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 ...

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

The author describes an interactive television (IATV) system set up between Massachusetts General Hospital and a medical station in Boston. The system has proven to be feasible and acceptable to individuals and institutions in the community, providing psychiatric skills on a much wider scale, in a more accessible way, and faster than any other system. The author delineates the implications and future uses that appropriately placed IATV links could have, such as significantly multiplying existing manpower and more evenly distributing psychiatric care without placing greater demands on manpower.

Telepsychiatry: Psychiatric consultation by interactive television.

Telepsychiatry (consultation carried out through 2-way interactive television) has been the object of a number of trials in the past twenty years, but to our knowledge there is no previous control study which compares CCTV and face-to-face interviews. Various aspects of the interviews carried out on CCTV were rated on a 5-point scale in questionnaires filled out by: (a) patients; (b) consultees and; (c) consultants. No significant difference was elicited with control interviews in respect to patients' diagnosis, age and sex. CCTV interview ratings by consultee and consultant were rated only slightly below those of the control group. Such findings should encourage a broader application of interactive CCTV, particularly as a complement to live consultations in distant areas.

Telepsychiatry: Psychiatric consultation through two-way television: A controlled study.

We evaluated user satisfaction with a PC-based videoconferencing system used for child psychiatry assessments and performed a cost analysis. Thirty patients (aged 5-16 years), accompanied by a parent, completed a psychiatric assessment using the videoconferencing system. One of five child psychiatrists was randomly assigned to each assessment. Satisfaction questionnaires were completed after each assessment by the psychiatrist, patient and parent. Parents also completed a cost questionnaire. The telecommunications bandwidth was 336 kbit/s. The psychiatrists stated that they were either 'very satisfied' or 'satisfied' with the telepsychiatry assessments. On a five-point Likert scale (1 = lowest, 5 = highest), 28 of the 30 parents (93%) rated their satisfaction level as 5; the other two rated it 4. All 30 parents (100%) stated that they 'liked' the telepsychiatry assessment and would use the system again. Twenty-nine parents (97%) indicated that they would prefer to use the telepsychiatry system to travelling to see a child psychiatrist in person. Eleven children (aged 5-12) participated and all (100%) said they 'liked' using the telepsychiatry system. Five out of nine children (56%) stated they liked the 'television doctor' better than the 'real' doctor; four said they had no preference. Nineteen adolescents (aged 13-16 years) participated and most were very satisfied or satisfied with the system. Seventeen of the 19 adolescents (89%) said they would prefer to see the psychiatrist on the videoconferencing system to travelling for an assessment, and the same number said that they would use telepsychiatry again. The estimated total travel cost for the 30 patients was $12,849, an average of $428 per patient. The total cost of the telepsychiatry service for the three-month pilot was $12,575, or $419 per patient.

A prospective satisfaction study and cost analysis of a pilot child telepsychiatry service in Newfoundland.

We examined all articles describing video applications of telemedicine for psychiatry (i.e., “telepsychiatry”) that have been published in peer-reviewed journals. We found three reports of video application to continuing education, eight uncontrolled studies or anecdotal clinical reports of video application to assessment or consultation, five clinical investigations including a control group or control condition, three studies evaluating the reliability of administering psychological rating scales by video, and two studies of the cost-effectiveness of telepsychiatry. Although the conclusions of all studies reviewed recommend the use of telepsychiatry, evidence currently available is insufficient to suggest its widespread implementation. Additional studies are needed to determine when and for what age groups and conditions telepsychiatry is an effective way to deliver psychiatric services, and whether it is cost-effective. We recommend that telepsychiatry be employed on a limited basis and be restricted t...

Telepsychiatry at Forty: What Have We Learned?

Consultation services via two-way closed circuit television have proved to be effective in helping nonpsychiatric physicians to improve their knowledge of psychiatry and to treat their emotionally ill patients. The authors describe such a service set up between Hanover, N.H., and Claremont, N.H., a community 26 miles away. The service has aided the physicians in maintaining the majority of their referred cases in the community and has provided them with a valuable educational experience.

Charles Solow

Papers

24-Hour Psychiatric Consultation Via TV