Search

Background: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice., Objective: The aim of this study was to investigate patients' and clinicians' experiences and attitudes toward using VCs in clinical practice., Methods: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis., Results: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians' experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically., Conclusions: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients' and clinicians' perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions., (©Ali Abbas Shaker, Erik Simonsen, Kristine Tarp, Radoslav Aleksandrov Borisov, John Aasted Sørensen, Henrik Bechmann, Stephen F Austin. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.08.2024.)

Background: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models., Objective: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting., Methods: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD., Results: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house-developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD., Conclusions: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology., (©Ali Abbas Shaker, Stephen F Austin, Mie Sedoc Jørgensen, John Aasted Sørensen, Henrik Bechmann, Henriette E Kinnerup, Charlotte Juul Petersen, Ragnar Klein Olsen, Erik Simonsen. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 30.11.2023.)

Background: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses., Objective: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment., Methods: A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome., Results: A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I 2 =19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I 2 =44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I 2 =0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I 2 =75%, 6 trials, n=539)., Conclusions: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine., Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357., (©Ali Abbas Shaker, Stephen F Austin, Ole Jakob Storebø, Julie Perrine Schaug, Alaa Ayad, John Aasted Sørensen, Kristine Tarp, Henrik Bechmann, Erik Simonsen. Originally published in JMIR Mental Health (https://mental.jmir.org), 05.07.2023.)