背景:Telepsychiatry是使用虚拟通信,比如视频链接,进行心理健康评估,治疗,和后续行动。以前的研究表明心灵感应是可行的,与亲自练习相比准确,让精神科医生和病人满意。Telepsychiatry还与减少评估的等待时间有关,在一些研究中,较低的录取率。然而,以前的大多数研究都集中在社区环境中使用心灵感应疗法,而不是非自愿入院。
目的:本研究的目的是使用视频链接检查精神科急诊科(ED)非自愿入院患者评估的有效性和实施过程。
方法:这项类型1的混合实施研究将检查心灵感应的有效性和实施过程,通过将心灵感应(n=240)与以前进行过面对面评估的历史对照(n=240)进行比较,以色列5例精神病ED的常规护理期。暂时放弃只需要亲自评估的常规政策,为了研究的目的,是从以色列卫生部获得的。在心灵感应阶段,临床工作人员和患者将参加ED的视频通话,而主治医师将在其他地方登录。卫生服务研究实施促进行动(PARIHS)框架将指导对ED中心灵感应实施过程的评估。PARIHS具有以下3种结构:(1)证据:员工对创新的可行性和实用性的意见,他们对其使用的满意度,和患者对变化的看法;(2)背景:ED对新策略的认可程度,决策过程,以及临床团队交流和合作的方式;(3)促进:使用冠军报告的促进工作的充分性。主要临床结果包括ED住院时间和从医疗记录中获得的暴力事件。
结果:这项研究获得了赫尔辛基Abarbanel心理健康中心伦理委员会的批准(174;2023年3月13日),耶路撒冷精神卫生中心(22-21;2022年11月6日)Lev-Hasharon精神健康医疗中心(LH12023;2023年2月12日),特拉维夫医疗中心(TLV-22-0656;2023年1月3日),和Sha\'arMenashe(1-4-23;2023年4月18日)。数据收集于2023年7月在2个研究地点开始,并将很快在其他地点开始。
结论:Telepsychiatry可能对精神病性ED患者有显著的益处。检查心灵感应在ED中的有效性,除了确定在不同紧急情况下实施它的促进者和障碍之外,将有助于就其实施做出更好的政策决定。
背景:ClinicalTrials.govNCT05771545;https://clinicaltrials.gov/study/NCT05771545。
■DERR1-10.2196/49405。
BACKGROUND: Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission.
OBJECTIVE: The aim of this
study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link.
METHODS: This type 1 hybrid implementation
study will examine
telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff\'s opinions regarding the innovation\'s viability and practicality, their satisfaction levels with its use, and patients\' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records.
RESULTS: This
study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha\'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2
study sites and will begin soon at the others.
CONCLUSIONS: Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation.
BACKGROUND: ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/
study/NCT05771545.
UNASSIGNED: DERR1-10.2196/49405.