The impact and the experiences of mental health consultations remotely or in-person - a mixed methods study

利用电话和基于互联网的资源进行远程咨询，是减少有需要的人缺乏心理健康治疗的有希望的方法。由于需要保持社会距离，2019冠状病毒病大流行促使卫生服务部门实施远程护理。在心理健康领域，远程护理和面对面护理之间的含义和差异知之甚少，在心理健康领域，联系是治疗关系的关键要素，因为它已经被心理健康专业人员广泛认同，基于约翰·鲍尔比的依恋理论。因此，这个博士提案旨在回答一个研究问题：“在患者的结果和实施方面，远程和面对面提供心理健康咨询有什么不同？”拟议的混合方法博士研究将遵循三个步骤：1)证据审查审查将侧重于评估现有文献在远程和现场心理健康咨询时减轻症状和其他健康结果的有效性差异，以及这两种护理模式之间实施结果的差异。South London & Maudsley NHS Foundation Trust （SLaM）于2008年开发了一个临床记录平台，使SLaM的电子健康记录可用于研究，实时包含患者的健康信息。SLaM的数据分析旨在比较伦敦南部面对面和远程心理健康咨询对健康结果的影响，如症状减轻、生活质量和治疗依从性。这些分析将是有益的，因为平台的数据可以大规模地访问现实生活中的情况。3)服务用户和专业人员的意见将与服务用户和卫生专业人员进行个别访谈，以确定南伦敦精神卫生服务远程和面对面咨询的意见和经验。采访将被录音并逐字抄写。使用基于依恋理论的反身性主题分析对数据进行编码和分析。

Remote consultations, using telephone and internet-based resources, are promising approaches to reducing the lack of mental health treatment for people who need it. TheCOVID-19 pandemic precipitated the implementation of remote care in health services due to social distancing requirements.Little is known about the implications and differences between remote and in-person care in the mental health field, where bonding is a crucial element of the therapeutic relationship, as it has been widely identified by mental health professionals based upon John Bowlby's attachment theory. Therefore, this PhD proposal aims to answer the research question: "What are the differences between providing mental health consultations remotely and in-person in patients' outcomes and its implementation?"The proposed mixed-methods PhD study will follow threesteps:1) Review of the evidence The review will focus on assessing the existent literature on the differences in the effectiveness of reducing symptoms and other health outcomes when accessing remote and in-person mental health consultations, as well as the differences in implementation outcomes between these two models of care.2) Clinical records data analyses South London & Maudsley NHS Foundation Trust (SLaM)developed a clinical records platform in 2008 to make SLaM's electronic health records available for research, containing patients' health information in real time. The SLaM's data analyses will aim to compare how in-person and remote mental health consultations in South London impact health outcomes, such as symptom reduction, quality of life and treatment adherence. These analyses will be beneficial as the platform's data gives access to real-life situations on a large scale.3) Service user and professional views Individual interviews will be carried out with service users and health professionals to ascertain views and experiences of remote and in-person consultations in mental health services in South London. Interviews will be audio-recorded and transcribed verbatim. Data will be coded and analysed using reflexive thematic analysis based on the attachment theory.