Is Telepsychiatry Equivalent to Face-to-Face Psychiatry? Results From a Randomized Controlled Equivalence Trial

Irving Kuo, MD


November 01, 2007

Is Telepsychiatry Equivalent to Face-to-Face Psychiatry? Results From a Randomized Controlled Equivalence Trial

O'Reilly RO, Bishop J, Moddox K, Huchinson L, Fisman M, Takhar J.
Psychiatr Serv. 2007:58:836-843.

Clinical outcomes between telepsychiatry vs face-to-face psychiatric encounters was compared. Four hundred ninety-five patients residing in rural Canada referred by their family physicians for a psychiatric consultation were randomized to either a face-to-face (n = 254) or a telepsychiatric (n = 241) examination. Psychiatrists were allowed to provide monthly follow-up visits for up to 4 months. The primary outcome measure was the proportion of patients whose Brief Symptom Inventory score went from the dysfunctional to the functional range, indicating a reduction in subjective patient distress. Secondary outcome measures included inpatient admissions, cost, patient satisfaction, and changes evaluated on the mental health subscale of the Medical Outcome Study Short Form (SF-36).

The 2 delivery systems were equivalent on both primary and secondary outcome measures. Levels of clinical improvement were similar in both groups, as were the hospitalization rates. Patient satisfaction, at a moderate degree, was equivalent for both face-to-face and telepsychiatry encounters. Total cost was approximately 10% less for telepsychiatry vs face-to-face appointments.

Delivering healthcare to rural and isolated areas can be quite challenging. Telepsychiatry is 1 possible answer to this problem, but questions regarding the effectiveness of this delivery system compared with face-to-face encounters have arisen. In this study, limited psychiatric consultations, clinical outcomes, and patient satisfaction were equivalent and cost favored telepsychiatry.

In this trial, a connection speed of 384 kilobytes per second (kps) was used for videconferencing because previous research indicates that assessment of affective symptoms clinically was not as reliable with speeds under 128 kps.[1]

For basic psychiatric encounters, including diagnostic evaluations and medication-based follow-up appointments, telepsychiatry may be sufficient. However, it may not prove to be effective or appropriate for other types of psychiatric treatments requiring more intensive psychotherapies. Further equivalence studies are warranted.



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