Remote Consultation Clinical Trial
Official title:
Telepsychiatry: Cost Analysis, Quality of Life, Satisfaction and Effectiveness of Psychiatric Consultation Through Videoconference in a Primary Care Setting
In our study we will aim to examine the issues of cost analysis, quality of life, clinical efficacy and satisfaction of psychiatric consultations through videoconference in a primary care setting in comparison with in-person psychiatric treatment and primary care only. The main hypotheses of the study are: Satisfaction of the patients will increase, the use of telepsychiatry will reduce the costs for the primary and mental health care centers as well as for the patients, the treatment will be as effective as in-person treatment, the number of patients referred to mental health treatment will be higher than that of the previous year, quality of life will improve and that there will be a stigma reduction of mental illness.
Telepsychiatry, as a method which utilizes videoconferencing as a means for consultation,
examination and treatment of patients as a substitute for in-person treatment has been in
use now for over 40 years. With telepsychiatry there is an attempt to deal with the issues
of providing service to patients who reside at a considerable distance from the mental
health facilities or that conversely do not call for mental health services for other
diverse reasons such as loss of work days, social stigma, travel expenses and so forth.
In Israel, mental health services are provided to 1.5% of the population whereas the
incidence in other developed countries is significantly higher, reaching 3-5%, while the
prevalence of mental illness in Israel is similar. One can hypothesize that the above
factors such as social stigma, mental health care availability, loss of work days and travel
expenses all play a role in this. Consequently, patients may prefer to see their primary
care physician as an alternative, and according to reports of the Israeli national health
services, 30%-50% of visits to the primary care physician are mental health related. Thanks
to the technological advances in telecommunications, especially regarding cost reduction and
higher bandwidths, there has been a renewed interest in telepsychiatry. However, the issue
of the cost effectiveness of telepsychiatry is still controversial. Out of 380 studies on
telepsychiatry published from 1956 to 2002, only 12 dealt with the question of cost
effectiveness, and among those the results were equivocal. Another question that has
scarcely been studied is that of quality of life within telepsychiatry treatment. Finally,
the issue of telepsychiatry that is used as a consultation tool in the aid of the primary
physician that occurs physically in his own practice is another novel angle we wish to
explore. The advantages embodied in this are potentially many - patient discreteness and
confidentiality, decrease in expenses and stigma reduction among others.
In our study we will attempt to address the above issues that have not received the focus of
attention in many of the published studies so far - cost analysis and quality of life within
the context of telepsychiatry consultation in primary care. Additionally, we will address
the issues of clinical efficacy and satisfaction (of the primary care provider as well as
that of the patient) from the treatment.
Our study hypotheses are:
1. The satisfaction of the patients will increase during the 12 months of study in the
group treated by telepsychiatry in comparison with the control groups.
2. Cost analysis - the use of telepsychiatry will reduce the costs for the primary health
care centers and/or for the mental health centers: Travel expenses, a decrease in
visitations to the primary health care center, a decrease in hospitalizations in
general hospitals and/or psychiatric hospitals, a decrease in the number of ancillary
tests and of lost work days.
3. Effectiveness of treatment - the mental and physical well being of the patients will
improve or at least not be impaired in the group treated by telepsychiatry as compared
to the control groups due to the increased availability of the consultation service.
4. The number of patients referred to mental health treatment will be higher than that of
the previous year due to the increased availability of telepsychiatry within the
primary care setting.
5. The patients will prefer the telepsychiatry service as compared to a referral to a
mental health center.
6. Quality of life will improve or it least not be impaired in the group treated by
telepsychiatry as compared to the control groups.
7. Stigma reduction - Visitations to the primary health care center as opposed to the
mental health center will lower the possibility of the formation of a social stigma of
mental disease.
Comparison Groups:
1. Telepsychiatry treated patients within the primary care setting.
2. In-person treated patients by a psychiatrist at the mental health center.
3. Primary care treated patients without a psychiatry consultation.
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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