cammedicine

As a psychiatrist in a regional area in Australia, about 50% of my patients live in another town. Some of my patients travel five hours one -way to see me. Sometimes there is an emergency, orfloods (not recently) or not enough money to make the trip.

Video-conferencing has been legislated as an acceptable way to ‘see’ patients but the technology is expensive and limited and difficult to access. I have used it many times in the past to supervise case managers, provide training and review patients for diagnosis and treatment. I have seen patients in alternate facilities, and supervised family therapy. The cost and availability of formal video-conferencing facilities is too difficult and the main reason I don’t use this technology.

If I had a video camera attached to my laptop Internet connection, this should be equivalent to video-conferencing. Many people in the bush have satellite Internet but not all will have this facility. Part of the research I am doing for this negotiated project will assess the access percentage. Just talking to most of my patients, they all at least know someone or have a younger family member who could help them.

Queensland has been the word leader in tele-psychiatry. The RANZCP has approved tele-psychiatry and there are Medicare Australia rebates specifically to encorage tele-psychiatry.
The efficacy has been proven but the role of tele-psychiatry has expanded. Worldwide uptake of tele-psychiatry, real time diagnosis, treatment, forensic evaluations, guardianship evaluations, supervision of primary health providers, support for carers has expanded as has conferences, education and some forays into the schools of children with mental health problems. This is a logistical issue at first glance. The epidemic of mental illness has been poorly planned for across the globe and there is a lack of psychiatrists globally. There is a dearth of rural and regional services and many places have just done without, for example South Australia where at one time recently had no psychiatrists at all.

The cost for laptop is very low, $120 for camera and microphone and the software is free to download. The problems include social presence because to picture is not good enough to pick p all the emotional states or negative features of schizophrenia due to lag time. People tend to talk slower and thus there is a lack of spontaneity. There can be a lack of privacy when people are accessing their computers with other people present but this is less of a problem than formal video-conferencing units. There is a problem for very dangerous and disturbed people but safety mechanisms can be put in place.
After this review of the literature I would have to say that I will be buying the equipment next week.



http://www.ranzcp.org/
http://www.sofweb.vic.edu.au/internet/video.htm
http://science.uniserve.edu.au/pubs/callab/vol11/CAL-laborate%20web.2004f.pdf
http://www.psych.org/psych_pract/tp_paper.cfm
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1440-1614.2001.00853.x?cookieSet=1&journalCode=anp
http://www.leaonline.com/doi/abs/10.1207/s15326888chc3501_3
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10824374&dopt=Abstract
http://www.newstarget.com/020700.html
http://pn.psychiatryonline.org/cgi/content/full/38/23/11?etoc
http://www.abc.net.au/rural/events/ruralhealth/2005/papers/8nrhcfinalpaper00565.pdf
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=10794004
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15006208
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=11346475