar; Basu, Debasish

doi:10.1016/j.ajp.2021.102582

Cited by 21 publications

(24 citation statements)

References 16 publications

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“…This is especially relevant for service users on low in-When service users only have access to an insecure, unstable, and poor-quality internet [19,39,41,42,44,47,[50][51][52][53][54][55][56][57][58][59][60] Service users…”

Section: Tings)mentioning

confidence: 99%

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review

Schlief¹,

Saunders²,

Appleton³

et al. 2022

Interact J Med Res

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Background Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed. Objective This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms. Methods Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including “gray literature,” to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups. Results A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed. Conclusions Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910

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Section: Tings)mentioning

confidence: 99%

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review

Schlief¹,

Saunders²,

Appleton³

et al. 2022

Interact J Med Res

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“…By August 31, 2020, 160 new and 219 follow-up patients were registered in the teleaddiction service. Among them, 128 (80%) and 198 (90.2%) patients received teleconsultations, respectively [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…• Compared to the same period of 2019, the number of patients seen in a psychiatric outpatient service for patients with substance abuse dropped (May: 170 vs 22; June: 351 vs 43; July: 467 vs 44; August: 436 vs 51) [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review

Zangani¹,

Ostinelli²,

Smith³

et al. 2022

JMIR Ment Health

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Background The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. Objective We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. Methods We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country’s COVID-19 Stringency Index, which reflects the stringency of a government’s response to COVID-19 restrictions at a specific time. Results Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries’ face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. Conclusions During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients’ preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users.

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“…Privacy in teleconsultation can be compromised due to the presence of others in the vicinity during the consultation, using others’ mobile phones for consultation, or for obtaining prescriptions. [ 7 31 32 ] Increased use of mobile phones (m-Health) and social media for telehealthcare have a higher risk of compromising patients’ privacy. [ 33 ] In countries such as India that have criminalized drug use, a concern for privacy protection may be seen as a major barrier to implementing telehealth care for SUD.…”

Section: Discussionmentioning

confidence: 99%

The therapeutic relationships, empathy, and satisfaction in teleconsultation for substance use disorders: Better or worse than in-person consultation?

Ghosh¹,

Mahintamani²,

Sharma³

et al. 2022

Indian Journal of Psychiatry

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Context: Telemedicine has become one of the essential modes of healthcare delivery. Different aspects of the physician–patient relationship during tele and in-person consultation need to be studied. Aims: This study aimed to compare perceived empathy and therapeutic relationship between tele and in-person consultation and assess the patient’s satisfaction during teleconsultation for substance use disorder (SUD). Methodology: We consecutively recruited 100 adult patients with SUD, registered to the tele-addiction service between June and September 2020, and experienced both video and in-person consultations. We assessed therapeutic relationships, perceived empathy (for teleconsultation and in-person consultation), and patients’ satisfaction (with teleconsultation) with specific scales. We compared the scores of the therapeutic relationship and physician empathy scales for tele and in-person consultation. Results: The mean age of the patients was 35.5 (±10.4) years. Sixty percent had alcohol, followed by opioids (42%) and cannabis dependence (24%). Sixty percent of patients had comorbid tobacco dependence. Telehealth satisfaction (TSS) rating shows around 40% of patients had difficulty accessing the telehealth service and 7% felt their privacy was poorly respected. The mean total therapeutic relation (STAR) (t = −14.4; P <.001), positive collaboration (t = −12.8; P <.001), positive clinical input (t = −11.9; P <.001), and total Patient’s Perceptions of Physician Empathy (PPPE) score (t = −8.4; P < .001) were lower in the teleconsultation than in-person consultation group. TSS was positively correlated with positive collaboration, positive clinician input, and STAR total score. Conclusions: Our study suggests a stronger therapeutic relationship and higher physician empathy during in-person consultations. Poor accessibility and privacy concerns were critical challenges in telehealth service. TSS and therapeutic relationships positively influence each other.

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Telemedicine-assisted stepwise approach of service delivery for substance use disorders in India

Cited by 21 publications

References 16 publications

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review

Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review

The therapeutic relationships, empathy, and satisfaction in teleconsultation for substance use disorders: Better or worse than in-person consultation?

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