Advantages and disadvantages of the long-term use of telepsychiatry
Advantages and disadvantages of the long-term use of telepsychiatry
复制标题
长期使用远程精神病学的优点和缺点
DOI：
10.1017/ipm.2022.21
复制
发表时间：
2022
影响因子：
5.1
通讯作者：
T. Kishimoto
中科院分区：
文献类型：
--
作者：
S. Kinoshita;T. Kishimoto
编辑认为，不仅在精神病学领域，而且在医学的其他领域，关于长期使用远程医疗的证据仍然不足。根据经济合作与发展组织2020年1月发表的卫生工作文件，在加拿大、澳大利亚和葡萄牙等已公布远程医疗使用数据的国家，远程医疗的使用约占面对面护理就诊的0.1%至0.2%(Hashiguchi 2020)。在新冠肺炎大流行之前，远程医疗是每个国家医疗体系的一个小组成部分，即使在发达国家也是如此。随着远程医疗变得越来越普遍，预计有关其长期使用的报告将会增加，在我们能够准确地讨论其长期使用的利弊之前，需要积累更多的证据。精神疾病通常有一个慢性病程，反复复发和发作需要长期治疗。新冠肺炎大流行期间美国最近的一项研究表明，远程医疗更多地用于现有患者，而不是首次患者，以及需要长期治疗的患者，而不是短期患者；这些趋势尤其适用于精神障碍患者(Cortez等人)。2021年)。因此，如果长期适当地使用心灵感应，它的好处可能是巨大的。在许多疾病中，远程医疗已被证明与面对面护理一样有效(Snoswell等人。2021年)。在精神病学领域，有证据表明心灵感应可以改善抑郁症、双相情感障碍和精神分裂症患者的治疗依从性(Baset等人。2020)。尤其是对于抑郁症患者，最近的一项综述报告称，心灵感应可以提高生活质量评分，防止复发(Sharma&Devan 2021)。随着未来此类证据的积累，可能会确定特定的疾病和病例陈述，对于这些疾病和病例陈述，应该更积极地使用心灵感应来进行后续护理。此外，低家庭收入和收入下降与精神障碍的患病率和风险有关(Sareen等人。2011年)。虽然必须考虑初始硬件成本和互联网连接的可用性，但远程心理治疗通常被认为比面对面的护理更便宜、更耗时(Hubley等人)。2016)，且治疗时间越长，给患者带来的经济效益越大。另一方面，当考虑到长期使用心灵感应的缺点时，这些在短期使用中也可以看到的缺点可能会变得更加明显。例如，心灵感应的使用可能会使建立良好的融洽关系变得困难(Shore 2013)。因此，与面对面的练习相比，长期使用心灵感应可能会使建立良好的融洽关系的时间更长，或者可能会降低已建立的融洽关系的质量。当考虑使用长期心灵感应疗法时，将目标对准那些在面对面的实践中与其建立了良好关系的患者可能是可取的。然而，心灵感应被认为是继续向患有强迫症、社交退缩(如Hikikomori)和其他使他们难以外出或使用公共交通工具的患者提供医疗服务的有效手段(Aboujaoude等人)。2015年；Rooksby等人。2020)。这些患者可能欢迎长期使用心灵感应；然而，对于这些患者来说，暴露于诸如外出等也被认为是他们治疗的必要过程(Teo 2016；Tandt等人)。2021年)。因此，心灵感应应该以适当的方式与面对面的护理相结合，以便长期应用心灵感应不会减少这种机会。如上所述，必须牢记长期使用心灵感应的好处和坏处。在任何情况下，根据患者的意愿和患者的医疗状况使用心灵感应，同时牢记需要保持良好的融洽关系，无疑将提供仅靠面对面治疗无法获得的好处。在新冠肺炎大流行中，长期使用心灵感应已成为必要，基层医生需要根据情况灵活使用心灵感应，而不是严格限制针对患者和疾病的使用。
To the Editor, Evidence regarding the long-term use of telemedicine remains inadequate not only in the field of psychiatry, but in other areas of medicine as well. According to the Health Working Papers published by the OECD in January 2020, the use of telemedicine in countries such as Canada, Australia, and Portugal, where figures on the use of telemedicine have been published, represented about 0.1% to 0.2% of face-to-face care visits (Hashiguchi 2020). Prior to the COVID-19 pandemic, telemedicine was a small component of each country’s healthcare system, even in developed countries. As telemedicine becomes more widespread and reports on its long-term use are expected to increase, the accumulation of further evidence is needed before we can accurately discuss the pros and cons of its long-term use. Psychiatric disorders commonly have a chronic course, with repeated relapses and flare-ups requiring long-term treatment. A recent study in the United States during the COVID-19 pandemic showed that telemedicine was more often used for existing patients, rather than for first-time patients, and for patients requiring long-term treatment, rather than short-term; these trends were especially true for patients with psychiatric disorders (Cortez et al. 2021). Therefore, the benefits of telepsychiatry could be substantial if it is used appropriately over the long term. Inmany diseases, telemedicine has been shown to be as effective as face-to-face care (Snoswell et al. 2021). In the psychiatric field, there is evidence that telepsychiatry may improve treatment adherence in patients with depression, bipolar disorder, and schizophrenia (Basit et al. 2020). Particularly for patients with depression, a recent review reported that telepsychiatry may improve quality-of-life scores and prevent relapses and recurrences (Sharma & Devan 2021). As such evidence accumulates in the future, it may be possible to establish specific diseases and case presentations for which telepsychiatry should be used more actively for follow-up care. In addition, low household income and declining income are associated with the prevalence and risk of developing mental disorders (Sareen et al. 2011). Although the initial hardware cost and the availability of an Internet connection must be considered, telepsychiatry is generally considered to be less expensive and less time-consuming than face-to-face care (Hubley et al. 2016), and the longer the treatment, the greater the economic benefit to the patient. On the other hand, when the disadvantages of the long-term use of telepsychiatry are considered, these disadvantages that are also seen in short-term use may become more apparent. For example, the use of telepsychiatry can make it difficult to establish a good rapport (Shore 2013). For this reason, the long-term use of telepsychiatry may make it longer to establish a good rapport or may decrease the quality of an established rapport, compared with face-to-face practice. When considering the use of longterm telepsychiatry, the targeting of patients with whom a good rapport has been sufficiently established in face-to-face practice might be advisable. Nevertheless, telepsychiatry is thought to be an effective means of continuing to deliver medical care to patients with obsessivecompulsive disorder, social withdrawal (e.g. hikikomori), and other conditions that make it difficult for them to go out or use public transportation (Aboujaoude et al. 2015; Rooksby et al. 2020). These patients may welcome the long-term use of telepsychiatry; for these patients, however, exposures such as going out are also considered necessary processes for their treatment (Teo 2016; Tandt et al. 2021). Hence, telepsychiatry should be combined with face-to-face care in an appropriate manner so that the long-term application of telepsychiatry does not reduce such opportunities. As mentioned above, both the advantages and the disadvantages of the long-term use of telepsychiatry must be kept in mind. In any case, the use of telepsychiatry in accordance with the wishes of the patient and the patient’s medical condition, while keeping in mind the need to maintain a good rapport, will undoubtedly provide benefits that cannot be obtained by faceto-face treatment alone. In the COVID-19 pandemic, the longterm use of telepsychiatry has become necessary, and primary physicians need to be flexible in using telepsychiatry depending on the situation, rather than strictly limiting its use to target patients and diseases.