Addressing concerns and adapting psychological techniques for videoconsultations: A practical guide

Objective: The 2020 coronavirus pandemic required many psychologists to rapidly transition to telehealth services to reduce virus exposure. Telepsychology services expanded quickly in Australia. This article seeks to provide simple and practical recommendations for clinicians who are changing their practice. Method: A narrative literature review focusing on psychologists' concerns regarding telehealth-facilitated psychology or telepsychology was undertaken. Results: Research literature and guidelines from peak professional bodies such as The Australian Psychological Society and the American Psychological Association, inform two sections of the article: Common Concerns about Videoconsultations and;Practical Considerations for Effective Videoconsultations. Telepsychology, has numerous benefits, especially during emergency situations. However, concerns regarding efficacy, therapeutic alliance, and the digital divide have contributed to psychologists' unwillingness to use telepsychology. Evidence suggests that efficacy and therapeutic alliance is comparable between telepsychology and in-person services. Simple evidence-based adjustments to therapeutic practice can optimise videoconsultations and increase the effectiveness of telepsychology. Despite the rapid change to videoconsultations, evidence suggests that Australian psychologists need not be concerned about clinical efficacy or therapeutic alliance related to telepsychology. However, it is acknowledged that transitioning to telehealth models of care is disruptive. Conclusion: This paper can assist clinicians in selecting appropriate clients for telepsychology, increase effectiveness and mitigate risks. Key Points: What is already known about this topic: (1) Research supports the clinical efficacy and establishment of therapeutic alliance related to telepsychology services and highlights that concerns regarding the digital divide need to be evidence-based, not based on assumptions. (2) As outlined in this paper, it is important to consider client suitability and ethical considerations prior to delivering telepsychology services. (3) The adaptations to psychological techniques, as highlighted in this paper, can increase the effectiveness of videoconsultations. What this topic adds: (1) An examination of common concerns related to videoconsultations including: efficacy, therapeutic alliance and the digital divide. (2) A practical evidence-based checklist for pre-therapy videoconsultation considerations. (3) An evidence-based checklist of practice adaptations that can increase effectiveness in videoconsultation. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Cancer care and management during COVID-19: A comparison of in-person, video and telephone consultations.

In Australia, the COVID-19 pandemic has resulted in the exponential growth in the delivery of telehealth services. Medicare data indicates that the majority of telehealth consultations have used the telephone, despite the known benefits of using video. The aim of this study was to understand the perceived quality and effectiveness of in-person, telephone and videoconsultations for cancer care. Data was collected via online surveys with consumers (n = 1162) and health professionals (n = 59), followed by semi-structured interviews with telehealth experienced health professionals (n = 22) and consumers (n = 18). Data were analysed using descriptive statistics and significance was tested using the chi-square test. A framework analysis and thematic analysis were used for qualitative data. Results indicate telehealth is suitable for use across the cancer care pathway. However, consumers and health professionals perceived videoconsultations facilitated visual communication and improved patients' quality of care. The telephone was appropriate for short transactional consultations such as repeat prescriptions. Consumers were rarely given the choice of consultation modality. The choice of modality depended on a range of factors such as the type of consultation and stage of cancer care. Hybrid models of care utilising in-person, video and telephone should be developed and requires further guidance to promote the adoption of telehealth in cancer care.

Increase in telemental health services on the Medicare Benefits Schedule after the start of the coronavirus pandemic: data from 2019 to 2021.

Objective To describe the change in telemental health service volume that resulted from the introduction of the Medicare Benefits Schedule (MBS) item numbers in 2020 for services provided by psychologists and psychiatrists in Australia for a 3-year period, from January 2019 to December 2021. Methods Quarterly MBS activity and cost data for mental health services provided by consultant psychiatrists, clinical psychologists, and psychologists between January 2019 and December 2021 were extracted from the MBS statistics website. Data were grouped by profession and delivery mode (in-person, telephone or videoconference) and reported using activity counts. Descriptive analysis and interrupted time-series regression analysis were conducted. Specific descriptive explorations were also conducted for psychiatrists, including: new client consultations, review or general consultations, and group consultations. Results The delivery of mental health services by telehealth (telemental health) during the pandemic has increased (P < 0.0001). When the pandemic started in March 2020, telemental health services provided by psychiatrists and psychologists increased from a combined 1-2% per quarter to 29% videoconference and 20% telephone in quarter two 2020. After the onset of the pandemic, videoconference remained the primary form of telehealth for these professions. However, the telephone accounted for approximately a third of the telehealth activity after the new item numbers were introduced. Conclusion Telemental health services are more likely to be conducted by videoconference than by telephone. The observed increase in telehealth service activity confirms how crucial appropriate funding models are to the sustainability of telehealth services in Australia. The growth in telehealth was used to support people with mental health conditions in Australia.

Exploring factors of uneven use of telehealth among outpatient pharmacy clinics during COVID-19: A multi-method study.

BACKGROUND: To enable services to be provided at a distance during the COVID-19 pandemic, outpatient pharmacy services in Australia underwent near-immediate reform by moving to telehealth, including telephone and video consults. OBJECTIVE: To investigate how telehealth was used in a metropolitan outpatient pharmacy setting before and after the start of the COVID-19 restrictions and the various influences on the uptake of phone and video modalities. METHODS: A multi-methods approach was used including: (1) quantifying administrative activity data between July 2019 to December 2020 and, (2) semi-structured interviews with key stakeholders (n = 34). RESULTS: Activity data: Between July 2019 to December 2020 16,377 outpatient pharmacy consults were provided. Of these, 13,543 (83%) were provided in-person, 2,608 (16%) by telephone and 226 (1.4%) by video consult. COVID-19 impacted how these services were provided with telephone activity more than four-times higher in April 2020 than March 2020 and slight increases in video consults. Pharmacists have heavily favoured using the telephone despite the recommendation that video consults be used as the primary mode of contact and that telephone only be used when a video consult was not possible. As soon as COVID-19 restrictions eased, clinicians gradually returned to in-person appointments, maintaining some use of telephone and very limited use of video consult. Semi-structured interviews: Whilst clinicians recognised the potential benefits of video consults, challenges to routine use included the additional administrative and planning work required pre-consult, perceptions that patients were unable to use the technology, and the belief that in-person care was 'better' and that the telephone was easier. CONCLUSION: Organisational strategies that encouraged the use of video over telephone (e.g. through financial incentives) did not appear to influence clinicians' choice of care modality. Implementation studies are required to co-develop solutions to embed telehealth options into outpatient pharmacy settings that provide the best experience for both patients and clinicians.

Building on the momentum: Sustaining telehealth beyond COVID-19.

The 2019 coronavirus pandemic (COVID-19) has resulted in tremendous growth in telehealth services in Australia and around the world. The rapid uptake of telehealth has mainly been due to necessity - following social distancing requirements and the need to reduce the risk of transmission. Although telehealth has been available for many decades, the COVID-19 experience has resulted in heightened awareness of telehealth amongst health service providers, patients and society overall. With increased telehealth uptake in many jurisdictions during the pandemic, it is timely and important to consider what role telehealth will have post-pandemic. In this article, we highlight five key requirements for the long-term sustainability of telehealth. These include: (a) developing a skilled workforce; (b) empowering consumers; (c) reforming funding; (d) improving the digital ecosystems; and (e) integrating telehealth into routine care.

Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic.

In March 2020, the Australian Government added new temporary telehealth services to the Medicare Benefits Schedule (MBS) to reduce the risk of patient-patient and patient-clinician transmission of the 2019 coronavirus (COVID-19). Here, the MBS statistics for general practitioner activity and the associated costs are described; a small increase in both activity and costs for the new MBS telehealth items were observed. The opportunities for future research and policy implications are also discussed.