The health care field is rapidly adopting the use of technology, and this is especially true in the midst of the Covid-19 pandemic. Due to physical distancing guidelines, an increasing number of health care professionals are using technology to provide services remotely.
The use of technology for health care is unfamiliar to many people. Exploring and embracing technology, however, will help individuals stay connected with health care providers and continue to receive services.
What is Telehealth & Telepsychology?
The World Health Organization describes telehealth as the delivery of health care services via telecommunications and virtual technology. Telehealth relies on technology to allow a patient to communicate and share information from their home with a health care professional. The delivery of mental health treatment via technology is known as telepsychology.
Telepsychology can be delivered in a variety of forms, including telephone, videoconferencing, web chats (i.e. internet text-based therapy), and apps. The common factor among all these modalities is the need for an Internet connection and an electronic device, such as a laptop or cell phone. These formats differ on whether the service is received in “real-time” or not.
Real-time telepsychology is most similar to traditional in-person treatment due to the live interaction between a health care provider and a patient. Asynchronous telepsychology refers to treatment delivery that does not provide real-time interaction between a provider and a patient. Examples of this include email and automated responses through an app. This article will focus on real-time telepsychology services, as this is the primary approach health care professionals have been using as an alternative to in-person services during the Covid-19 pandemic.
This blog post draws from recent research studies to identify the benefits of telehealth, as well as address concerns regarding its use, with a particular focus on psychotherapy. In turn, this may help promote the use of telehealth to access health care.
What are the Benefits of Telehealth?
Telehealth is a promising health care delivery method that increases access to services, including health care specialists. In addition, it overcomes several barriers to treatment including geographical distance and isolation (e.g. underserved areas), difficulty accessing transportation, travel costs, and time commitments due to travel and wait times to see a health care provider.
Patients can receive care without the need for in-person appointments. Telehealth also allows patients and health care providers to store and forward patient health information for rapid communication with patients or between health care providers. Telepsychology is a convenient alternative that allows for access to treatment from the privacy of one’s home, while allowing optimal use of a patient’s time.
Is Telehealth Effective?
Despite the benefits, individuals may be reluctant to try telepsychology for a variety of reasons. One reason is the belief that the physical presence of a health care professional would be more effective than services received via technology. With the increasing use of, and reliance on, technology for health care delivery, research studies have taken a closer look at whether telehealth is as effective as in-person appointments.
Almathami and colleagues published a study in 2020 in which they investigated the efficacy of telehealth for the treatment of different health conditions and diseases. The authors conducted a qualitative analysis of 45 published research studies that examined treatment delivery via videoconferencing between a patient and a doctor. The patients in these studies ranged from 1 to 80 years of age, and received treatment within their home for either mental health (e.g. psychotherapy) or physical health conditions (e.g. cardiovascular disease). Treatment ranged in duration from 2 weeks to 12 months. Almathami and colleagues found that 98% of the articles reported that videoconferencing treatment delivery achieved the desired health outcomes. Specifically, videoconference was an effective method in assessing patients’ health conditions and improving patients’ overall health conditions.
What about telepsychology specifically? A study by Varker and colleagues published in 2019 investigated the efficacy of real-time telepsychology treatment of adults with mental health disorders. The authors critically evaluated 25 published studies that examined the efficacy of telephone, videoconferencing, or web chat based treatment for four mental health disorders: major depression, anxiety disorders, post traumatic stress disorder and adjustment disorder. This study found that there is strong and high-quality research examining the efficacy of telephone and videoconference treatment approaches, as opposed to studies examining the efficacy of web chat (i.e. internet text-based live chat). Furthermore, telephone and videoconferencing treatment were found to be as effective as standard in-person treatment on a range of outcomes (e.g. severity of symptoms). There was insufficient evidence to determine the benefits of web chat. The authors concluded that there is clear, consistent evidence of the benefits of telephone and video conferencing treatment delivery methods for psychotherapy, with no evidence suggesting negative effects of these methods.
Limitations of Telehealth
Though these studies highlighted the efficacy of telehealth and telepsychology, it is important to note that telehealth may be challenging with certain treatment populations. For example, young children or a geriatric population with hearing or vision loss and/or a cognitive impairment may have difficulty engaging in online treatment. Almathani and colleagues found mixed results for these populations, as some studies reported challenges, while others reported success and no additional difficulties. The authors concluded that further investigation is required to explore the use of telehealth with these populations.
Overall, research has found that telepsychology is an effective alternative to traditional in-person treatment. In addition to examining the effectiveness of telehealth, researchers have also examined factors that can positively and negatively influence the use of telehealth.
Influencers and Barriers to Telehealth
Almathami and colleagues identified several factors that can either facilitate or serve as barriers to telehealth. These factors can be categorized as situational (e.g. access to technology) or personal factors (e.g. technology knowledge and skill). Together these factors can influence a patient’s satisfaction and convenient use of telehealth. These factors are summarized below along with suggestions to address barriers and enhance telehealth services.
Telepsychology services (particularly videoconferencing) require access to the Internet. Internet speed and quality can interfere with the ability to clearly see and hear the health care provider. Internet quality can be influenced by the network and wireless signal coverage in the area, as well as obstructions within or outside the home. Sitting close to the Internet source or connecting to the Internet directly using a cable may improve the Internet connection and speed.
In addition to Internet access, telepsychology services require an electronic device that is equipped with video and/or microphone. This can be a desktop computer, laptop, cell phone or tablet. Some devices may allow for easier access to a comfortable and private location for a psychotherapy appointment. For example, using a cell phone or laptop may provide more privacy than the desktop computer in a common area of the home.
Security and Privacy
The storage, transfer and communication of personal health information are important to consider, as not all technology platforms provide the necessary security measures to protect patient privacy. There are telehealth video platforms available that comply with legislation for the use of, management and storage of health information and records for enhanced security. Eastwood Psychologists uses a video platform called Virtualcare (https://www.thinkresearch.com/ca/products/virtualcare/) that has end-to-end encryption to protect the privacy of personal health information and communication. Virtualcare also allows documents to be shared securely over the platform.
Patients can also take steps to protect their privacy within their own home. It is important to hold appointments in a quiet, private space where personal information can be discussed openly. It may be helpful for patients to schedule appointments when other family members will be busy or out of the home. Patients can also ask their health care providers questions about privacy and security. Health care providers can help clarify any security concerns about the systems used, and help address concerns about privacy within the home.
Telehealth can allow for flexibility in scheduling. Patients may be able to schedule an appointment time that is suitable and convenient. This convenience may help patients be more willing to engage in, and comply with treatment, which in turn may help improve effectiveness. Health care providers may have availability that is suitable to patients’ schedules and at a time for increased privacy and reduced distraction during appointments.
Familiarity with technology and the online system can ease a patient’s transition to telehealth and promote openness to this approach. Health care providers or their office staff may be able to provide a test call or tutorial to help patients become more acquainted with the system. The use of technology for health care can be frustrating and anxiety provoking at first, but with repeated use, it can hopefully become a familiar and comfortable tool.
Telephone or Video Conferencing?
Patients may be offered a choice of videoconferencing or telephone sessions for health care appointments. As mentioned above, both approaches have been found to be effective. The choice of video or phone may be made based on patient preference, quality of the available Internet connection, and ease of use. Video conferencing may allow for more nonverbal communication (i.e. gestures, eye contact and body language) between patient and psychotherapist. On the other hand, telephone sessions may be more familiar and comfortable for some people.
Based on these studies, telepsychology is a promising treatment delivery method due to its benefits, efficacy and similarity to standard in-person treatment. Telepsychology can overcome barriers to treatment, including recommended physical distancing due to Covid-19. Considering factors that can improve the quality of the telehealth experience may improve patient satisfaction with the experience. The adoption of telepsychology will allow patients to benefit from continued psychological services for effective and remote treatment from the comfort of one’s home.
Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services, 16(4), 621-635.
Almathami HKY, Win KT, Vlahu-Gjorgievska E (2020). Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review. J Med Internet Res 2020;22(2):e16407.