The researchers reported initial enthusiasm by both primary care and mental health providers following the trial period of 6 months. However, some mental health providers were concerned about the potential impact of the technology on the physician-patient relationship. There were no patient complaints about the technology. Other than occasional “image freeze” (delay), no other technical limitations were noted. Some patients saw the benefits of accessing specialty care through a videophone, while others saw the use of the technology itself as “unremarkable.”
We have used the videophone to augment access to medical and psychiatric services by a case management team that serves a severely mentally ill patient population.1,9 Case managers carry a videophone while making patient home visits and use it to discuss nonemergency clinical needs with the team psychiatrist and other team members. These needs include medication follow-up, monitoring clinical improvement, adverse-effect evaluations, and family support. The videophones have increased the involvement of family members in treatment planning and access to team members (eg, clinical pharmacists).9 This has helped with medication refill authorization and preparation questions. Although it has not been measured, we believe this has resulted in improved treatment adherence. This application has also resulted in better resource utilization and has reduced the need for patient travel and has improved case managers’ productivity by saving time and travel expenses.
Menon and colleagues10 demonstrated that videophones are a valuable tool for evaluating patients remotely. No differences were found between face-to-face and videophone results when 24 geriatric patients were evaluated using the Geriatric Depression Scale and Hamilton Depression Rating Scale. In addition, most patients preferred a videophone interview because of the convenience of avoiding unnecessary travel. The researchers noted the additional benefit of avoiding falls or accidents that may occur as unintended consequences of travel. This is especially significant in a geriatric population. As in a previous study, there was image delay (movement artifact).8
Jacobsen and colleagues11 conducted a series of neuropsychological tests in a cohort of 32 patients in Norway. Patients were evaluated both face-to-face and by videophone. The image size on the videophone was augmented with a connection to a Tandberg screen. Results were consistent and reliable for both videophone and face-to-face testing. It is notable that the group did not express a preference for videophone. The researchers concluded that videophones are a reasonable alternative means of specialized testing. This is especially significant when weather and geographical barriers limit treatment alternatives where specialized trained staff are at a premium.
Videophones have also been used successfully to provide access and “virtual visits” to nursing home residents from distant family members in an effort to prevent isolation and depression.12 This visual access, although limited to small screen size, provided enough “social presence” to allow family members to “visit” with a nursing home resident and alleviate some of the isolation these residents often experience.13 The videophone also allowed family members to participate in treatment team decisions and thus decreased guilt and may have prevented their own onset of depressive symptoms.12