Client acceptability and quality of life--telepsychiatry compared to in-person consultation.

We evaluated client satisfaction and one-month mental health outcomes for telepsychiatry clients compared with those undergoing a face-to-face psychiatric consultation. Clients were asked to complete an SF-12 health survey before the consultation, a satisfaction survey after the consultation, and were contacted for a one-month follow-up SF-12 survey by telephone. Forty-eight of the 62 initial responders (77%) were available for contact by telephone after one month. Telepsychiatry clients demonstrated significant improvements on pre- and post-SF-12 mental health measures (t = 3.7; P = 0.001), while there was no change for the in-person group (t = 1.0; P = 0.35). Telepsychiatry clients felt that they could present the same information as in person (93%), were satisfied with their session (96%), and were comfortable in their ability to talk (85%); this was similar to the in-person clients. They reflected slightly lower levels of satisfaction regarding feeling supported and encouraged than did the in-person clients. Both telepsychiatry clients and traditional face-to-face psychiatry clients were satisfied with their experience of mental health care service provision, and mental health improvements were evident in the telepsychiatry patients.

Telepsychiatry as a routine service--the perspective of the patient.

Patient perspectives were examined as part of an assessment of a routine telepsychiatry service in rural Alberta. Information was gathered through self-report questionnaires and telephone interviews. Of 379 questionnaires distributed to patients, 230 (61%) were returned. Of the patients who completed questionnaires, 89% reported being satisfied with the service and 96-99% were satisfied with the equipment and the room. Twenty-nine of 31 patients who were interviewed by telephone preferred telepsychiatry to waiting for a consultation, were willing to use the service again and would recommend telepsychiatry to a friend. While 25 of these 31 patients preferred telepsychiatry to travelling to a consultation, 15 indicated that they would prefer a face-to-face interview to telepsychiatry and a further seven were unsure. Twenty-three of the 31 patients interviewed would have had to miss time from work or pay for child care in order to travel to a conventional psychiatric consultation. The availability of telepsychiatry led to an estimated cost saving of $210 per consultation for patients who would otherwise have had to travel. From the patient's perspective, telepsychiatry was an acceptable technique in the management of mental health difficulties that both increased access to services and produced cost savings.

Evaluation of a routine telepsychiatry service.

An assessment was undertaken of a routine telepsychiatry service in rural areas of a Canadian province as a follow-up to a pilot telepsychiatry project. Over two years, there were 546 consultations at the five participating general hospitals, although the level of use varied considerably between them. Health professionals expressed high satisfaction with the service. While there were equipment problems in 17% of all consultations in the second year, they did not seem to affect acceptance of the technique. A cost analysis comparing consultations provided by a visiting psychiatrist and telepsychiatry found a break-even point of 348 consultations a year. However, when use of the videoconferencing network for administrative meetings was considered, the break-even point was 224 consultations a year, substantially below the actual utilization of telepsychiatry. Telepsychiatry appeared to result in increased access to community mental health services, suggesting future increased demand for these. From the perspective of health authorities and health professionals, telepsychiatry proved to be a useful and sustainable addition to existing mental health services.

Evaluation of a Canadian telepsychiatry service.

A telepsychiatry pilot project linking five rural general hospitals and Alberta Hospital Ponoka was implemented in June 1996 as a response to both a scarcity of psychiatric resources in the Province of Alberta and the emphasis on community-based care. Psychiatrists located at Alberta Hospital Ponoka provided psychiatric consultations using videoconferencing technology in response to referrals from general practitioners. The project was evaluated through the use of questionnaires administered to consumers, service providers, and psychiatric consultants. Questionnaires were supplemented by interviews, site visits, logs, telephone interviews with consumers, and surveys to general practitioners at the rural sites. A total of 109 consultations occurred during the pilot stage. Results strongly suggested acceptance and satisfaction with the consultation by consumers, general practitioners and psychiatrists. The patient's perceived benefits included timeliness of service, service within their own community, decreased work time loss for self or family, and positive outcomes as a result of specialist expertise. Up until September 30, 1998 a total of 535 consultations had been completed, 381 of which were new referrals and 154 of which were follow up referrals. Seventy-two different physicians referred to the service. The practice profile is dramatically different to outpatient psychiatric practice in which approximately 90% of patient contacts are follow-up visits.