EVALUATION OF A TELEPSYCHIATRY CLINICAL APPLICATIONS

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INTRODUCTION Teleconference is a kind of Telepsychiatry services for many years globally and has today rapid development. In our country it is used from June 2001 (KLIMAKA's pilot project) A new program of Telepsychiatry was implemented for first time in Greece in the process of evaluating and preparing patients, who were going to be transferred from psychiatric hospitals to boarding houses. This program consisted of clinical applications, specifically Telepsychiatry via video - conference, using Athens as the central unit and Tripoli and Corfu, as peripheral units. PURPOSE The aim of this project is to explore the technical parameters of Telepsychiatry system's application. The purpose was also to research the patients' as well as the mental health professionals' reactions during a Telepsychiatry pilot project in the process of de-instutionalisation. MATERIAL- METHODOLOGY The applications of the program concern: o Assessments for psychiatric evaluation of patients o Meetings via video - conferences between: - the intervention team in Tripoli (psychologists, social workers, psychiatric nurses) - psychiatrists in Athens o Evaluation of patients' progress, who were accommodated in the boarding house, within their vacation period, through - meetings of the therapeutic group - sessions with the patients The project was evaluated through the use of questionnaires administered to patients and mental health professionals. The goal of the study was to estimate the parameters of the sessions, the impressions and reactions of the patients and the mental health professionals, involved in the project. The speed connection is 256 kbits/ sec (two lines ISDN). The sufficient bandwidth for examining and making decisions concerning most mental disorders is 128kbits/sec, as the Telepsychiatry Project of the Consolidated Department of Psychiatry of Harvard medical School has showed. RESULTS During this project 76 sessions via video - conference took place: 32 of them were assessments for psychiatric evaluation, 33 concerned group meetings ( 22 between the intervention team in Tripoli and psychiatrists in Athens and 11between the boarding house therapeutic group and the psychiatrists in Athens), and 11 sessions for the progress of the patients in boarding house. The data selected concerns 43 patients and 40 mental health professionals, who have used the video - conference system for the first time. From the patients' point of view z 19 stated that they felt very comfortable during the contact with the Psychiatrist through videoconference and 24 stated that they felt quite comfortable z 37 stated that the time of the conference didn't create any problem and 6 stated that the conference lasted long and they got tired. z 23 stated that they preferred videoconference to communicate with the psychiatrist, and 20 that they preferred face to face communication. The mental health professionals who accompanied the patients to the room of the videoconference, evaluated the collaboration of the patients through the following questions (the results are shown to the following tables 1 and 2). 1. How much do you think that the patient understood the meaning of Telepsychiatry? (that a Psychiatrist examines him or her from a distance?) 2. Did you find out that the behaviour of the patient during the videoconference of Telepsychiatry, was integrated to the frame of his/her psychopathology (for example his/her delusion of persecution?) From the mental health professionals' point of view z 34 found that the starting procedure of the videoconference is very easy, 6 that it easy, and none of them stated that it is less difficult or very difficult z 30 minutes were needed to learn how to operate the system for the connection between the units z 31 stated that they were very satisfied with the procedure, and 9 quite satisfied z 40 (100%) stated that they were inclined to use again the system of Telepsychiatry. About the quality of sound and picture In 76 videoconferences with total length of 138 hours, were mentioned: -6 disconnections -9 videoconferences with small problems of the picture (relevant vagueness) and 6 with comparatively bigger problems (no regular movement) -7 videoconferences with mild microphonism and 3 with a few sound disconnec- tions. Generally, the users of the system characterize the communication "very good" in 58 teleconferences, "good" in 10, and 8 "moderate". CONCLUSIONS z Only few technical problems were "recorded" during the teleconferences (disconnections, problems of quality of the sound and the picture) z The majority of the patients have accepted the new method of examination without problems and the level of satisfaction from the method appears to be high. z The majority of mental health professionals found the video - conference system very easy to use. On average 30 minutes were needed for them to learn how to connect with the other unit. The majority was found to be very satisfied with the procedure and they are all willing to use the video - conference system again. z This study demonstrates that Telepsychiatry can have strong support from the patients and all service providers. z The study demonstrates that many patients with psychiatric problems can be effectively managed in their local hospitals with good outcomes. The trauma of having to move them away from their families and familiar surroundings can be avoided and their recovery can take place in an environment in which they feel safe. REFERENCES ALLEN D., ALLEN A., (1994) Telemental health services today. Telemedicine Today, 2 (2): 1, 24 BAER L., ELFORD R., CUCOR P., (1997) Telepsychiatry at forty: what have we learned. Harvard Review of Psychiatry 5: 7-17 BASHSHUR R.L. (1995). On the definition and evaluation of telemedicine. Telemedicine Journal 1:19-30 GOSH G. J., MCLAREN P.M., WATSON J.P. (1997). Evaluating the alliance in video-link telethera- py. Journal of Telemedicine and Telecare, 3:33-5 GUSTKE S.S., BALCH D.C., WEST V.L., ROFERS L.O. Patients satisfaction with telemedicine services. Telemedicine Journal, 6: 5-13 MILLER E. A. (2001). Telemedicine and doctor-patient communication: an analytical survey of the literature. Journal of Telemedicine and Telecare, 7:1-17 PEREDNIA D. A. (1994). Evaluating the use of telemedicine for mental health applications. Telemedicine Today 2, 2: 10-11, 1994 WAKEFIELD D.S., KIENZLE M. G., ZOLLO S.A., KASH J.B., UDEN- HOLMAN T. Health care providers' perceptions of telemedicine services. Telemedicine Journal 3: 59-65 WOOTTON R., DARKINS A. (1997). Telemedicine and the doctor-patient relationship. Journal of the Royal College of Physicians of London, 31: 598-9 EVALUATION OF A TELEPSYCHIATRY CLINICAL APPLICATIONS Konstantakopoulos G., Zacharopoulou C., Valma V., Tsirika N., Yfantis, A., Katsadoros K. Department of Research and Development

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