背景:COVID-19大流行需要迅速改变医疗保健服务,包括从面对面到数字化提供心理治疗的转变。虽然这些变化有助于确保及时提供心理治疗,存在许多担忧,包括临床,文化,实用,隐私,和安全问题。
目的:本范围审查系统地映射了现有的同行评审研究,治疗师为被诊断患有精神疾病的人提供基于网络的心理治疗。通过艾伯塔省健康质量矩阵(AQMH)的镜头分析数据,以评估该文献在多大程度上解决了医疗保健质量的关键指标。此分析有助于识别和组织有关基于网络的心理治疗的知识差距,强调以前优先考虑的护理维度与需要进一步关注的维度之间的潜在差异。
方法:本综述遵循PRISMA-ScR(系统综述的首选报告项目和范围综述的Meta分析扩展)指南。我们将同行评审的主要研究研究纳入英语同步调查,治疗师提供的远程心理治疗提供给成年人(18岁及以上)的精神疾病诊断和统计手册或国际疾病统计分类诊断精神疾病。排除所有其他引文。相关研究通过MEDLINE确定,APAPsycINFO,Embase(OVID),WebofScience:CoreCollection(Clarivate),科克伦图书馆(威利),和Scopus(Elsevier)数据库。2021年3月18日搜索了数据库。对于每个被考虑的出版物,数据由两名审稿人独立绘制,如果出现差异,主要研究者验证了两种提取器的选择。根据6个AQMH维度对结果进行了主题描述:可接受性,可访问性,适当性,有效性,效率,和安全。
结果:来自13,209份出版物,共48篇文章,主要来自北美的研究。大多数研究测量了治疗有效性(n=48,100%)和可接受性(n=29,60%)健康质量维度。超过80%(40/48)的研究调查了创伤后应激障碍或情绪或焦虑障碍的认知或暴露干预,通常表明与面对面治疗具有可比性的结果。安全性(n=5,10%)在较少的研究中被测量,虽然治疗可及性,适当性,在任何研究中都没有明确衡量效率,尽管这些维度被称为未来的方向,假设,或潜在的结果。
结论:关于基于网络的治疗师为被诊断患有精神疾病的人提供的心理治疗,医疗保健质量的重要方面(可及性,适当性,效率,和安全)几乎没有接受科学检查,强调需要解决这些差距。还有一些与这些文献的概括性有关的重大问题,包括许多地理区域的代表性不足,文化,人口,临床背景,和心理治疗方式。在代表性不足的人群和环境中进行的定性研究可能会发现重要的患者和背景因素,这对于将来实施基于网络的高质量心理治疗很重要。
The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues.
This scoping
review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed
mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention.
This
review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed
mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety.
From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome.
In relation to web-based therapist-delivered psychotherapies for those with a diagnosed
mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.