University of São Paulo: Telepsychiatry had good acceptance during the pandemic and brought good therapeutic results

Physicians are almost unanimous (90%) in supporting telepsychiatry as a viable alternative for the provision of mental health services. The modality proved to be effective and brought good therapeutic results. On the other hand, patients who were on the other side of the screen, although they felt satisfied with the quality of care as a way of guaranteeing access to health care, felt the lack of physical contact between doctor and patient. The finding is from a study of 530 psychiatric patients on new medical approaches as an emergency measure during the coronavirus pandemic. The only caveat is that psychiatric emergencies – psychotic breaks, risk of suicide, aggression towards oneself or others, and intoxication from alcohol and drug use – need to be dealt with face-to-face.

The results of this study were described in the article Satisfaction with Telepsychiatry during the COVID-19 pandemic: Patients’ and psychiatrists’ report from a University Hospital , published on January 6, 2022 in the International Journal of Social Psychiatry.

The research was carried out between February and September 2021 at the National University of Asunción, Paraguay, and had the participation of psychiatrist João Maurício Castaldelli-Maia, from the Faculty of Medicine (FM) of USP. The proposal was to evaluate, from a medical point of view, the satisfaction of patients who used the telepsychiatry service offered by the Department of Psychiatry of the Hospital de Clínicas of the University of Asunción.

For Castaldelli-Maia, “telemedicine is a viable alternative for the provision of face-to-face mental health services and is here to stay. The coronavirus pandemic only accelerated this process that had already been increasing in recent decades because there is a gap between the demand and availability of mental health care”, explains Castaldelli-Maia to Jornal da USP . Safety in care, the possibility of medical support for people in rural and/or remote areas and the exclusion of the time spent by the patient traveling to the office or hospital are other advantages mentioned by the researcher.

Patients involved in the research, aged between 18 and 75 years, of both sexes, were invited to answer twenty questions by telephone, divided into the following areas: perception of telepsychiatric care; quality of care in telepsychiatry; doctor-patient relationship in telepsychiatry; and trust in the telepsychiatry service. The volunteers’ disorders were depression, anxiety, borderline personality disorder, bipolar disorder, substance abuse, schizophrenia, sleep disorders and other psychotic disorders.

Results
Of the psychiatrists who provided care to patients, 90% considered the online modality extremely adequate and 75% reported that they had managed to make a good mental health diagnosis. Of these professionals, 62% showed a preference for performing telepsychiatry in follow-up consultations, that is, before starting with virtual consultations, there should be a first face-to-face assessment of the patient.

From the patients’ point of view, they had high satisfaction and security scores regarding the acceptance of telepsychiatry as a viable modality for health care, and lower satisfaction scores regarding the strengthening of doctor-patient bonds.

According to Castaldelli-Maia, in the telepsychiatry support line there are already meta-analysis studies (studies that use data from several previous studies) that show the quality of online mental health services and that confirm equivalence in videoconference interventions when compared to those carried out in person: Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice .

For psychiatric emergencies,
Castaldelli-Maia face-to-face care recognizes that direct dialogue with the patient – ​​eye to eye – provides better exploration of non-verbal signs, symptoms and laboratory manifestations. “Right in the first meeting, a welcoming interaction is established that provides the patient with greater confidence and the possibility of opening up to talk and mitigating suffering”, however, this issue needs to be circumvented, he says.

Telemedicine will not completely replace face-to-face consultation, but it is favorable to the incorporation of new technologies in psychiatry by facilitating access to health services and the modality being more viable for people with mobility difficulties and geographically isolated populations.

Castaldelli-Maia also recalls psychiatric emergencies – psychotic outbreaks, risk of suicide, aggression towards oneself or others, and intoxication from alcohol and drug use – that cannot be treated via telepsychiatry. In these cases, the patient is asked to attend the office in person for reception, evaluation and prescription of medication, if necessary.

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