The DOI matches its Crossref record; 132 of the 140 references it cites were found in a registry or an index.
Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers
Open accessAbstract
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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“However, in addition to external barriers, mental health clinicians report many beliefs, attitudes, and feelings about telehealth that may be inconducive for the adoption of these technologies.”
From Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic (2022) · cites this paper as Cowan et al., 2019
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“Many barriers to telehealth implementation are rooted in policies and systems such as constraints in reimbursement and credentialing (Cowan et al., 2019) and added administrative and training burdens (Perry et al., 2020).”
From Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic (2022) · cites this paper as Cowan et al., 2019
The cited source says what the claim attributes to it.
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“Recent reviews of barriers to telehealth indicate a central theme of clinician reluctancy (Cowan et al., 2019; Langarizadeh et al., 2017).”
From Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic (2022) · cites this paper as Cowan et al., 2019
In the citing paper
“Poor sound quality may limit understanding and mutual contact [41-44].”
From Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study (2021) · cites this paper as [41]
In the citing paper
“In telemedicine, the inability to examine the patient in person not only affects the physicians’ habits, but also sound and light present during telemedicine examinations can affect physicians’ diagnoses and treatment recommendations [41].”
From Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study (2021) · cites this paper as [41]
In the citing paper
“In telemedicine, the inability to examine the patient in person not only affects the physicians’ habits, but also sound and light present during telemedicine examinations can affect physicians’ diagnoses and treatment recommendations [41].”
From Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study (2021) · cites this paper as [41]
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Citations
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8 of the 140 references couldn’t be matched to a known paper.
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“…this, with racialized, rural, and lower-income individuals less likely to receive OAT care virtually, sometimes in spite of patients’ preference for virtual appointments (51, 61, 66–68), thereby limiting access for PWOUD who may benefit most from flexible, low-barrier treatment models (69).”
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“7,8 9 – 11 Such barriers are particularly evident in complex cases requiring interdisciplinary collaboration.”
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“Consistent with prior studies (Breton et al., 2021; Cowan et al., 2019; Fiske et al., 2019), challenges in providing remote services stem from the limited technological skills of both clinicians and clients, highlighting the need for targeted training and education.”
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Chang, X., Hu, X., Shao, Y., & Qiao, Y. (2026) · Healthcare · doi:10.3390/healthcare14111472 · Cited by 1
“The ethics questionnaire was based on the Expert Consensus on the Management Norms and Ethical Guiding Principles for Telepsychological Services [30], with a total of 19 items.”
Ngangula, P., Joel, L., Rwakilomba, J. D., Parker, R. A., Madundo, K., Amiri, I., Tupetz, A., Yamey, G., Hertz, J. T., Dow, D., et al. (2026) · AIDS Care · doi:10.1080/09540121.2026.2670485
“A transformative aspect of telehealth is telehealth counseling, also referred to as telemental health (Adem et al., 2023; Cowan et al., 2019; Galvin et al., 2022; Nicholas et al., 2021).”
Influentialamini, B. S., Nourani, A., & Rahimi, B. (2026) · Iranian South Medical Journal · doi:10.66224/ismj.28.5.850
Parri, L. A., Lau, R., & Addy, K. B. E. (2026) · JMIR Formative Research · doi:10.2196/95939
“This distinction matters because clinicians can often act as gatekeepers to implementation, influencing whether technologies are recommended, integrated, or rejected in practice [42,43].”
Obieche, O., Tan, J.-Y. B., Sharma, S., Bressington, D. T., & Wang, T. (2026) · Issues in Mental Health Nursing · doi:10.1080/01612840.2026.2704658
Pye, S., Hazell, C. M., Smith, K. J., & Bergin, A. (2026) · Behavioral Sciences · doi:10.3390/bs16101827
“Historically, clinician acceptance has been identified as a barrier to the adoption of safe and effective technologies (Cowan et al., 2019).”
Başay, Ö., Arı, P., Büber, A., & Başay, B. K. (2026) · Pamukkale Medical Journal · doi:10.31362/patd.1807086
Shaharuddin, M. A.-A., Daud, T. I. M., Sy-Cherng, L. W., & MANAF, M. R. H. A. (2026) · Australasian Psychiatry · doi:10.1177/10398562261501495
Metadata
- 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
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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