Abstract
Telepsychiatry can be considered as one of the main methods that are used in modern medicine under the field of telemedicine. It can be considered to have different benefits that can be attributed to the fact that it can be applied to a number of different fields. These benefits include less cost while being able to achieve the goals that are needed to be achieved by mental health intervention to be able to be effective.
To be able to achieve the objectives of the study of determining the possible application of the said method as an alternative intervention to the traditional and conventional face-to-face intervention in the application of the cognitive and behavioral treatments.
Based on the results of the study that had been undertaken, telepsychiatry can be considered as a beneficial method that has the capability to be able to be an alternative for the traditional and conventional methods.
Introduction
Psychiatric service is one of the most important sectors in the field of medicine. Due to the importance that can be related to psychiatry, it is essential to both the public and the medical specialists of the field to determine the most effective method that can be applied to corresponding patients. The said action can be translated as the determination of the unprecedented discoveries as well as the development and improvement of methods that are already being applied.
Based on the advent of technology specifically in the field of medicine, new methods specified in the field of psychiatric medicine are important to consider and given attention mainly in the field of research. Thus, on the basis of such notion, the main objective of the study undertaken is to be able to present a calculated view on the possibility and feasibility of the effective application of the new method referred to as telepsychiatry in psychiatry.
Background of the Study
Mainly, the attention considered in the study of telepsychiatry is based on the notion that the requirements that are needed by face-to-face patient psychiatric intervention can be accomplished in the said method. In relation to the said assumption then, a view on the effects of the said method in the efficiency of the treatment is the main target to be presented.
To be able to determine the effectiveness of the method, there are different factors that can be undertaken. These factors include the result of the assessment for the satisfaction of the patient which can be described through the study of the cases wherein the method is applied. Another is the determination of the success of the application that can be measured through the outcomes of the clinical application of the said method.
The Definition of the Elements of the Telepsychiatry
The methods of the determination of the success of telepsychiatry can be related to the factors that can determine their feasibility.
Assessment of the Patients Satisfaction
The determination of the satisfaction of the patients can be considered as the most important way to measure the feasibility of the application of the method under study. There are different methods that can be used to establish the applicability of the method through patients’ levels of satisfaction.
The Likert scale can be considered as one of the psychometric response scales that can be used to be able to assess the satisfaction of the patients. The said scale can be observed in different types of questionnaires. Thus, the determination of the results of the study can be achieved even in the absence of face-to-face interaction (Likert, 1932). Thus this is the method incorporated and applied in telepsychiatry.
Mainly, the method is undertaken through the construction of the statements and questions that are used in the assessment of the patients. The efficiency of the system can be analyzed on the fact that it is widely used in the assessment of behaviors and opinions of people most especially in the field of social research and medical research.
The Likert scale works on the basis of the gradation of the choices mainly corresponding to the level of agreement to the presented alternatives. Mainly is a particular option is given priority, it can be translated to scale that can provide an analysis (Likert, 1932; Meyers, Guarino and Gamst, 2005). This is the main reason for the effectiveness in the application of the system.
There are different views to be able to determine the satisfaction of the patients. One is the direct study of the reaction of the patients on the basis of the clinical factors. Another is the determination of the level of satisfaction of the patients based on the study conducted by the physicians, thus, their observations and encounters can be considered as another important perspective.
Patient Satisfaction based on Clinical Factors
There are different patient satisfaction studies that had been conducted related to the application of telemedicine, specifically in the field of psychiatry. This can be considered important on the basis that the method of incorporation of telecommunication technology in the field of medicine is one of the most important exponentially growing sectors in the health care field.
Based on studies conducted related to the patients’ satisfaction, the incorporation of telecommunication was considered as an applicable notion, although such studies can be considered preliminary in nature since the said field is relatively young. Thus, continuous study on the said field is required on a continuous basis.
It is important though to consider the different factors that are classified as key predictors of satisfaction. Such ideas are already being applied to the field of telepsychiatry. This is in spite of the fact that the required factors are still needed to be established. But also it is important to consider the effect carried by the transmission and the equipment that is required and used (Hilty et al., 2004).
It is a unique observation that the satisfactory rate of the patients that had to undertake the telepsychiatry is higher than expected. The expectation can be attributed to the fact that most patients are projected to be traditional. Also, technical problems that can be considered to provoke negative reactions of the patients were no recognized as a problem (Hilty et al., 2002).
Important factors that are recognized as benefits are reduction in the travel time and cost. Another is the decrease in the prevalence of being gone from work and other causes that can be translated as a waste of time (Hilty et al., 2004).
Due to the benefits that can be related to the said method, generally estimated cost savings can be converted for every consultation required from the patient. This saving is inclusive of the possible travel expenses and other costs that are related (Simpson, Doze, Urness, Hailey and Jacobs, 2001).
Based on the different sources that had been used, telepsychiatry can be considered as an adequate and acceptable method in relation to mental health interventions. If improvement of the patient at lower cost and higher savings can readily be experienced, then, the relatively high acceptance and satisfaction level is justified.
Patient Satisfaction based on Physician Encounters
Aside from the first-hand information and data that can be gathered from the patients themselves on their level of satisfaction with the use of telepsychiatry as a mental health intervention, patient satisfaction on the basis of the view of the physician is also another important issue.
The view of the physician can be affected by different factors. One is the effectiveness of the intervention used. Another is the satisfaction of the patient. Due to the fact that the use and choice of different methods and interventions can be affected by the success of the said method on previous patients and the satisfaction of these patients, the physicians, and their opinions count in the determination and assessment of the satisfaction and thus recommendation of the said method.
Telepsychiatry in terms of positive projections in terms of the number of models of care and consultation are related to the factors that can satisfy patients. In terms of interpersonal behavior issues, both positive and negative effects can arise. Also when it comes to the view of the specialists, clinical and technical views are included. For that matter, although the view of the physician can be considered secondary, it is more in-depth compared to the patient (Hilty et al., 2002).
The view of the patients in terms of satisfaction can mainly be based on both comforts and in the long run cure. On the other hand, the physician has the ability to provide theoretical explanations to the behavior of the patient including satisfaction, a factor of importance in the study.
Operational Outcomes
The issues that are inclusive of the operational outcomes can be related to the possible projections that can be related to the field of telepsychiatry based on the results of its application in the present era. It can then be considered to be composed of both the positive and the negative notions.
Positive notions can be translated as the fields that are needed to be continued in terms of the use of telepsychiatry. This can be considered that in such cases and scenarios, the application of the said method had become the main method of psychiatric and medical health intervention.
Thus, more study and exploratory applications can be projected to help more people. On the other hand, there are cases wherein the negative notions had outweighed the positive ones. That scenarios and application then, a decline in the application can be observed.
One of the important studies undertaken is which is primarily included in the general evaluation of the field of telemedicine. Based on the systematic analysis of the subject which is the effective use of telemedicine, technical evaluation can be considered as one of the most important methods.
The said study is important on the basis that telepsychiatry is covered in the subject of telemedicine. As one of the important methods used in the evaluation, the Likert scale is also utilized. This is classified as a technical method that is effective in the technical approach. On the other hand, objective methods are also employed (Thiyagarajan and Clarke, 2006).
To be able to determine the positive and negative results in the application of telepsychiatry as a mental health intervention, it is important to consider different factors. One is the type of mental ailment that is needed to be given attention. Similar to the personal and traditional method of consultation, telepsychiatry also needs to determine the background of the patient that is needed to be given attention.
Another factor is the type of patient that requires medical attention. The baseline information, specifically the background of the family and the historical background can be considered as an essential issue.
These are only some of the factors that are needed to be taken into consideration in terms of the evaluation of the effectiveness of the method of telepsychiatry. These can be attributed to the fact that patients can be characterized by the said information. This consequently becomes the basis for the methods that can be applied in terms of a mental healthcare intervention. Such cases are included in the mental health cases that are studied.
Literature Review
To be able to determine the importance and the applicability of the method of telepsychiatry, it is important to consider the different studies that are undertaken related to the said method. Through the said action, the main goal of determining and establishing the capability of the said method as an alternative for a personal consultation and face-to-face medical attention can be achieved.
The accumulated knowledge based on the said notion can be identified into different categories. These categories are mainly based on the application of the method to different types of patients and into different situations.
Satisfaction Assessment
Case Studies on the Application of Telepsychiatry
The application of the method covers different categories and types of cases. The study of the specific cases wherein the method of telepsychiatry is used is important in the presentation and study of definitive information regarding the utilization of the method.
It is an accepted notion that the application of telepsychiatry can cover different types of patients that can belong to different age groups. In the study conducted by Cottrell and colleagues (2007), the main focus is the feasibility of the behavioral treatment for adolescent migraine which is administered through the telephone.
The main method under study is the behavioral migraine management intervention that is given through the telephone. The instructions and the evaluation were achieved through the Migraine Specific Quality of Life Questionnaire – Adolescent. A scale similar to the Likert was used (Cottrell et al., 2007).
Results of the said study are important specifically on the basis that the choice of the patients points out to the preference for the telephone-based treatment over in-clinic visits. Also, the manual and tapes can be considered as essential to the achievement of cure in the said process. The clinical basis also proved positive on the basis that improvement was achieved upon the application of the treatment (Cottrell et al., 2007).
Another field wherein the applicability of the method was applied is the effectiveness of manualized cognitive-behavioral therapy conducted through videoconferencing technology for posttraumatic stress disorder. The said study is important to the issue under study since the main methods that are comparatively analyzed are the modes of treatment namely telepsychiatry (TP) and same room (SR) (Frueh, Monnier, Grubaugh, Elhai, Yim, and Knapp, 2007).
The experiments that were conducted also resulted in positive results. Also, telepsychiatry did not cause the cognitive and behavioral methods to be compromised. Also, the success of the treatment is not hindered by the mode of treatment related to the rapport and the patients (Frueh, Monnier, Grubaugh, Elhai, Yim, and Knapp, 2007).
Based on a randomized trial of telepsychiatry for post-traumatic stress disorder on a long-term basis, no difference between the telepsychiatry and the same room set-up was observed. Even the satisfaction of the patients is similar (Frueh, Monnier, Yim, Grubaugh, Hamner and Knapp, 2007).
The said results can be considered as a preliminary expression of the possible efficient application of the telepsychiatry methods in the mental health field even as an alternative and replacement for the same room or face-to-face method or intervention.
Another ailment wherein the research had been undertaken is related to the acute stress disorder that is indicated by rapid eye movement. The said method was undertaken through the use of video conferences. Based on the result of the study a successful treatment of the acute stress disorder was achieved through the intervention conveyed through the telepsychiatry method (Todder and Kaplan, 2007).
The field of pediatric telepsychiatry can be considered as one of the most important applications and exploration of the method. In terms of the recommendations that are made in relation to the telepsychiatry method, one question is the implementation of the treatment. The main question lies in the components of the intervention which includes monitoring, changing, starting, and stopping the treatment. The results of the study revealed that the important components of the application of telepsychiatry do not include the use of technology (Boydell, Volpe, Kertes, and Greenberg, 2007).
The factors that are considered of greater priority are the participation and cooperation of the child, which are the patient and the guardian. Even the guidance of the people that are of first-hand influence to the child is also an important consideration. Also, the clear understanding through proper conveying of recommendations that are not hindered by the use of telecommunication technology is an important factor (Boydell, Volpe, Kertes and Greenberg, 2007).
The need for medical attention for children specifically in the rural areas is another important field that is explored by the telepsychiatric field. The said need is related to the fact that rural areas commonly are scarce in health care medical facilities. The medical and educational systems are underdeveloped in the said locations.
The advent of telemedicine can be considered to improve the chance of the patients to be given attention in terms of mental health conditions. The only requirement is the setting up of the facilities that are required to be able to conduct the telepsychiatric consultations and interventions. In the application of the system more children and their families are reached (Sulzbacher, Vallin and Waetzig, 2006).
The study of the different fields where telemedicine and telepsychiatry can be used is important to be able to determine the effectiveness of the method. Based on the different studies that became the focus, the continuous expansion of the application of the method can be attributed to the fact that the method is greatly appreciated by different groups.
Application of the Telepsychiatry in the Present Era
The continuously increasing frequency of application of the said method can be considered as important evidence to the positive feedback that can be related to the method.
The increasing utilization of the said method can even be related to the use of the method even in routine referrals. The said method can be considered an important diagnostic technique. Thus, the utility can be projected as positive. Through a primary, cross-sectional study that is clinical-based, the study on the accuracy of the telepsychiatric method on the said routine referrals over the face-to-face results of consultation was undertaken.
Based on the said study, the accuracy of the method of telepsychiatry can be considered of a high level of confidence that can be applied to the patients with substantial results. The said level of accuracy is very important specifically since it is compared to the traditional face-to-face patient interaction (Singh, Arya and Peters, 2007).
The confidence being placed on the method was achieved in spite of the fact that it involves new and unconventional technology. This was encountered when the said technology was introduced in the field of medicine. The first decade upon the introduction of telemedicine can be considered as the years wherein the utilization and application of the said method are on its initiation.
In Norway, the past 20 years can be considered as the main development and period of acceptance of the method of telemedicine, a concern since telepsychiatry is mainly included in the said field. The said utilization of the method of telemedicine can be attributed to the fact that it can be viewed as extensive since it even involves the field of medical education and clinical health practice (Hartvigsen et al., 2007).
As evidence, it even involves different specializations in medicine wherein telepsychiatry is included such as teleradiology, telepathology, teledermatology, teleotorhinolaryngology (remote endoscopy), remote gastroscopy, tele-echocardiography, remote transmission of ECGs. Also, other fields include teleophthalmology, teledialysis, teleemergency medicine, teleoncology, telecare, telegeriatric, teledentistry, and maritime telemedicine (Hartvigsen et al., 2007).
When it comes to services even the paperwork and records that are required by the patients can be serviced through the telemedicine services. Teaching and education can also be given in the said manner specifically to both the healthcare personnel and patients (Hartvigsen et al., 2007).
Variables Related to Physician-Patient Encounter
The determination of the possible factors that can be considered as essential to the acceptance of telepsychiatry as the major alternative for personal, face-to-face, and same room intervention is the mains issue to consider.
In the study conducted by O’Reilly and colleagues (2007) a randomized controlled equivalence trial was undertaken to be able to determine the applicability of telepsychiatry to face-to-face psychiatry. The main focus is the application of video conferencing to be able to achieve psychiatric services. Similar results were achieved. This is on the basis that although the method is unconventional, the application of the method to be able to improve health service in locations that are of low proximity.
The results of the study then point out that the results in terms of treatment of the said method are similar to that of the other studies, conforming to the issue that the effectiveness of the personal treatment and the telepsychiatry are both effective. An equivalents level of satisfaction was also achieved in the two set-ups (O’Reilly et al., 2007).
But in terms of the cost, the application of telepsychiatry is more cost-effective, specifically 10% less than the traditional method. This is based on the costs and expenses that can be incurred related to the achievement of the healthcare done on a personal and face-to-face basis (O’Reilly et al., 2007).
Acceptability was measured by another study that was conducted. An evaluation of the satisfaction of the patient was measured through a period of 1 month through the completion of the SF-12 survey prior to the consultation and a satisfaction survey subsequent to the psychiatric consult. The patients also show a positive reaction to telepsychiatry like other studies that had been conducted (Urness, Wass, Gordon, Tian and Bulger, 2006). Although this is the case a slightly lower satisfaction level is achieved based on the fact that some are more into conventional methods.
In another study that had been undertaken, the main perspective that was used is the comparative analysis of the use of telepsychiatry with the traditional method. In the said study the traditional FTF (face-to-face) method is considered as the standard. Although this can be considered as another perspective, a positive result was also achieved in relation to the application of telepsychiatry in mental health patients (Bishop, O’Reilly, Maddox and Hutchinson, 2002).
In another study that used a randomized clinical trial, an important positive observation is was translated through the result of the CGI and SCL-90- R Global Indexes scores both in the setup for the telepsychiatry and that of the personal basis of intervention. Similarity even in statistical evidence was observed in the results of the efficacy of the VCTP treatment and the F2FC psychiatric treatment efficacy (De Las Cuevas, Arredondo, Cabrera, Sulzenbacher and Meise, 2006).
Thus the said study can also be considered as important proof of the role and importance of the said technique in the method of delivery of the interventions in mental health patients, specifically in remote locations where healthcare facilities are scarce.
In terms of the study of the factors in the application of new methods and technologies, important notions in most times include the factor of cost or cost-effectiveness.
In the study that has been considered as essential to the application and the determination of the utility of telepsychiatry, the most important issues that became the main focus of the study are the cost-effectiveness, the safety in the application, and the level of satisfaction (Modai, Jabarin, Kurs, Barak, Hanan and Kitain, 2006).
Specifically, included in such factors are the “institutional ambulatory and hospitalization costs, treatment adherence, patient and physician satisfaction, and treatment safety between mental healthcare via videoconferencing and care provided in person.” (Modai, Jabarin, Kurs, Barak, Hanan and Kitain, 2006).
The study was undertaken for a year and a comparative analysis was established with the behavior of the group in the subsequent year. Significant results based on the adherence ratios are considered to be similar in proportion but can be considered as high. Although this is the case, the limitation can be attributed to the low sample size.
Summary
Based on the data gathered, positive feedbacks are included in different issues that are considered. Also, the intervention presets a higher percentage than that of the negative can be observed. But such negative effects can be considered minimal and can only be generalized on the basis of the traditional notions that old methods are still more effective due to the fact that they had been tested through time.
Results and Recommendation
Upon the determination of the benefits and the background information related to the application of telepsychiatry, the main objective of the study to be able to determine the capability of the method of telepsychiatry to be an alternative for the traditional and conventional method of having a personal face to face consultation.
In relation to the determination of the improvement in an encounter that can lead to the satisfaction of the patient, it can be considered that essential factors can be achieved even in the absence of face-to-face patient intervention.
Bloom Taxonomy
The determination of the effectiveness of telepsychiatry can be related to the requirement for effective intervention. This can be attributed to the fact that the treatments and interventions are related to the different domains that are recognized by Bloom’s Taxonomy which includes the Cognitive, Psychomotor, and Affective domains.
These are the basis of any mental health intervention that can be utilized. In relation to the cognitive aspect, the methods and evaluative techniques to determine the patients’ level in this aspect can be measured through telepsychiatry (Kern et al., 1998).
This is also the case for the affective domain. The phases such as the receiving, the responding, the valuing, the organization, and the characterization can be considered as factors and concepts that can be answered by the telepsychiatric method. This can be attributed to the fact that the concepts such as specific attitudes, values, beliefs, and emotions can be targeted by the said method (Kern et al., 1998).
Psychomotor abilities on the other hand can be analyzed through video conferencing. This can be the reason why telepsychiatry was observed as effective in the majority of the studies that have been included in the research.
Summary of Important Points Related to the Application of Telepsychiatry
Based on the study undertaken, the application and efficiency of telepsychiatry are independent of the limitations caused by geographical distance since the requirements for the study of the Cognitive, Psychomotor, and Affective domains can be undertaken through the distance.
It is important to consider though that in diagnostic evaluation, telepsychiatry is most effective, although it is still recommended to be able to have a personal consultation at some point through the treatment process.
Conclusion
Limitations of the study
Based on the results of the study, telepsychiatry can be a ‘part’ replacement and not a ‘total’ replacement. This can be attributed to the fact that it is still recommended to be able to have an optimum treatment process. There are certain cases wherein the patients are needed to be observed personally by the physician.
The telepsychiatry method though can be considered as a very important method to be able to increase the attention that can be given to the remote places that lack medical attention. Thus, limitations lie in the treatment of more serious cases.
Telepsychiatry use might be critical in areas like a continuum of care.
The continuum of care is one of the main limitations of the method of telepsychiatry. This can be attributed to the fact that more extensive attention is needed to be given to the patients of critical cases.
Future Research on the Affective Domain in Medical Education
The continuous research related to the application of technology in the field of medicine can be considered an important area of future study and exploration. This can be attributed to the possibility of answering the present limitation of telepsychiatry as an intervention.
References
Babbie, E. R. (2005). The Basics of Social Research. Thomson Wadsworth.
Baigent, M. F., Lloyd, C. J., Kavanagh, S. J., Ben-Tovim, D. I., Yellowlees, P. M., Kalucy, R. S. and Bond, M. J. Telepsychiatry: ‘tele’ yes, but what about the ‘psychiatry’? J Telemed Telecare, 1997, 3 Suppl 1, 3-5.
Bishop, J. E., O’Reilly, R. L., Maddox, K. and Hutchinson, L. J.. Client satisfaction in a feasibility study comparing face-to-face interviews with telepsychiatry. J Telemed Telecare, 2002, 8(4), 217-21.
Boydell, K. M., Volpe, T., Kertes, A. and Greenberg, N. A review of the outcomes of the recommendations made during paediatric telepsychiatry consultations. J Telemed Telecare, 2007, 13(6), 277-81.
Chae, Y. M., Park, H. J., Cho, J. G., Hong, G. D. and Cheon, K. A. The reliability and acceptability of telemedicine for patients with schizophrenia in Korea. J Telemed Telecare, 2000, 6(2), 83-90.
Clarke, P. H. A referrer and patient evaluation of a telepsychiatry consultation-liaison service in South Australia. J Telemed Telecare, 1997, 3 Suppl 1, 12-4.
Cohen, L., Manion, L. and Morrison, K. (2000). Research Methods in Education. London: Routledge Falmer.
Cottrell, C., Drew, J., Gibson, J., Holroyd, K. and O’donnell, F. Feasibility assessment of telephone-administered behavioral treatment for adolescent migraine. Headache, 2007, 47(9), 1293-302.
Coolican, H. (1995). Introduction to Research Methods and Statistics in Psychology. London; Hodder and Stoughton.
De Las Cuevas, C., Arredondo, M. T., Cabrera, M. F., Sulzenbacher, H. and Meise, U. Randomized clinical trial of telepsychiatry through videoconference versus face-to-face conventional psychiatric treatment. Telemed J E Health, 2006, 12(3), 341-50.
Doze, S., Simpson, J., Hailey, D. and Jacobs, P. Evaluation of a telepsychiatry pilot project. J Telemed Telecare, 1999, 5(1), 38-46.
Dyer, C. (1995). Beginning Research in Pschology. Oxford: Blackwell.
Elford, R., White, H., Bowering, R., Ghandi, A., Maddiggan, B., St John, K., House, M., Harnett, J., West, R. and Battcock, A. A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing. J Telemed Telecare, 2000, 6(2), 73-82.
Elford, D. R., White, H., St John, K., Maddigan, B., Ghandi, M. and Bowering, R. A prospective satisfaction study and cost analysis of a pilot child telepsychiatry service in Newfoundland. J Telemed Telecare. 2001, 7(2), 73-81.
Eysenck, M. (1998). Psychology: An Integrated Approach. Essex: Addison Wesley Longman.
Frueh, B. C., Deitsch, S. E., Santos, A. B., Gold, P. B., Johnson, M. R., Meisler, N., Magruder, K. M. and Ballenger, J. C. Procedural and methodological issues in telepsychiatry research and program development. Psychiatr Serv, 2000, 51(12), 1522-7.
Frueh, B. C., Monnier, J., Grubaugh, A. L., Elhai, J. D., Yim, E. and Knapp, R. Therapist Adherence and Competence With Manualized Cognitive-Behavioral Therapy for PTSD Delivered via Videoconferencing Technology. Behav Modif, 2007, 31(6), 856-66.
Frueh, B. C., Monnier, J., Yim, E., Grubaugh, A. L., Hamner, M. B. and Knapp, R. G. A randomized trial of telepsychiatry for post-traumatic stress disorder. J Telemed Telecare, 2007, 13(3), 142-7.
Gelber, H. (2001). The experience in Victoria with telepsychiatry for the child and adolescent mental health service. J Telemed Telecare, 2001, 7 Suppl 2, 32-4.
Greenwood, J., Chamberlain, C. and Parker, G. Evaluation of a rural telepsychiatry service. Australas Psychiatry, 2004, 12(3), 268-72.
Gross, R. (2001). Psychology: The Science of Mind and Behaviour. London: Hodder and Stoughton.
Hartvigsen, G., Johansen, M. A., Hasvold, P., Bellika, J. G., Arsand, E., Arild, E., Gammon, D., Pettersen, S. and Pedersen, S. Challenges in telemedicine and eHealth: lessons learned from 20 years with telemedicine in Tromsø. Medinfo, 2007, 12(1), 82-6.
Hawker, F., Kavanagh, S., Yellowlees, P. and Kalucy, R. S. Telepsychiatry in South Australia. J Telemed Telecare, 1998, 4(4), 187-94.
Hilty, D. M., Luo, J. S., Morache, C., Marcelo, D. A. and Nesbitt, T. S. Telepsychiatry: an overview for psychiatrists. CNS Drugs, 2002, 16(8), 527-48.
Hilty, D. M., Marks, S. L., Urness, D., Yellowlees, P. M. and Nesbitt, T. S. Clinical and educational telepsychiatry applications: a review. Can J Psychiatry, 2004, 49(1), 12-23.
Hyler, S. E. and Gangure, D. P. A review of the costs of telepsychiatry. Psychiatr Serv, 2003, 54(7), 976-80.
Hyler, S. E., Gangure, D. P. and Batchelder, S. T. Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies. CNS Spectr, 2005, 10(5), 403-13.
Kavanagh, S. and Hawker, F. The fall and rise of the South Australian telepsychiatry network. J Telemed Telecare, 2001, 7 Suppl 2, 41-3.
Kern, D. E. et al. (1998). Curriculum Development for Medical Education: A Six-Step Approach. Baltimore, Maryland: John Hopkins Press.
Kobak, K. A. A comparison of face-to-face and videoconference administration of the Hamilton Depression Rating Scale. J Telemed Telecare, 2004, 10(4), 231-5.
Kopel, H., Nunn, K. and Dossetor, D. Evaluating satisfaction with a child and adolescent psychological telemedicine outreach service. J Telemed Telecare, 2001, 7 Suppl 2, 35-40.
Likert, R. (1932). A Technique for the Measurement of Attitudes. Archives of Psychology 140, 1-55.
Likert, R. and Hayes, S. (1957). Some Applications of Behavioural Research. Paris: Unesco.
Mahmud, K. and Lenz, J. The personal telemedicine system. A new tool for the delivery of health care. J Telemed Telecare, 1995, (3), 173-7.
Matsuura, S., Hosaka, T., Yukiyama, T., Ogushi, Y., Okada, Y., Haruki, Y. and Nakamura, M. Application of telepsychiatry: a preliminary study. Psychiatry Clin Neurosci, 2000, 54(1), 55-8.
Maurer, T. and Andrews, K. (2000). Traditional, Likert and Simplified Measures of Self-efficacy. Educational and Pschological Measurement, 60 (6).
Meyers, L. S., Guarino, A. and Gamst, G. (2005). Applied Multivariate Research: Design and Interpretation. Sage Publications Inc.
Modai, I., Jabarin, M., Kurs, R., Barak, P., Hanan, I, and Kitain, L. Cost effectiveness, safety, and satisfaction with video telepsychiatry versus face-to-face care in ambulatory settings. Telemed J E Health, 2006, 12(5), 515-20.
Monnier, J., Knapp, R. G. and Frueh, B. C. Recent advances in telepsychiatry: an updated review. Psychiatr Serv, 2003, 54(12), 1604-9.
Norman, S. The use of telemedicine in psychiatry. J Psychiatr Ment Health Nurs, 2006, 13(6), 771-7.
O’Reilly, R., Bishop, J., Maddox, K., Hutchinson, L., Fisman, M. and Takhar, J. Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatr Serv, 2007, 58(6), 836-43.
Page-Bucci, H. (2003). The value of Likert scales in measuring attitudes of online learners. 2007. Web.
Shore, J. H., Savin, D., Orton, H., Beals, J. and Manson, S. M. Diagnostic reliability of telepsychiatry in American Indian veterans. Am J Psychiatry, 2007, 164(1), 115-8.
Simpson, J., Doze, S., Urness, D., Hailey, D. and Jacobs, P. Telepsychiatry as a routine service–the perspective of the patient. J Telemed Telecare, 2001, 7(3), 155-60.
Singh, S. P., Arya, D. and Peters. T. Accuracy of telepsychiatric assessment of new routine outpatient referrals. BMC Psychiatry, 2007, 7(1), 55.
Stevens, A., Doidge, N., Goldbloom, D., Voore, P. and Farewell, J. Pilot study of televideo psychiatric assessments in an underserviced community. Am J Psychiatry, 1999, 156(5), 783-5.
Sulzbacher, S., Vallin, T. and Waetzig, E. Z. Telepsychiatry improves paediatric behavioural health care in rural communities. J Telemed Telecare, 2006, 12(6), 285-8.
Todder, D. and Kaplan, Z. Rapid eye movements for acute stress disorder using video conference communication. Telemed J E Health, 2007 Aug, 13(4), 461-3.
Thiyagarajan, C. and Clarke, M. A systematic review of technical evaluation in telemedicine systems. Conf Proc IEEE Eng Med Biol Soc. 2006, 1, 6320-3.
Urness, D., Wass, M., Gordon, A., Tian, E. and Bulger T. Client acceptability and quality of life–telepsychiatry compared to in-person consultation. J Telemed Telecare, 2006, 12(5), 251-4.
Yoshino, A., Shigemura, J., Kobayashi, Y., Nomura, S., Shishikura, K., Den, R., Wakisaka, H., Kamata, S. and Ashida, H. Telepsychiatry: assessment of televideo psychiatric interview reliability with present- and next-generation internet infrastructures. Acta Psychiatr Scand, 2001, 104(3), 223-6.
Zarate, C. A. Jr, Weinstock, L., Cukor, P., Morabito, C., Leahy, L., Burns, C. and Baer, L. Applicability of telemedicine for assessing patients with schizophrenia: acceptance and reliability. J Clin Psychiatry, 1997, 58(1), 22-5.