Journal Article Annotations
2021, 4th Quarter
Annotations by Brandon A Francis, MD, MPH
This is a prospective cohort study that evaluated perspectives on provider empathy from 70 adult stroke patients in the Emergency Department using the Consultation and Relational Empathy (CARE) questionnaire. The authors found no difference in reports of provider empathy from patients seen in-person or through tele-medicine. Those seen through tele-medicine were younger (p = 0.04), had lower rates of cognitive deficits (p= 0.02), and lower NIHSS scores (p = 0.03; National Institutes of Health Stroke Scale – lower scores are associated with less severe functional impairment). The consultation time was also shorter in those who engaged in telemedicine (p=0.04). There was no difference in rates of tPA administration (p = 0.17) which is a time-sensitive potentially therapeutic intervention that has been associated with improved functional outcomes in patients with acute ischemic stroke at 90 days. In a multivariate analysis the authors controlled for consultation duration, NIHSS, age and found no difference in ‘good to excellent’ CARE rating ((odds ratio (TM vs in-person) = 1.72, 95% confidence interval (CI) 0.43–7.70, p = 0.48).
Strengths and weaknesses:
This study had significantly more patients in the telemedicine arm of the study. This was unblinded and therefore subject to bias as evidenced by the statistically significant difference in patient demographics between groups (ex: age). The sample size was small (n = 70) and was conducted in a setting where there was already a good working relationship between the primary hospital and its hub which may limit generalizability. This study’s main strength is that they employed a multivariable analysis to control for some of those potential confounders that strengthens the results.
study can inform our perspectives on engaging in telepsychiatric consultations in settings where in-person connection is not possible or logistically challenging. From this study we can reasonably suspect that at least a cohort of younger, cognitively intact patients being evaluated for a stroke seem to tolerate telehealth in the emergent environment. There seems to be no significant difference in perceptions of empathy in this patient population when comparing in-person vs telehealth. The next step would be to validate this in a small psychiatric population given there can be significant differences in the development of rapport and availability of resources such as ongoing patient support post-consultation.
This multisite study assembled focus groups of providers, psychiatrists, and psychologists who were participating in the remote care of their patients. The primary objective was to ascertain provider barriers to tele-health. The authors found that the providers were motivated to participate, but there were various operational challenges including but not limited to electronic medical record function, communication with other providers such as primary care, technological challenges, and credentialing at various sites.
Strengths and weaknesses
This study is related to a larger comparison of telepsychiatry to a collaborative care model which included just over 1000 patients referred to as the SPIRIT (the Study to Promote Innovation in Rural Integrated Psychiatry) trial. That study was aimed at addressing unmet psychiatric needs in rural communities. This study evaluated the perspective of the providers who were part of that SPIRIT trial. This provider focus-group based study had only 10 providers participate. The sample size is small which can limit the interpretation of the results. However, given the paucity of data on provider perspective on telepsychiatry in this context, any information can be a helpful starting point. This was a qualitative study limiting statistical utility.
In the current COVID environment telepsychiatry has become more common, and these data seem to reflect the challenges of the everyday process of engaging in remote care. The authors highlight the importance of patient rapport, teamwork such as with case workers and improving access to care. They also address some of the challenges these providers experienced during the study period. While the n is small – only 10 participants – their experience will likely resonate with others engaged in telepsychiatry. The next steps include a large sample of providers and integrating resources to limit the impact of operational challenges that can plague remote telehealth.
This observational study was conducted in the context of initiating a new tele-consultation-liaison psychiatry service for a remote hospital. The primary objective was to evaluate provider perspectives of this service. The providers in general did not find these remote consultations as rewarding or fulfilling as in-person consultations. The providers did appreciate the positive impact on the care of patients that would otherwise have gone without their consultation services.
Strength and weaknesses:
This is a qualitative study and only a small number of providers participated. This limits generalizability and statistical utility. However, there is limited data on provider perspectives in the context of initiating a CL service remotely.
This study offers provider perspectives on new remote CL services. These are likely shared among a cohort of psychiatrists, however, a larger sample size is needed to determine what components should be the topics of focus when building such a service.