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Cited by 238Telemedicine and Telehealth ImplementationDental Research and COVID-19Healthcare during COVID-19 Pandemic

Remote Treatment Delivery in Response to the COVID-19 Pandemic

Open access
Wright, Jesse H., Caudill, Robert·2020·Psychotherapy and Psychosomatics
DOI 10.1159/000507376PMC PMC7179517
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Abstract

Because containment efforts for the COVID-19 pandemic include social distancing, quarantine, and isolation, if indicated, health care providers are confronted with major challenges in delivery of care. As we write this editorial, the situation in the USA is extremely fluid with some clinics shuttering their doors and delivering services only via telephone, telemedicine, or other technologies; other clinics are continuing some face-to-face visits while moving toward the use of alternatives. Email channels among health care professionals are pulsing with questions about the use of telemedicine and other technologies.If you are already familiar with telemedicine methods and have used them in the past, the transition may not be daunting. However, most clinicians have not used telemedicine as a routine part of their daily work. Among the resources that can help clinicians learn about telemedicine, “Best Practices in Videoconferencing-Based Telemental Health” (https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Telepsychiatry/APA-ATA-Best-Practices-in-Videoconferencing-Based-Telemental-Health.pdf) [1], a consensus guideline from the American Psychiatric Association and the American Telemedicine Association, is a good place to start. Another valuable resource is an overview of administrative, clinical, and technical issues in videoconferencing by Jay Shore, MD, MPH [2].These experts in telemedicine [1, 2] have outlined key administrative issues for implementation. These include: (1) licensure requirements which usually dictate that the provider must be licensed in the state where the patient is located at the time of service; (2) malpractice insurance for telemedicine; (3) status of insurance coverage for virtually delivered services; (4) adherence to confidentiality and security regulations including those of the Health Insurance Portability and Accounting Act (HIPAA) in the USA; and (5) establishment of protocols for managing laboratory tests, prescriptions, and scheduling.In a time of crisis, these stipulations present barriers to rapid and broad implementation of telemedicine. However, governmental agencies in the USA have issued an emergency waiver suspending the requirement for complying with HIPPA and have noted that popular applications for video chats, such as Apple FaceTime and Facebook Messenger video chat, which are not HIPAA compliant, may be used if necessary. Also, the USA Center for Medicaid and Medicare Services released a guidance on March 17, 2020 allowing patients to be seen via videoconferencing in their homes, without having to travel to a qualifying “originating site” for Medicare telehealth encounters. Furthermore, the USA Drug Enforcement Administration (DEA) approved an exception that allows prescriptions for controlled substances via telemedicine without a prior in-person evaluation. Because of rapid changes in response to the COVID-19 pandemic, clinicians need to stay up-to-date with the current status of privacy, licensing, insurance, and other issues that could impact service delivery.Telemedicine is considered to be an especially good fit for psychiatric treatment and has been found to be effective, while reducing cost and improving access to care [2]. There are no absolute contraindications; however, it is recommended that patients be assessed for suitability for videoconferencing and that emergency protocols be developed for situations such as heightened risk for suicide or aggression toward others [1, 2]. Technical considerations have become less problematic in recent years as a variety of platforms have been developed with high-quality video transmission and appropriate confidentiality and security. Some of these platforms that offer secure options for medical applications include Zoom, Bluejeans, Doxy.me, thera-LINK, TheraNest, SimplePractice, and Vsee.Although telemedicine offers a great potential for delivering treatment during the COVID-19 pandemic, older technologies, such as telephonic communication and email, offer immediate and easy-to-use ways of providing care remotely. Research on telephone-delivered psychotherapy has found no decline in effectiveness compared to face-to-face therapy, in addition to an advantage for telephonic treatment in completion rates [3]. Email is typically used for brief exchanges with patients, but some internet-delivered programs use email extensively to offer an asynchronous psychotherapy experience.Other technologies that can be applied to help provide treatment during the pandemic are computer-assisted psychotherapy and mobile apps for behavioral health. Meta-analyses of computer-assisted cognitive-behavioral therapy (CCBT) for depression have found evidence for effectiveness [4], and studies comparing CCBT with face-to-face treatment have reported no differences in outcome [5]. CCBT is considerably more effective if it is delivered with at least a small amount of clinician support (usually 1–4 h for the entire course of treatm

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  • Researchers in some other countries found telemental health or online counseling services to be very effective.

    “Researchers in some other countries found telemental health or online counseling services to be very effective (28-33).”

    From A proposed framework based on literature review of online contextual mental health services to enhance wellbeing and address psychopathology during covid-19 (2020) · cites this paper as [32]

    The main text (pp. 130–132) says telemedicine for psychiatric treatment has been found effective and reports comparable outcomes for telephone-delivered psychotherapy and face-to-face therapy. It does not establish that the researchers were in other countries, and its description of effectiveness does not substantiate the stronger phrase “very effective.” (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Many researchers found online mental health or telemental health to be effective during the pandemic.

    “Additionally, many researchers found online mental health or telemental health to be effective during the pandemic experience (28-33)”

    From A proposed framework based on literature review of online contextual mental health services to enhance wellbeing and address psychopathology during covid-19 (2020) · cites this paper as [32]

    In the main text (Psychotherapy and Psychosomatics, pp. 130–132), Wright and Caudill report that telemedicine and computer-assisted psychotherapy have been found effective and discuss their use during COVID-19. The cited effectiveness research predates the pandemic, however, so this paper does not establish that researchers found these treatments effective specifically during the pandemic. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Previous studies have suggested that the outcomes of face-to-face interventions and self-help online resources have yielded effective results.

    “Previous studies have suggested that the outcomes of face-to-face interventions (ie, in-person or online) and self-help online resources have yielded effective results [9,10].”

    From Efficacy of a six-week-long therapist-guided online therapy versus self-help internet-based therapy for COVID-19–induced anxiety and depression: Open-label, pragmatic, randomized controlled trial (2021) · cites this paper as [9]

    The main text reports that telemedicine is effective and that computer-assisted cognitive-behavioral therapy (CCBT) has evidence of effectiveness, with outcomes comparable to face-to-face treatment. It does not establish the same result for self-help online resources used alone; it says CCBT is considerably more effective with clinician support than as a stand-alone program. Page numbers are not supplied in the passages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Remote delivery of psychological treatment services has been researched; studies conducted before the pandemic found that the efficacy of remote-based treatment services is as high as that of face-to-face treatment programs.

    “The remote delivery of psychological treatment services has been researched; studies conducted before the pandemic have found that the efficacy of remote-based treatment services is as high as that of face-to-face treatment programs [9,10].”

    From Efficacy of a six-week-long therapist-guided online therapy versus self-help internet-based therapy for COVID-19–induced anxiety and depression: Open-label, pragmatic, randomized controlled trial (2021) · cites this paper as [9]

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Authors
Wright, J. H., & Caudill, R.
Affiliations
University of Louisville (US)
ORCID
Venue
Psychotherapy and Psychosomatics
Publisher
S. Karger AG
Published
2020
Volume
89
Issue
3
Pages
130-132
ISSN
  • 0033-3190 (ISSN-L)
  • 1423-0348
DOI
10.1159/000507376
PMC
PMC7179517
OpenAlex
W3013095303
Cited by
238
References
12
Citations by year
2026: 3 · 2025: 9 · 2024: 11 · 2023: 22 · 2022: 40 · 2021: 89 · 2020: 62 · 2019: 2
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychotherapy and Psychosomatics (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
  • Physical Sciences › Computer Science › Information Systems › Healthcare during COVID-19 Pandemic
Keywords
telemedicine, telepsychiatry, COVID-19 pandemic, videoconferencing, telemental health, telemedicine regulation, social distancing, mental health service delivery
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Mental Disorders, Delivery of Health Care, Humans, Pneumonia, Viral, Psychiatry, Cognitive Behavioral Therapy, Telemedicine, Coronavirus Infections, Remote Consultation, Pandemics, Mobile Applications

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