Telesalud mental en una unidad pública de psiquiatría infanto-juvenil en pandemia: estudio cualitativo de implementación / Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study

Antecedentes La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. Métodos Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada Resultados En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. Conclusiones Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.

Background The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Learning from telepsychiatry during COVID-19 pandemic in India: Boon for public mental health in low- & middle-income countries

Novel coronavirus disease (COVID-19) pandemic has affected the mental well-being of the population and posed many challenges in availing mental healthcare. Telepsychiatry has been proven to be an effective route for the delivery of mental healthcare. We share our experience of using the telemedicine approach in providing mental health services at a tertiarycare hospital in India during the COVID-19 pandemic, following the break in routine outpatient services during the national lockdown. The telepsychiatry approach helped in ensuring the maintenance of mental healthcare. The utility of telepsychiatry as an option for such future situations and for its use in routine follow up care in indicated cases, have also been discussed.

Impacto de la pandemia COVID-19 sobre la atención en salud mental: una revisión sistemática / Impact of the COVID-19 pandemic on mental health care: a systematic review

Introducción: La enfermedad producida por el SARS-Cov-2, la COVID-19, tuvo un gran impacto a nivel mundial y los servicios de salud fueron los más afectados, entre estos los servicios que brindan atención en la salud mental. Objetivo: Conocer el impacto de la pandemia por la enfermedad COVID-19 en la atención de la salud mental. Material y Métodos: Se realizó un análisis de la literatura existente de bases de datos de Scopus, Lilacs y Pubmed. Además, se incluyeron publicaciones científicas completas de re-vistas indexadas en español e inglés, con pacientes adultos (>17 años), y trabajos originales con diseño analítico, prospectivo, transversal, aleatorizado, metanálisis y de libre acceso.Resultados: Se incluyeron 11 artículos, donde se describe una reducción en las consultas en emergencias, e incremento del consumo de sustancias o intentos de suicidio. Se imple-mentaron estrategias como la tele-psiquiatría, educación a la población y las medidas de distanciamiento. Conclusiones: Se concluyó que es posible brindar atención psiquiátrica en tiempos de pandemia, tomando cuenta varias medidas de prevención y reorganización de los servicios

Introduction: The disease produced by the SARS-CoV-2, the COVID-19, had a major impact worldwide and the health system was one of the most affected, including services that pro-vide mental health care.Objective: To know the impact of the COVID-19 pandemic on mental health care.Materials and Methods: An analysis of the existing literature on Scopus, Lilacs and Pubmed databases was carried out. Also, full scientific publications from indexed journals in Spanish and English, with adult patients (>17 years), and original works with an analytical, prospecti-ve, cross-sectional, randomized, meta-analysis, and free access design were included.Results: Eleven articles were included, describing a reduction in emergency visits and an increase in substance use or suicide attempts. Strategies such as tele-psychiatry, education to the population and distance measures were implemented. Conclusions: It was concluded that it is possible to provide psychiatric care in times of pandemic, taking into account various prevention measures and reorganization of services.

Use of digital technologies in mental health during COVID-19 / Uso de tecnologias digitais na saúde mental durante a COVID-19

Most countries did not have a consolidated digital health structure before the pandemic. Both social distancing and mental health problems resulting from the situation justify the urgency of discussions on web-mediated interventions. The objective of this work is to present the panorama of technological mediation in mental health services and their specificities in the context of the pandemic. This paper is grounded on a critical look at the migration from face-to-face care to the Internet environment, highlighting: the international experiences using digital technologies in the pandemic context; the challenges in online consultations, emphasizing the importance of the ethical, technical/technological, and clinical domains, which are recurring issues in the international literature; the challenges and perspectives in the use of technologies. It is essential to develop strategies aligned with government incentives, aiming at the quality of the offered services and the guarantee of an adequate hybrid qualification.

A maioria dos países não possuía uma estrutura de saúde digital consolidada antes da pandemia. Tanto o distanciamento social quanto os agravos psicológicos decorrentes da própria situação justificam a urgência de discussões científicas sobre intervenções mediadas pela web. O objetivo deste trabalho é apresentar o panorama da mediação tecnológica nos serviços de saúde mental e suas especificidades no contexto da pandemia. Parte-se de um olhar crítico diante da migração do cuidado face a face ao ambiente da Internet, ressaltando: experiências internacionais no uso das tecnologias digitais no contexto da pandemia; desafios nas consultas online, com destaque à importância dos domínios ético, técnico/tecnológico e da clínica recorrentes na literatura internacional; desafios e perspectivas do uso das tecnologias. É imprescindível desenvolver estratégias com incentivo governamental, visando a qualidade dos serviços oferecidos e a garantia de formação híbrida adequada.

Experiencias de telesalud en un hospital especializado en salud mental durante la pandemia de COVID-19 en Perú / Telehealth experiences in a specialized mental health hospital during the COVID-19 pandemic in Peru

RESUMEN El objetivo de este artículo es dar a conocer las experiencias de telesalud en un hospital especializado en salud mental en Lima, Perú durante la pandemia de COVID-19. En concordancia con las disposiciones, como el cierre temporal de la atención presencial y el confinamiento obligatorio entre los meses de marzo a diciembre del 2020, se brindó progresivamente atención a través de llamadas telefónicas, videollamadas o plataformas digitales; se realizaron 57398 atenciones de teleconsultas y telemonitoreos; 4411 orientaciones en salud mental; 295 teleinterconsultas en psiquiatría; 42 actividades de telecapacitación y 29 sesiones educativas en salud mental dirigidas a la población general. Concluimos que la implementación de la telesalud para la atención de los usuarios del Hospital Hermilio Valdizán contribuyó al cuidado de la salud mental y permite reducir las brechas de acceso a la atención especializada en psiquiatría por las consecuencias de la COVID-19.

ABSTRACT The objective of this article is to present the experiences of telehealth in a hospital specialized in mental health in Lima, Peru during 2020. In accordance with the provisions such as the temporary closure of face-to-face care and mandatory confinement between the months of March As of December, care was progressively provided through telephone calls, video calls or digital platforms, with 57,398 teleconsultations and telemonitoring, 4411 mental health orientations, 295 teleinterconsultations in psychiatry, 42 teletraining activities and 29 educational sessions in mental health aimed at the general population. We conclude that the implementation of telehealth for the care of the users of the Hermilio Valdizán Hospital contributed to mental health care and reduces the gaps in access to specialized care in psychiatry due to the consequences of COVID-19.

Asociación entre la procedencia del área urbana o rural y el desarrollo de trastornos del espectro depresivo: una experiencia desde la telepsiquiatría / Association between urban/rural background and the development of depressive spectrum disorders: an experience from telepsychiatry

RESUMEN Introducción: una de las estrategias que se consideraron a la hora de hacer frente a los problemas de salud mental durante la pandemia de COVID-19 fue la utilización de la telepsiquiatría. Objetivo: determinar si la procedencia urbana o rural se asocia al desarrollo de trastornos depresivos en pacientes que consultan a través de telepsiquiatría en un Hospital de referencia de Paraguay. Metodología: estudio observacional, descriptivo de asociación cruzada, de corte transversal. Se realizó un muestreo no probabilístico, de casos consecutivos. Se utilizaron fichas electrónicas de pacientes tratados en el Servicio de Psiquiatría del Hospital de Clínicas de la Universidad Nacional de Asunción entre marzo y junio de 2021. Se aplicó estadística descriptiva para todas las variables. Para la comparación de grupos con variables cualitativas nominales se utilizó la prueba de Chi cuadrado, calculando el odds ratio según sexo y área de residencia, considerando una p˂0,05 como significativa. Se utilizó, además, la prueba T de Student para comparar una variable nominal con una variable cuantitativa. Resultados: se analizaron 907 fichas clínicas, encontrándose 92 pacientes con trastornos del espectro depresivo. Al analizar la asociación entre el ambiente rural y urbano con la presencia de un episodio depresivo, se encontró una asociación significativa entre el ambiente rural y el diagnóstico de un trastorno depresivo (OR=7,81, χ2=63,33, p<0,001). Conclusión: nuestros resultados no condicen con estudios previos relacionados al tema. Esto podría deberse, al menos en parte, al impacto que las condiciones sociales y económicas tienen en el desarrollo de trastornos mentales, como la depresión.

ABSTRACT Introduction: one of the strategies considered when dealing with mental health problems during the COVID-19 pandemic was the use of telepsychiatry. Objective: to determine whether urban or rural origin is associated with the development of depressive disorders in patients consulting through telepsychiatry in a referral hospital in Paraguay. Methodology: observational, descriptive of cross-association, and cross-sectional study. A non-probabilistic sampling of consecutive cases was carried out. Electronic records of patients treated at the Psychiatry Service of the "Hospital de Clínicas" of the "Universidad Nacional de Asunción" between March and June 2021 were used. Descriptive statistics were applied for all variables. For the comparison of groups with nominal qualitative variables, the Chi-square test was used, calculating the odds ratio according to sex and area of residence, considering a p˂0.05 as significant. Student's t-test was also used to compare a nominal variable with a quantitative variable. Results: 907 clinical records were analyzed, finding 92 patients with depressive spectrum disorders. When analyzing the association between rural and urban environment with the presence of a depressive episode, a significant association was found between rural environment and the diagnosis of a depressive disorder (OR=7.81, χ2=63.33, p<0.001). Conclusion: our results do not agree with previous studies related to the subject. This could be due, at least in part, to the impact that social and economic conditions have on the development of mental disorders, such as depression.

El rol del psiquiatra colombiano en medio de la pandemia de COVID-19 / The Role of Colombian Psychiatrists in the Midst of the COVID 19 Pandemic

RESUMEN Introducción: La pandemia de COVID-19 genera impactos en múltiples niveles, uno de ellos es la forma de prestar servicios de atención en salud mental. Este estudio se planteó con el fin de identificar las posturas sobre el rol que debemos asumir como psiquiatras en el marco de la pandemia de COVID-19 en Colombia. Métodos: Se desarrolló un estudio mediante metodología tipo Delphi. Para la aplicación del instrumento, se incluyeron 3 tipos de participantes: psiquiatras directores de programas académicos de psiquiatría, psiquiatras directores de instituciones de salud mental y psiquiatras que ejercieran su labor clínica fuera del contexto académico. Resultados: Recolectaron las respuestas en el transcurso de 1 mes (entre abril y mayo) 24 participantes: 14 psiquiatras clínicos (58,3%), 6 directores de residencia (25,1%) y 4 coordinadores de servicios de salud mental (16,6%). Se describen los resultados agrupados en torno al quehacer psiquiátrico, el impacto generado por la pandemia y el posible rol del especialista. Conclusiones: Se identificó consistencia en torno a la necesidad de brindar un abordaje diferencial acorde con las vulnerabilidades propias de cada grupo de personas expuestas a la pandemia, así como la implementación de estrategias de atención psiquiátrica a distancia. © 2021 Publicado por Elsevier España, S.L.U. en nombre de Asociación Colombiana de Psiquiatría.

ABSTRACT Introduction: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. Methods: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. Results: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. Conclusions: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

Aceptabilidad de la telepsiquiatría por psiquiatras en Lima durante la pandemia de COVID-19

Introducción. La pandemia de COVID-19 ha provocado la adopción de la telepsiquiatría para la atención médica psiquiátrica. Objetivo. Evaluar la aceptabilidad de la telepsiquiatría por médicos psiquiatras, determinar las características de la atención por telepsiquiatría y solicitar recomendaciones para la mejora del servicio de telepsiquiatría. Métodos. Se administró una encuesta virtual a psiquiatras de los tres principales hospitales psiquiátricos de Lima del 16 de junio al 16 de julio del 2020. Resultados. El 42,9% había trabajado en telepsiquiatría y el 57,2% percibía una alta congruencia (80%-100%) entre la telepsiquiatría y la atención presencial. La media global y en cada uno de los cinco dominios del índice de aceptabilidad estuvo por encima del promedio. La principal recomendación fue mejorar el flujo de atención. Conclusión. La telepsiquiatría es una modalidad de atención aceptada por psiquiatras. Se espera que este servicio mejore a medida que se identifiquen y resuelvan los problemas del trabajo diario.

Introduction. The COVID-19 pandemic has prompted the adoption of telepsychiatry for psychiatric medical care. Objective. To evaluate the acceptability of telepsychiatry by psychiatrists, determine the characteristics of telepsychiatric care and request recommendations for the improvement of the telepsychiatry service. Methods. A virtual survey was administered to psychiatrists of the three main psychiatric hospitals in Lima from June 16 to July 16, 2020. Results. 42.9% had worked in telepsychiatry and 57.2% perceived high congruence (80% -100%) between telepsychiatry and face-to-face care. The global mean and in each of the five domains of the acceptability index was above the average. The main recommendation was to improve the flow of care. Conclusion. Telepsychiatry is a modality of care accepted by psychiatrists, this service is expected to improve as problems of daily work are identified and resolved.

Telepsychiatry Experience During The Covid-19 Pandemic At The Razi Psychiatric Hospital In Iran-A Case Report

@#Objective: During the COVID-19, Telehealth attention and use have been increased in all medical fields. We decided to share our experience on the Sabatavan platform in a Psychiatric Hospital. Methods: One patient diagnosed with schizophrenia spectrum disorder and depression participated 4 sessions in the Sabatavan platform and mental status examination, diagnosis, medication dose adjustment, and psychoeducation about conditions and medication performed through the psychiatrist's Sabatavan platform. Results: According to our experience, Telepsychiatry was some benefits, such as the possibility of more communication between the therapists and patient, easy use of both patient and clinicians, more Accessibility of the patients and their families to psycho educational data. Lack of Tele pharmacy to change or renew the drug prescription and the impossibility of comprehensive examination and documentation of the patient's progress and changes, and lack of standard and official guidelines is challenging for Tele psychiatry. Conclusion: Telepsychiatry is an excellent mechanism for providing high-level care to physicians and psychiatrists in Iran.

Telepsiquiatría: una experiencia exitosa en Antioquia, Colombia

Objetivo: Describir la experiencia que han tenido los médicos y pacientes del programa de Telepsiquiatría de la Facultad de Medicina de la Universidad de Antioquia en los primeros 12 meses de su implementación en 8 municipios del departamento. Métodos: Estudio descriptivo, que incluyó a 111 pacientes atendidos durante el primer año. Se diseñó un instrumento para evaluar la satisfacción de los pacientes y se empleó el instrumento de aceptación de tecnología para evaluar la de los profesionales de la salud. Resultados: Se realizaron 340 atenciones durante ese periodo a 111 pacientes; 70 (63,1%) de ellos recibieron al menos 2 atenciones por telepsiquiatría en el primer año. Se evaluó la experiencia en una muestra de 38 pacientes (34%), quienes manifestaron la resolución del problema (94,7%) y una satisfacción alta (100%). En el programa participaron 9 profesionales de la salud, que estuvieron de acuerdo en que la tecnología es útil y fácil de usar y tienen la intención de seguir usándola. Conclusiones: Los sistemas de salud de todo el mundo no han dado una respuesta adecuada a la carga de trastornos mentales; por esto, estrategias como la telepsiquiatría se consideran una modalidad de atención ideal para personas que viven en lugares remotos y tienen dificultad de acceso a los servicios de salud especializados, con adecuada aceptación.

Objective: To describe the experience of physicians and patients in the Telepsychiatry pro gramme at the University of Antioquia's Faculty of Medicine in the first 12 months after its implementation in eight towns across Antioquia. Methodology: A descriptive study involving the evaluation of 111 patients during the programme's first year. An instrument was designed to evaluate patients' satisfaction and the Technology Acceptance Model (TAM) was used to evaluate the health professionals' satisfaction. Results: 111 patients were seen on 340 occasions. 70 out of the 111 patients (63.1%) were seen by Telepsychiatry at least twice in the first year of implementation. A sample of 38 patients (34%) was used to evaluate their experience, of which 94.7% said their problem had been solved and 100% were highly satisfied. Nine health professionals took part in the programme, who agreed that the technology was useful and easy to use. They also stated that they wanted to continue using it. Conclusion: Health systems across the globe have failed to provide an adequate response to the mental health burden. Therefore, strategies such as telepsychiatry are considered an ideal treatment modality to give patients living in remote locations the specialised attention that they need.

Telepsiquiatría en niños y adolescentes: aplicación en contexto de pandemia / Telepsychiatry in children and adolescents: application in the context of a pandemic

Telemedicina, se refiere a las prestaciones de salud a distancia. Existen muchos modelos de telemedicina descritos e implementados en distintos lugares del mundo. La telepsiquiatría (y telemedicina) que se está implementando hoy en Chile y el mundo, ya sea desde un marco institucional o privado, es directa hacia el paciente, esto implica que no es una "inter -o tele -consulta" donde hay un profesional presencial que se hace responsable de la indicación, en este caso la atención completa y directa médico-paciente se lleva a cabo a distancia, quebrando, de alguna manera, la regla de oro de la atención clínica que es la consulta presencial entre el médico y el paciente. Se revisan algunas sugerencias descritas en la literatura y otras que ha dado la experiencia. La idea de este artículo es discutir los desafíos clínicos, éticos y legales, junto con los beneficios y oportunidades de la telepsiquiatría en el contexto actual.Palabras claves: Telemedicina, telepsiquiatría, teleconsulta, médico-paciente, covid-19.

Summary. Telemedicine refers to remote health care. There are many telemedicine models described and implemented in different parts of the world. The telepsychiatry (and telemedicine) that is being implemented today in Chile and the world, either from an institutional or private framework, is directed towards the patient, this implies that it is not an "tele-consultation" where there is a another face-to-face professional who is responsible for the prescription of treatment. In our case, the complete and direct doctor-patient care is carried out at a distance, breaking in some way the golden rule of clinical care that is face-to-face consultation between the doctor and the patient. Some suggestions described in the literature are reviewed and we make other suggestions based on our experience. The idea of this article is to discuss clinical, ethical and legal challenges, along with the benefits and opportunities of telepsychiatry in the current context.Key words: Telemecine, telepsychiatry, tele-consultation, physician-patient, covid-19.

Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review

Abstract Introduction Post-traumatic stress disorder (PTSD) is one of the most common psychiatric disorders found among victims of disaster, kidnapping, accidents, sexual assaults and war in Indonesia. However, lacking and unequal distribution of psychiatric medical personnel remains a barrier to its management. This review aims to introduce and evaluate the potential contribution of telepsychiatry to the management of PTSD based on published literature. Methods Original studies were obtained from PubMed, Science Direct, ProQuest, High Wire, and Elsevier Clinical Key databases. Results A total of 125 articles were found, of which 15 articles (12 randomized controlled trials, 2 open trials and 1 pilot study) fulfilled the inclusion criteria. A total of 991 subjects were found with a follow-up period ranging between 5 weeks and 18 months. Telepsychiatry is an innovative use of technology to aid the delivery of PTSD treatments in areas difficult to reach. The quality of care given by telepsychiatry both through video conferencing as well as web- and application-based is comparable to that of face-to-face therapy. Patient satisfaction, quality of doctor-patient relationship also remains high, with lower costs and shorter therapeutic time when compared to face-to-face therapy. Conclusion Various studies have shown that telepsychiatry is an effective solution for the management of PTSD. Studies have also reported that the quality of treatment through telepsychiatry is as effective as face-to-face therapy, with greater efficiency. Countries, especially those with a low patient-to-mental health professional ratio, should be encouraged to develop telepsychiatry systems to manage PTSD.

Telepsychiatry exposure, interest, and intention to use among young Psychiatrists in the Philippines

OBJECTIVE@#This was a descriptive study to determine the telepsychiatry exposure, interest, and intention to use among young psychiatrists in the Philippines in December 2014.@*METHODOLOGY@#This was done through a 14 to 25 item online survey adapted from Glover et al. (2013)1. Through purposive sampling, the population of third and fourth year residents and graduates within the last two years of accredited psychiatry training institutions was included in the study.@*RESULTS@#Seventeen young psychiatrists participated. Exposure to telepsychiatry of the respondents varied with 10 (58.82%) having had independent study, three (17.65%) having had didactics, and 11 (64.71%) having had awareness about telepsychiatry initiatives in their training institution. Ten respondents (58.82%) expressed interest in telepsychiatry as well as the importance and usefulness of telepsychiatry exposure. Despite this, only six (35.29%) young psychiatrists thought that telepsychiatry should be part of the residency training curriculum. As for intention to use, only eight (47.06%) respondents expressed receptiveness to it, two did not (11.76%), and seven were undecided (41.18%).@*CONCLUSION@#Though more than half of the respondents had exposure to telepsychiatry and considered it interesting and relevant, less than half of them had any actual intention to use it in their clinical practice.

Cost-effectiveness of synchronous vs. asynchronous telepsychiatry in prison inmates with depression / Costo-efectividad de telepsiquiatría sincrónica frente a asincrónica para personas con depresión privadas de la libertad

Abstract Introduction: Telepsychiatry is defined as the use of information and communication technology (ICT) in providing remote psychiatric services. Telepsychiatry is applied using two types of communication: synchronous (real time) and asynchronous (store and forward). Objective: To determine the cost-effectiveness of a synchronous and an asynchronous telepsychiatric model in prison inmate patients with symptoms of depression. Methods: A cost-effectiveness study was performed on a population consisting of 157 patients from the Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. The sample was determined by applying Zung self-administered surveys for depression (1965) and the Hamilton Depression Rating Scale (HDRS), the latter being the tool used for the comparison. Results: Initial Hamilton score, arrival time, duration of system downtime, and clinical effectiveness variables had normal distributions (p >0.05). There were significant differences (p < 0.001) between care costs for the different models, showing that the mean cost of the asynchronous model is less than synchronous model, and making the asynchronous model more cost-effective. Conclusions: The asynchronous model is the most cost-effective model of telepsychiatry care for patients with depression admitted to a detention centre, according to the results of clinical effectiveness, cost measurement, and patient satisfaction.

Resumen Introducción: La telepsiquiatría se define como la utilización de las tecnologías de la información y la comunicación (TIC) en la prestación de servicios de psiquiatría a distancia. La aplicación de la telepsiquiatría está dada por dos tipos diferentes de comunicación: sincrónico (tiempo real) y asincrónico (tiempo diferido). Objetivo: Determinar la costo-efectividad de un modelo de telepsiquiatría sincrónico frente a otro asincrónico en pacientes con síntomas de depresión internados en un centro de privación de libertad. Métodos: Se realizó un estudio de costo-efectividad. Constituyeron la población 157 pacientes del Establecimiento Penitenciario y Carcelario de Mediana Seguridad de Manizales, Colombia. La muestra se determinó con la encuesta auto aplicable Zung para la depresión (1965) y la escala de valoración de Hamilton para la evaluación de la depresión (Hamilton depression rating scale [HDRS]), instrumento con que se realizó la comparación. Resultados: Las variables Hamilton inicial, tiempo de llegada, duración de caídas del sistema y efectividad clínica presentaron distribución normal con p > 0,05; entre los diferentes modelos hubo diferencias significativas (p < 0,001) en los costos de atención, y se evidenció que, en promedio, el costo del modelo asincrónico es menor que el del sincrónico; en promedio, la modalidad asincrónica es más costo-efectiva. Conclusiones: El modelo de atención más costo-efectivo en telepsiquiatría para pacientes con trastorno depresivo internados en un centro de privación de libertad es el asincrónico según los resultados de efectividad clínica, medición de costos y satisfacción del paciente.

Programa API (Apoyo Psiquiatría Infantil): Programa piloto de colaboración en Salud Mental Infanto-Juvenil en el Servicio de Salud Valparaíso-San Antonio: 12 meses de funcionamiento / Program API (Support Child Psychiatry): Mental Health adolescent collaboration pilot program in the San Antonio-Valparaíso Health Service: 12 months of operating

El Programa API (Apoyo Psiquiatría Infantil), es un sistema colaborativo multimodal (telefónico y presencial), entre nivel primario (7 Consultorios) y secundario (Hospital Salvador, Valparaíso) de salud. Se presentan los resultados del estudio descriptivo prospectivo del Programa API durante 12 meses de funcionamiento, obtenidos desde los registros de consultoría telefónica y presencial. En un periodo de 12 meses se recibieron 105 llamadas telefónicas. De estas, 87% fueron hechas por psicólogos/as. Se indicó atención conjunta en 59% y derivación a nivel secundario en 16% de los llamados. Los psicólogos de los equipos de salud mental participantes, coinciden en ser quienes dirigen y recurren más a este sistema. Se resuelven la mayoría de las dudas, a través de sugerencia de hipótesis diagnósticas y de manejo. Se concluye que los profesionales de los CESFAM les interesa el apoyo del programa, facilitando el trabajo con niños y adolescentes con problemas de salud mental. Palabras claves: programa colaborativo, salud mental, telepsiquiatría, psiquiatría infantojuvenil

The API PROGRAM (Child Psychiatry Support) is a multimodal collaborative program (giving phonecall support and face-to-face collaboration), between 7 primary healthcare centers (PHC) and secondary level healthcare centers (Hospital del Salvador, Valparaiso. The objective of this study is to describe the API Program after 12 months of implementation. This is a descriptive and prospective study with follow up calls and face to face collaboration. After 12 months, 105 phone calls were received. Of these , 87% were made by psychologists. Joint consultation in PHC was suggested in 59% of calls and referral to secondary level was indicated in 16% of the incoming calls. Psychologists belonging to mental health teams were the professionals with the highest disposition to use the program. Most doubts are solved by telephone, through the suggestion of diagnostic hypotheses and management. PHC professionals seem very interested in the support provided by the API Program, facilitating their work with children and adolescents with mental health problems.Key words: mental Health, collaborative program, telepsychiatry, Child-juvenil Psychiatry

A randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing: design, methodology, and implementation

Healthcare providers are continuously challenged to find innovative, cost-effective alternatives and to scale up existent services to meet the growing demand upon mental health care delivery. Due to continuous advances in technologies, telepsychiatry has become an effective tool for psychiatric care. In 2012, the Institute of Psychiatry of the University of São Paulo Medical School started a randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing. Objective: The objective of this article is to describe the design, methodology and implementation of a pilot project, which aimed to verify the applicability and efficiency of psychiatric attendance via Internet-based videoconferencing in a resource-constrained environment. Methods: The project consisted of a 12 months follow-up study with a randomized clinical trial, which compared various quality indicators between home-based telepsychiatric aftercare via videoconferencing and face-to-face aftercare. Results: The final sample comprised 107 outpatients (53 in the telepsychiatry group and 54 in the control group). Among 1,227 realized consultations, 489 were held by videoconferencing. Satisfaction with the aftercare by videoconferencing and the medication delivery was high among patients. Attending psychiatrists were satisfied with the assistance by videoconferencing. Discussion: The experiences during this pilot project have overall been very positive and psychiatric outpatient care by videoconferencing seems viable to treat patients even in a resource-constrained environment...

Telepsiquiatría para el tratamiento de trastornos mentales comunes en la atención primaria / Telepsychiatry for the treatment of mental commmon disorders in the primary care

Introducción: Las tecnologías de la información y comunicaciones (TICYC) y su aplicación en la medicina, son variadas y han demostrado ser una alternativa efectiva de entrega de atención especializada en atención primaria de salud (APS). Objetivo: Evaluar el uso de TICYC en psiquiatría (telepsiquiatría) en la APS para el manejo de trastornos mentales comunes (TMC). Metodología: se hizo una revisión sistemática de la literatura publicada en Medline, Proquest, LILACS, SciELO, Sciencie Direct, EBSCO, Springer Link, Oxford Journals, The Cochrane Library. Se seleccionaron revisiones sistemáticas y metanálisis, ensayos clínicos aleatorizados, reportes de experiencias y estudios de evaluación económica, que estuvieran en el idioma inglés y/o castellano en la cual utilizaran TICYC en APS para el manejo de TMC. Resultados: Se encontraron 24 artículos relacionados con el uso de TICYC en el tratamiento de los TMC en la APS. Trece son de tratamiento, 5 de cribado, 2 de satisfacción, 1 de monitorización y 1 de costo-efectividad. Conclusiones: El uso de telpsiquiatría para el manejo de TMC en APS, tiene una buena fiabilidad comparado con la atención persona a persona, siendo el uso del teléfono la TICYC más utilizada para el cribado y seguimiento de programas en TSQ. El uso de TICYC en telpsiquiatría sería igualmente efectiva para el manejo de TMC en APS.

Introduction: information technology and communications (IT&C) and its application in medicine, are varied and have proven to be an effective alternative for delivery of specialized care in primary health care (PHC). Objective: To evaluate the use of IT&C in psychiatry (telepsychiatry) in the APS for the management of common mental disorders (CMD). Methodology: Conducted a systematic review of the literature published in Medline, Proquest, LILACS, Sky, Science Direct, EBSCO, Springer Link, Oxford Journals, The Cochrane Library. Were selected systematic reviews and meta-analysis, randomized clinical trials, reports of experiences and economic evaluation studies, which were in English and / or Spanish in which IT&C used in PHC to manage CMD. Results: There were 24 items related to the use of IT&C in the treatment of mental disorders in PHC. Thirteen are in treatment, screening 5, 2 of satisfaction, 1 monitor and 1 cost-effectiveness. Conclusions: The use of telepsychiatry for the management of CMD in PHC, has a good reliability compared with the attention from person to person, with the use of the IT&C your most used for screening and monitoring programs in telepsychiatry. IT&C use in telpsychiatry would be equally effective in the management of CMD in PHC.

PROTOCOLO DE TELEMEDICINA PARA LA CONSULTA PSIQUIÁTRICA / TELEMEDICINE PROTOCOL FOR PSYCHIATRY CONSULTATION

En Colombia existen diversas poblaciones en zonas aisladas que no tienen acceso a servicios de salud especializados, entre ellos salud mental. La telemedicina es una herramienta que permite proporcionar estos servicios, llevando medicina especializada a un menor costo y similar calidad a través de tecnologías de la información y las comunicaciones. Como una solución a esta problemática se propuso la estructuración de un protocolo de teleconsulta psiquiátrica y la implementación de una aplicación web, con el fin de proveer servicios de diagnóstico y control a pacientes con incidencia de enfermedades mentales. Para la realización de este proyecto se analizaron lineamientos clínicos y operacionales en servicios de telepsiquiatría, se realizó un análisis de algunas patologías de interés, se hizo un desarrollo del proceso de ingeniería de software, y por último se diseñó una evaluación técnica y clínica de la aplicación para así obtener una retroalimentación del sistema.

Colombia had are several isolated populations in areas without access to specialized health services, much less on mental health. Telemedicine is a tool that allows to provide these services, bringing specialized medicine at lower costs and similar quality through information and communication technologies. As a solution to this problem, a psychiatric tele-consultation protocol and the implementation of a web application was proposed in order to provide diagnosis and follow up to patients with mental diseases. For the development of this project; clinical and operational guidelines in Telepsychiatry services were reviewed, diseases of interest were analyzed, a software engineering process was implemented, and finally a clinical and technical evaluation were designed in order to have a feedback for the system.