Telemedicine in Geriatric Psychiatry: Relevance in India

Abstract

Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.

Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings

“…The unavailability of reliable internet connectivity and hardware infrastructure was reported as a critical barrier to telemedicine adoption in primary healthcare systems and all modes of real-time delivery 26,30,31,47,49,50,52,58,61,65 . The concerns with internet quality (e.g., slow speeds, poor connectivity, and high costs) have been highlighted in the literature as a continuing challenge for the operation of telemedicine systems.…”

“…Additionally, we also identified the lack of training and awareness regarding the usage of telemedicine and the associated equipment among patients and providers as a significant barrier to the adoption of telemedicine systems in primary and secondary healthcare 26,30,31,36,44,45,49,56,58,61,65 . This may probably be due to the limited dissemination of information regarding telemedicine through workshops, conferences, seminars, and other platforms.…”

“…Data privacy and security risks associated with telemedicine are the most widely reported barriers and are reported as significant barriers to the delivery of primary and secondary care 26,30,31,43,46,48,51,52,56,58,61 in all modes of real-time delivery. The adoption of telemedicine in India was reported to be impacted by the security, safety, and confidentiality of patient data 11,30,31,43,46,48,51,52,[55][56][57][58] .…”

“…It is perceived that providers typically require financial backing from the government or development partners to make telemedicine operations sustainable, and without adequate support, telemedicine initiatives may not succeed due to the high costs associated with purchasing, installing, and maintaining the technology 36,60 . Some socio-cultural and infrastructural barriers like limited telemedicine awareness among the patients and local healthcare professionals, low ICT literacy, and restricted access to infrastructure and technology are reported to be the reasons for the perception that telemedicine is costly 11,22,26,29,30,36,50,[58][59][60][61]64 .…”

Bibliometric review of telemedicine interface design for accessibility of monitoring current condition in healthcare services

“…Distance is a crucial consideration in the practice of telemedicine, which is the use of digital communication technology to deliver and promote health and health-related services [1]. This calls for the proper sharing of data on the diagnosis, management, prevention of illness and damage, health information, patient education, research, and training [2]. Medical professionals can analyze, diagnose, and treat patients remotely using information and telecommunications technologies.…”