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      Telepsychiatry in the Post-COVID-19 Era: Moving Backwards or Forwards?

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          Abstract

          Dear Editor, In their interesting paper, Wright and Caudill [1] highlight the importance of telemedicine in the context of the COVID-19 pandemic. Although there were many barriers to telemedicine [2], the unexpected worldwide COVID-19 pandemicrequired a rapid and tremendous pragmatic turn to telepsychiatry in order to respond to treatment needs during the pandemic [3, 4]. Currently, it is unclearwhether this innovation will move backwards or forwards in the post-COVID-19 era and durably change the way to provide psychiatric care [5]. In an anonymous survey, we assessed to which extent patients (n = 1,732) and psychiatrists (n = 27) of the area of the Mood Center Paris Saclay plan to continue with telepsychiatry in the post-COVID era. The Mood Center Paris Saclay consultation unit provides general psychiatric care with both biological and psychotherapeutic treatments for an area comprising a part of the south of Paris downtown and its close suburbs. In this area, 14.3% of the inhabitants live below the poverty line, the unemployment rate is 12, and 84.8% of the active individuals work in the tertiary sector (services). The mean age of patients is 46 years, 57.1% are women, and their main primary diagnoses are major depressive disorders, bipolar disorders, anxiety disorders, and substance use disorders (mainly alcohol or tobacco). Whereas few teleconsultations were performed before the COVID-19 pandemic in this Mood Center, all face-to-face consultations were switched to teleconsultationson the first day of confinement in France. At the beginning of de-confinement 2 months later, the expected continuation of telepsychiatry in the post-COVID era was assessed. All psychiatrists responded to a questionnaire that gathered information about their own preferences and individual data about their patients. Since psychiatrists obtained data from their patients during the tele-consultations, the percentage of response was high: 95% of the patients responded to the survey. In the post-COVID era, 69% of the patients wish to continue with telepsychiatry (alternately with face-to-face consultation or exclusively). Of note, patient wishes to continue with telepsychiatry did not differ according to their demographics (age, gender, or time needed to come to the consultation) and primary diagnoses. The results of the survey show that 100% of the psychiatrists plan to continue with telepsychiatry for 31% (CI95% [22.0–39.8]) of their consultations. There is no association between both their years of practice and the perceived risk of COVID-19 and their preference for face-to-face or distance-based services. Psychiatrists indicate their preference for face-to-face consultation under each following circumstance: for first-time consultations (81.8% of the psychiatrists), in case of limited access to a private room (77.2% of the psychiatrists), potential severity with a high risk of hospitalization (50% of the psychiatrists), and hearing loss (22.7% of the psychiatrists). After the pandemic, two-thirds of the patients wish to continue durably with telepsychiatry. Moreover, all psychiatrists plan to continue with telepsychiatry for one-third of their consultations. Our results show that patients may prefer telemedicine more than their doctors. However, patients were not surveyed on reasons for wanting telemedicine. However, it could be suggested that telemedicine is more convenient for patients than for doctors, regarding travel time and cost savings. This point should be further studied. Furthermore, it could be suggested that doctors may be resistant to a paradigm shift and may see concerns that patients do not see, especially for severe patients who could require inpatient treatment in the short term. Our results go beyond those of a report published 15 years ago [6], which failed to show any difference in accuracy and satisfaction between psychiatric face-to-face and teleconsultation. Further studies should focus on the indications and contra-indications of telepsychiatry, adequate longitudinal integration between face-to-face and teleconsultation, and the efficiency and safety of the migration of care away from institutions with telepsychiatry. Finally, our results suggest that COVID-19 may trigger a future widespread use of telepsychiatry. Conflict of Interest Statement The authors declare that they have no conflicts of interest to disclose. Funding Sources This work received no funding. Author Contributions R.C., A.E.K.A.T., D.D.L., E.S.-C., E. Corruble: conception and design of the study, acquisition and analysis of data, drafting the manuscript, editing. L.C., B.B., K.C., P.-A.L., F.G., R.M., S.R., A.R., S.Z., M.G., A.M., C.N., E. Chaneac, S.M., W.C., P.H.: acquisition and analysis of data, editing.

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          Most cited references 4

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          Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies.

          The authors conducted a review and meta-analysis of the literature comparing telepsychiatry with "in-person" psychiatric assessments. Approximately 380 studies on telepsychiatry published between 1956 and 2002 were identified using MEDLINE, PsycINFO, and cross-referenced bibliographies. Of these, 14 studies with an N > 10 compared telepsychiatry with in-person psychiatry (I-P) using objective assessment instruments or satisfaction instruments. Three of these studies compared high bandwidth (HB) with low bandwidth (LB) telepsychiatry. Fourteen studies of 500 patients met inclusion criteria and were included in the meta-analysis. Telepsychiatry was found to be similar to I-P for the studies using objective assessments. Effect sizes were on average quite small, suggesting no difference between telepsychiatry and I-P. Bandwidth was found to be a significant moderator. Three moderators were tested, effect sizes remained largely heterogeneous, and further analyses are needed to determine the direction of effect. There was no difference between I-P and telepsychiatry between the HB and LB groups, although there are anecdotal data suggesting that HB was slightly superior for assessments requiring detailed observation of subjects. Out of a large telepsychiatry literature published over the past 40+ years, only a handful of studies have attempted to compare telepsychiatry with I-P directly using standardized assessment instruments that permit meaningful comparisons. However, in those studies, the current meta-analysis concludes there is no difference in accuracy or satisfaction between the two modalities. Over the next few years, we expect telepsychiatry to replace I-P in certain research and clinical situations.
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            • Record: found
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            Remote Treatment Delivery in Response to the COVID-19 Pandemic

             Jesse H. Wright (corresponding) ,  Robert Caudill (2020)
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              A Viewpoint From Paris on the COVID-19 Pandemic: A Necessary Turn to Telepsychiatry

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                Author and article information

                Journal
                Psychother Psychosom
                Psychother Psychosom
                PPS
                Psychotherapy and Psychosomatics
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                0033-3190
                1423-0348
                27 August 2020
                : 1-2
                Affiliations
                aService Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, MOODS Team, INSERM, CESP, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Le Kremlin Bicêtre, France
                bDirection de l'Organisation Médicale et des Relations avec les Universités, Assistance Publique-Hôpitaux de Paris, Paris, France
                Author notes
                *Romain Colle, Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, FR–94275 Le Kremlin Bicêtre (France), romain.colle@ 123456aphp.fr

                Romain Colle and Abd El Kader Ait Tayeb share first authorship.

                Article
                pps-0001
                10.1159/000511024
                7490503
                Copyright © 2020 by S. Karger AG, Basel

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Page count
                References: 6, Pages: 2
                Categories
                Letter to the Editor

                Clinical Psychology & Psychiatry

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