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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
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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
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“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]
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“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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(1976)
Flagged first, then by citations
8 of the 140 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Frydman, 2009, Patient-driven research: rich opportunities and real risks, J Particip Med, 1, e12
- Saeed, 2012, Telepsychiatry: overcoming barriers to implementation, Curr Psychiatr, 11, 28
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Sorted by citations
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“In addition, there are concerns regarding the impact on patient rapport, workforce, liability and legal issues, and time constraints [21].”
BackgroundPhilippe, T. J., Sikder, N., Jackson, A., Koblanski, M. E., Liow, E., Pilarinos, A., & Vasarhelyi, K. (2022) · JMIR Mental Health · doi:10.2196/35159 · Cited by 436
“Health care providers are also at risk of feeling social and professional isolation as well as burnout [26,394,400], which must be properly managed by managers, the professional organization, and practitioners themselves.”
BackgroundInfluentialCarlo, F. D., Sociali, A., Picutti, E., Pettorruso, M., Vellante, F., Verrastro, V., Martinotti, G., & Giannantonio, M. D. (2020) · International Journal of Clinical Practice · doi:10.1111/ijcp.13716 · Cited by 225
“An important recommendation is to connect with on-site staff who may intervene if necessary [7].”
InfluentialAppleton, R., Williams, J., Juan, N. V. S., Needle, J. J., Schlief, M., Jordan, H., Rains, L. S., Goulding, L., Badhan, M., Roxburgh, E., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/31746 · Cited by 219
“A range of other ethical, regulatory, technological, cultural, and organizational barriers have also been identified, both before and during the pandemic [12,24-27].”
BackgroundUscher-Pines, L., Sousa, J., Raja, P., Mehrotra, A., Barnett, M. L., & Huskamp, H. A. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000250 · Cited by 183
“Nonetheless, relatively few psychiatrists were using telemedicine due to regulatory and reimbursement barriers, lack of training, and resistance to practice change.(5,6) Fewer than half of community-based behavioral health organizations offered telemedicine in 2018,(7) and only 5% of psychiatrists who provided care in…”
Background
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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