Cited by 380Telemedicine and Telehealth ImplementationPsychiatric care and mental health servicesHealthcare Systems and Technology

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

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Cowan, Kirsten E., McKean, Alastair J., Gentry, Melanie T., Hilty, Donald M.·2019·Mayo Clinic Proceedings

Abstract

Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.

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  1. [2]2. Cunningham PJ. Beyond parity: primary care physicians' per- spectives on access to mental health care. Health Aff (Mill- wood). 2009;28(3):w490-w501.
  2. [24]24. Frydman G. Patient-driven research: rich opportunities and real risks. J Particip Med. 2009;1(1):e12.
  3. [27]27. Saeed SA, Bloch RM, Diamond JM. Telepsychiatry: over- coming barriers to implementation. Curr Psychiatr. 2012; 11(12):28-31.

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Authors
Cowan, K. E., McKean, A. J., Gentry, M. T., & Hilty, D. M.
Affiliations
  • Mayo Clinic (US)
  • University of California, Davis (US)
Corresponding author
McKean, Alastair J.
Venue
Mayo Clinic Proceedings
Publisher
Elsevier BV
Published
2019-12
Volume
94
Issue
12
Pages
2510-2523
ISSN
0025-6196 (ISSN-L)
OpenAlex
W2990993692
Cited by
380
References
140
Citations by year
2026: 22 · 2025: 40 · 2024: 49 · 2023: 65 · 2022: 75 · 2021: 84 · 2020: 45
FWCI
8.34
Type
journal article
Language
en
Open access
Locations
  • Mayo Clinic Proceedings (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
telepsychiatry, telehealth adoption barriers, clinician attitudes, telemedicine, telemental health, clinical workflow, organizational culture, patient satisfaction
MeSH terms
Humans, Mental Health Services, Telemedicine, Videoconferencing

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