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Table of Contents
PERSPECTIVE
Year : 2021  |  Volume : 3  |  Issue : 2  |  Page : 117-119

Tele-health Services – Can “Virtual” be as Good as “Real”?


1 Department of Psychiatry, Level III Hospital, Goma, Congo
2 Department of Anaesthesiology and Critical Care, Level III Hospital, Goma, Congo

Date of Submission05-Mar-2021
Date of Acceptance08-Jul-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Shibu Sasidharan
Department of Anaesthesiology and Critical Care, Level III Hospital, Goma
Congo
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wsp.wsp_8_21

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  Abstract 


COVID-19 pandemic has pronounced unimaginable ripples in the normal functioning of the world we live in and has also compelled us to bring a paradigm shift in health-care provisions and how we practice it. Telehealth services have almost dramatically replaced traditional in-person treatment, especially in mental health services. This significant change in the practice of medicine has forced us to question our very perception of ideal health care. Telemedicine will do for health care what the personal computer has done for the office. Or so its proponents believe. Its opponents believe that it represents a threat to the doctor–patient relationship and is an intrinsically unsafe way of practicing medicine. In this brief clinical update, we delve into the core of telemental health services and try to unravel its impact on human lives during this pandemic.

Keywords: COVID-19, Internet, mental health, telehealth services


How to cite this article:
Dhillon HS, Sasidharan S. Tele-health Services – Can “Virtual” be as Good as “Real”?. World Soc Psychiatry 2021;3:117-9

How to cite this URL:
Dhillon HS, Sasidharan S. Tele-health Services – Can “Virtual” be as Good as “Real”?. World Soc Psychiatry [serial online] 2021 [cited 2021 Nov 29];3:117-9. Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/2/117/324992




  Introduction Top


COVID-19 pandemic has transformed the global educational, economic, health services, and even political interventions from an in-person interaction to virtual platforms. The epidemics of this proportion and natural disasters, in general, pose multiple challenges in delivering health care. The health services for chronic illnesses, including most mental health conditions require uninterrupted monitoring and long-term follow-up to ensure continuity of care and adherence to drugs. Therefore, most of the health service providers have shifted from in-person treatment to telehealth services (THS). In this short communication, we would like to deliberate on the pros and cons of this momentous shift and examine the impact it would make in the future of the practice of medicine.

Telemedicine is an umbrella term that encompasses any medical activity involving an element of distance.[1] Oxford's telemedicine definition is “the remote diagnosis and treatment of patients by means of telecommunications technology.” There are various definitions of telemedicine. The most general one (”medicine at a distance”) covers the whole range of medical activities, including treatment and education.[2] Telemedicine refers specifically to administer healthcare to patients who are geographically separated from providers. For example, a radiologist doing teleradiology, or a physician giving an urgent care consultation via video for a non-life-threatening condition. Whereas, telehealth is a blanket term that covers all components and activities of healthcare and the healthcare system that are conducted through telecommunications technology. Healthcare education, wearable devices that record and transmit vital signs, and provider-to-provider remote communication are examples of telehealth activities.[3] Virtual consultations and THS may prevent unnecessary in-person referrals to a specialist, reduce waiting times for specialist input and eliminate unnecessary travel. In the background of COVID-19, this proves beneficial to both the doctor and patient.

It is important to understand that telemedicine is a process, and not a technology. The process of telemedicine has become much more feasible in the past few years as a result of technological advances and continuing cost reductions. Because it is feasible, people are beginning to try it out (there is nothing wrong with this – indeed, it may be unethical not to try out a new technique if there is a reasonable rationale that it may be advantageous). However, there is at present inadequate scientific evidence that telemedicine works.[4]

The goals of telehealth also called e-health or m-health (mobile health), include the following:

  1. Make health care accessible to people who live in rural or isolated communities
  2. Make services more readily available or convenient for people with limited mobility, time, or transportation options
  3. Provide access to medical specialists
  4. Improve communication and coordination of care among members of a health care team and a patient
  5. Provide support for self-management of health care
  6. Improved access to information
  7. Provision of care not previously deliverable
  8. Improved professional education
  9. Quality control of screening programs
  10. Reduced health-care costs.


While telehealth cannot cater to all your medical needs, there are many departments where you can benefit significantly, while staying in the comfort of your personal space. The types of care that you can get using telehealth may include:

  1. General health care, like wellness visits
  2. Prescriptions for medicine
  3. Dermatology (skin care)
  4. Superficial eye examinations
  5. Nutrition counseling
  6. Mental health counseling
  7. Medical conditions needing attention, such as sinusitis, urinary tract infections, common rashes, etc.


Telemental health technology is essential to provide continued health care to patients with existing diseases while ensuring safety from COVID-19 for both patients as well as health care workers. THS can be divided into synchronous or asynchronous services.[5] Synchronous service is real-time, interactive communication over telephone and video conferencing, and can be considered closest to a face-to-face scenario. Asynchronous treatments on the other hand include texts, emails, faxes, online programs, and smartphone-based apps.

Internet-based THS have been shown to be effective in children, adolescents, and adults for anxiety, depression, adjustment disorders, and even post-traumatic stress disorder.[6] The internet-based cognitive behavior therapy (CBT) has been the most studied modality for a variety of anxiety and psychosomatic psychiatric conditions and is paralleled with clinician-provided CBT.[7] Other psychotherapy modalities such as interpersonal psychotherapy, acceptance and commitment therapy, and psychodynamic approaches have shown good efficacy when delivered online.[8],[9]

In addition to existing chronic illnesses, the psychological symptoms relating to COVID-19 such as stress, anxiety, burnout, depressive symptoms, hoarding, loneliness due to lockdown, paranoia about attending community events, and diminished support from family and friends, have been frequently reported in recent studies.[10]

Various countries have proposed and catered for counseling, supervision, training, and psychoeducation through online platforms to combat these symptoms.[11]

The attitude of clinicians for the THS (synchronous) was found to be largely positive, acceptable, and effective, especially in the COVID-19 pandemic settings.[12]

The beneficiaries of THS also expressed satisfaction with respect to easy availability, convenience of timing, and perceived sense of privacy.[13]

Doctors can also take advantage of technology to provide better care for their patients. One example is a virtual consultation that allows primary care doctors to get input from specialists when they have questions about your diagnosis or treatment.

Few clinicians have expressed trepidations regarding the lack of humane approach, difficulty in establishing rapport and sustaining a therapeutic alliance, which are considered to be the mainstay in the management of chronic illnesses and especially mental health conditions.[14] The clinical quality of the THS provided and accountability are significant other concerns, which need to be streamlined.

Limitations of telehealth

While telehealth has potential for better-coordinated care, it also runs the risk of fragmenting health care. Fragmented care may lead to gaps in care, overuse of medical care, inappropriate use of medications, or unnecessary or overlapping care. Some of the problems with telehealth include:

  1. If your virtual visit is with someone who is not your regular provider, he or she may not have all of your medical history
  2. After a virtual visit, it may be up to you to coordinate your care with your regular provider
  3. In some cases, the provider may not be able to make the right diagnosis without examining you in person. Or your provider may need you to come in for a lab test
  4. There may be problems with the technology, for example, if you lose the connection, software glitch, etc., There is also an issue of data theft
  5. The potential benefits of telehealth services may be limited by other factors, such as the ability to pay for them. Some insurance companies may not cover telehealth visits[15]
  6. Some people who would benefit most from improved access to care may be limited because of regional internet availability or the cost of mobile devices. This is especially the case in low-income countries
  7. Possible legal implications - Although it is yet to be tested in the courts, telemedicine is not thought to raise any new issues of principle in comparison with the use of telephone, fax, mail, or email for consulting. It does not alter either the duty of care owed to patients by healthcare staff or their interprofessional relationships[16]
  8. Having to rely on an amanuensis during teleconsultation - However, experience shows that a rapport is quickly established
  9. Depersonalization[14]
  10. Bureaucracy - The use of telemedicine may require a radical change in the way that services are provided and paid for
  11. Overdependence on technology that may be unreliable
  12. Clinical risk - As with any other activity, the clinical risks associated with telemedicine must be managed.[4]


Recommendations

  1. THS should be prioritized for high risk and front-line workers such as doctors, nurses, policemen, and conservancy staff. who have continued working in their respective departments despite lockdown. This is especially true for mental health
  2. Video conferencing technology can be utilized to provide care for inmates, military personnel, and patients located in rural locations
  3. Remote patient monitoring, which involves the reporting, collection, transmission, and evaluation of patient health data through electronic devices such as wearables, mobile devices, smartphone apps, and internet-enabled computers can be successfully used to remind patients to monitor themselves and transmit the measurements to their physicians. Vital sign data can be transferred including blood pressures, cardiac stats, oxygen levels, and respiratory rates[15]
  4. Wide coverage and provision of internet-based technologies should be made accessible to remote areas in developing countries and low-income countries
  5. Governments should ensure patient privacy, data protection, and accountability during telemed communications.



  Conclusion Top


Technology has the potential to improve the quality of health care and to make it accessible to more people. Telehealth may provide opportunities to make health care more efficient, better coordinated, and closer to home. Research about telehealth is still relatively new, but it is growing. THS has a valuable role in supporting physical and psychological needs of patients as well as general population in these perilous times. It offers a simple and effective means to connect with people across geographical boundaries and to provide psychoeducation, monitor and pick up psychological distress, and also provide cognitive and/or relaxation skills to deal with mild symptoms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Roine R, Ohinmaa A, Hailey D. Assessing telemedicine: A systematic review of the literature. CMAJ 2001;165:765-71.  Back to cited text no. 1
    
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Cooper SE, Campbell LF, Barnwell SS. Telepsychology: A primer for counseling psychologists ψ. Couns Psychol 2019;47:1074-114.  Back to cited text no. 5
    
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Varker T, Brand RM, Ward J, Terhaag S, Phelps A. Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychol Serv 2019;16:621-35.  Back to cited text no. 6
    
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Bonnert M, Olén O, Lalouni M, Benninga MA, Bottai M, Engelbrektsson J, et al. Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome: A randomized controlled trial. Am J Gastroenterol 2017;112:152-62.  Back to cited text no. 7
    
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Donker T, Bennett K, Bennett A, Mackinnon A, van Straten A, Cuijpers P, et al. Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: Randomized controlled noninferiority trial. J Med Internet Res 2013;15:e82.  Back to cited text no. 8
    
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Ivanova E, Lindner P, Ly KH, Dahlin M, Vernmark K, Andersson G, et al. Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial. Anxiety Disord 2016;44:27-5.  Back to cited text no. 9
    
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Lai L. Fear and panic can do more harm than coronavirus: PM Lee, Singapore News and Top Stories-The Straits Times; 2020. Available from: https://www.straitstimes.com/singapore/fear-and-panic-can-do-more-harm-than-the-coronavirus-says-pm-lee-hsien-loong. [Last cited on 2021 Jun 5].  Back to cited text no. 10
    
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Perednia DA, Allen A. Telemedicine technology and clinical applications. J Am Med Assoc 1995;273:483-8.  Back to cited text no. 12
    
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Gittlen S. Digital technology adoption depends on EHR interoperability. NEJM Catal 2021;21:2.  Back to cited text no. 13
    
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Sasidharan S, Singh H. PPE-A hindrance to therapeutic alliance! Turk J Anaesthesiol Reanim 2021;49:183-5.  Back to cited text no. 14
    
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Bush J, Barlow DE, Echols J, Wilkerson J, Bellevin K. Impact of a mobile health application on user engagement and pregnancy outcomes among wyoming medicaid members. Telemed J E Health 2017;23:891-8.  Back to cited text no. 15
    
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Darkins A. The management of clinical risk in telemedicine applications. J Telemed Telecare 1996;2:179-84.  Back to cited text no. 16
    




 

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