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If There's Something Strange in Your Neighbourhood, Who You Gonna Call? Perceived Mental Health Service User Suitability for Video Consultations.

ABSTRACT: COVID-19 has placed additional challenges on mental health services. Video consultations (VCs) have provided a short-term solution to lockdown restrictions but could also increase long-term capacity to meet the anticipated rising demand. A total of 7752 VCs were conducted over six weeks. Thematic analysis of 474 online survey responses identified twenty patient attributes that influenced staffs' decisions to offer VCs. Their opinions were diverse, at times contradictory, and not always evidence based. There was reasonable consensus (and published evidence to support) of the probable suitability of VC for patients who: are IT savvy and suitably equipped; are teenagers; live in remote/rural locations; have caring responsibilities; have anxiety disorders or express a preference. No consensus was reached regarding eight attributes and there was a corresponding paucity of evidence, indicating the need for further research. Conversely, old age; paranoia, sensory impairment/communication difficulties; high risk and trauma/PTSD (posttraumatic stress disorder) were generally seen as contraindicated by staff, despite published evidence of success elsewhere. It may be possible to overcome staff's reticence to offer these groups VCs. As staff are effectively the gatekeepers to VC interventions, it is important to understand and support them to overcome reservations that are contrary to the empirical evidence base. This will ensure that their initial anxieties do not become unnecessary barriers to services for those most in need. As with all mental healthcare, such decisions should be made collaboratively, and on an individual basis.

SUBMITTER: Painter J

PROVIDER: S-EPMC8146145 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway.ObjectiveThis study aims to document GPs' experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic.MethodsA nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs' perceived suitability of the VCs, the nature of the patients' main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests.ResultsIn total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting.ConclusionsOur study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs' perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.

Project description:BACKGROUND:Pre-recorded videotapes have become the standard approach when teaching clinical communication skills (CCS). Furthermore, video-based feedback (VF) has proven to be beneficial in formative assessments. However, VF in CCS with the use of pre-recorded videos from real-life settings is less commonly studied than the use of simulated patients. To explore: 1) perceptions about the potential benefits and challenges in this kind of VF; 2) differences in the CCC scores in first-year medical residents in primary care, before and after a communication program using VF in a curricular formative assessment. METHOD:We conducted a pre/post study with a control group. The intervention consisted of VF sessions regarding CCS, performed in a small group with peers and a facilitator. They reviewed clinical consultations pre-recorded in a primary care setting with real patients. Before and after the intervention, 54 medical residents performed two clinical examinations with simulated patients (SP), answered quantitative scales (Perception of Patient-Centeredness and Jefferson Empathy Scale), and semi-structured qualitative questionnaires. The performances were scored by SP (Perception of Patient-Centeredness and CARE scale) and by two blind raters (SPIKES protocol-based and CCOG-based scale). The quantitative data analysis employed repeated-measures ANOVA. The qualitative analysis used the Braun and Clarke framework for thematic analysis. RESULTS:The quantitative analyses did not reveal any significant differences in the sum scores of the questionnaires, except for the Jefferson Empathy Scale. In the qualitative questionnaires, the main potential benefits that emerged from the thematic analysis of the VF method were self-perception, peer-feedback, patient-centered approach, and incorporation of reflective practices. A challenging aspect that emerged from facilitators was the struggle to relate the VF with theoretical references and the resident's initial stress to record and watch oneself on video. CONCLUSION:VF taken from real-life settings seems to be associated with a significant increase in self-perceived empathy. The study of other quantitative outcomes related to this VF intervention needs larger sample sizes. VF with clinical patients from real healthcare settings appears to be an opportunity for a deeper level of self-assessment, peer-feedback, and reflective practices.

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If There's Something Strange in Your Neighbourhood, Who You Gonna Call? Perceived Mental Health Service User Suitability for Video Consultations.

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