A. B. Summerfield

Bio: A. B. Summerfield is an academic researcher from Guy's Hospital. The author has contributed to research in topics: Telepsychiatry & Service (business). The author has an hindex of 3, co-authored 3 publications receiving 121 citations.

A comparison of communication modes in adult psychiatry.

Abstract: The process and outcome of clinical tasks in an acute psychiatric unit were compared using four different communication modes: face to face, telephone, hands-free telephone, and a low-cost videoconferencing system. Six doctors and six patients took part in the study. Four assessment measures were used. The videoconferencing system was positively received by both patients and doctors. Both doctors and patients preferred communication modes with visual cues. However, there were few significant differences between communication modes when using single measures; only multiple levels of analysis can adequately assess the differences between such modes of communication.

Telepsychiatry in an inner-city community psychiatric service.

Abstract: In the UK psychiatric services have become community based. Staff resources, which have not increased to keep up with the change in service demand, are unevenly spread throughout the various service elements. Community nurses, mental health teams and psychiatrists spend time moving between hostels, teaching centres and small community inpatient units, general practice surgeries and patients’ homes. Outpatient clinics take place at sites closer to the patients and away from inpatient services. In inner-city sectorized services the geographical distances may be small, but travelling times may still be long. This is often compounded by traffic congestion, poor public transport and travel costs. Techniques such as videoconferencing have the potential to improve communications between service elements, to reduce travelling time for staff and patients, to increase the accessibility of services for patients and to improve supervision by staff1. We have investigated the use of a videolink betweena community mental health centre, the Speedwell centre in Deptford, south-east London, and the inpatient ward for the sector at Guy’s Hospital in central London, 5 miles (8 km) away. The centre is open from 09:00 to 17:00 on weekdays and is staffed by about 25 persons including nurses, social workers, occupational therapists, administrative and support staff. Many of the staff have sessions at the inpatient unit as well as at the mental health centre. Patients usually present to the Speedwell centre for emergency consultation or to make informal inquiries. At the start of the study the communication requirements identified between the inpatient service and the Speedwell centre were the handing over of information to members of the community mental health team for the follow-up of patients with severe mental illness who were discharged from the ward, and arranging for the admission of patients in the community who had become ill. Before the installation of the telemedicine link communication was by post, telephone and by staff travelling between sites. The videolink was installed as part of the European Commission’s Telemed project (RACE-1086). This was designed to evaluate broadband communications links in a variety of medical applications. The equipment was a prototype videoconferencing system known as the MCVC and was based on a 386 PC which produced a digitized video signal from a monochrome camera. The MCVC was connectedvia a multiplexer (Craycom2000) to a 2 Mbit/s private leased circuit (BT Megastream). The transmitted picture was displayed on a 12 inch (30 cm) monochrome monitor at a resolution of 128 ́ 128 pixels with 64 greyscales, at about 25 frames/s. Sound was transmitted via the public telephone network using hands-free telephones (GEC) modified by bypassing the integral microphone with a clip-on microphone. Three cases are reported from a trial clinic which the sector consultant held over the link to review certain long-term patients. The psychiatrist was at Guy’s Hospital and the patients were at the mental health centre. All interactions were recorded on video and audio tape, and patients were asked to report their responses on a self-completion questionnaire, the Focused Observation Schedule (FOS) II. Observations were recorded in a logbook.

Preliminary evaluation of a low cost videoconferencing system for teaching in clinical psychiatry.

Abstract: The use of a digitized low cost videoconferencing system (LCVC) for the teaching of clinical medical students on clinical attachment to a psychiatric ward is described. This work was performed as part of the Telemed project which is evaluating the use of the LCVC in a range of tasks in clinical psychiatry. Any move towards greater reliance on communications technology in psychiatry should take account of the requirements of clinical teaching. The case presentation was used as a teaching paradigm in a controlled study comparing teaching face-to-face with teaching mediated via the LCVC. A questionnaire was developed for student evaluation of the case presentation. General user responses to the LCVC are reported. No significant differences were found between the conditions. User responses were favourable, suggesting that remote interactive teaching via the LCVC warrants further investigation.

Systematic review of studies of patient satisfaction with telemedicine.

Abstract: Objective: To review research into patient satisfaction with teleconsultation, specifically clinical consultations between healthcare providers and patients involving real time interactive video. Design: Systematic review of telemedicine satisfaction studies. Electronic databases searched include Medline, Embase, Science Citation Index, Social Sciences Citation Index, Arts and Humanities Citation Index, and the TIE (Telemedicine Information Exchange) database. Subjects: Studies conducted worldwide and published between 1966 and 1998. Main outcome measures: Quality of evidence about patient satisfaction. Results: 32 studies were identified. Study methods used were simple survey instruments (26 studies), exact methods not specified (5), and qualitative methods (1). Study designs were randomised controlled trial (1 trial); random patient selection (2); case-control (1); and selection criteria not specified or participants represented consecutive referrals, convenience samples, or volunteers (28). Sample sizes were20 (10 trials),100 (14), >100 (7), and not specified (1). All studies reported good levels of patient satisfaction. Qualitative analysis revealed methodological problems with all the published work. Even so, important issues were highlighted that merit further investigation. There is a paucity of data examining patients9 perceptions or the effects of this mode of healthcare delivery on the interaction between providers and clients. Conclusions: Methodological deficiencies (low sample sizes, context, and study designs) of the published research limit the generalisability of the findings. The studies suggest that teleconsultation is acceptable to patients in a variety of circumstances, but issues relating to patient satisfaction require further exploration from the perspective of both clients and providers.

A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing.

Abstract: We used a PC-based videoconferencing system to conduct child psychiatry assessments. The telecommunications link was six digital lines, giving a total bandwidth of 336 kbit s. Twenty-three patients aged 4-16 years, accompanied by their parents, completed two psychiatric assessments, one via videoconferencing and another face to face FTF. The order of assessments was randomized. Questionnaires were used to record the diagnosis, treatment recommendations and the psychiatrists', patients' and their parents' satisfaction with each assessment. An independent evaluator concluded that in 22 cases 96 the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF. The psychiatrists stated that videoconferencing assessments were an adequate alternative to FTF assessments and did not interfere with diagnosis. However, the responses from the psychiatrist satisfaction questionnaire showed that they preferred FTF assessments. No significant difference was found in the ...

Limitations of Patient Satisfaction Studies in Telehealthcare: A Systematic Review of the Literature

Abstract: The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.

Clinical and educational telepsychiatry applications: a review

Abstract: Objective: Telepsychiatry in the form of videoconferencing brings enormous opportunities for clinical care, education, research, and administration. Focusing on videoconferencing, we reviewed the telepsychiatry literature and compared telepsychiatry with services delivered in person or through other technologies. Methods: We conducted a comprehensive review of telepsychiatry literature from January 1, 1965, to July 31, 2003, using the terms telepsychiatry, telemedicine, videoconferencing, effectiveness, efficacy, access, outcomes, satisfaction, quality of care, education, empowerment, and costs. We selected studies for review if they discussed videoconferencing for clinical and educational applications. Results: Telepsychiatry is successfully used for various clinical services and educational initiatives. Telepsychiatry is feasible, increases access to care, enables specialty consultation, yields positive outcomes, allows reliable evaluation, has few negative aspects in terms of communication, generally satisfies patients and providers, facilitates education, and empowers parties using it. Data are limited with regard to clinical outcomes and cost-effectiveness. Conclusions: Telepsychiatry is effective. More short- and long-term quantitative and qualitative research is warranted on clinical outcomes, predictors of satisfaction, costs, and educational outcomes.