Accepted for/Published in: JMIR Mental Health
Date Submitted: Dec 5, 2022
Open Peer Review Period: Dec 3, 2022 - Jan 28, 2023
Date Accepted: May 22, 2023
Date Submitted to PubMed: Jun 5, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Psychiatric treatment conducted via telemedicine versus in-person modality in PTSD, mood and anxiety disorders: a systematic review and meta-analysis
ABSTRACT
Background:
Telemedicine (TM) has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the Covid-19 pandemic. Furthermore, TM usage is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in the scientific literature. However, there is a need for a comprehensive quantitative review, analyzing and considering different clinical outcomes and psychiatric diagnoses.
Objective:
To assess if individual psychiatric outpatient treatment for adults conducted using TM is equivalent to in-person (IP) treatment.
Methods:
A systematic search of RCTs was conducted in recognized databases for this review. Four outcomes were assessed: (1) efficacy, (2) levels of patient satisfaction, (3) working alliance, and (4) attrition rates. The inverse-variance method was used to summarize the effect size for each outcome.
Results:
7414 records were identified (N=2804), and 20 trials were included in the systematic review and meta-analysis. The trials included post-traumatic stress disorder (PTSD) (nine trials), depressive disorder (six trials), a mix of different disorders (four trials), and general anxiety disorder (GAD) (one trial). Overall, the analyses yielded evidence supporting that TM is comparable to IP treatment regarding treatment efficacy (SMD = -0.01, 95% CI = [-0.12, 0.09], P = 0.84; I2 = 19 %, seventeen trials, n = 1814), patient satisfaction (MD = -0.66, 95% CI = [-1.60, 0.28], P = 0.17; I2 = 44 %, six trials, n = 591), and attrition rates (RR= 1.07, 95% CI =[0.94, 1.21], P = 0.32; I2 = 0%, twenty trials, n = 2804). Results also indicated that the working alliance between TM and IP modalities was comparable, but heterogeneity was substantial to considerable (MD = 0.95, 95% CI = [-0.47, 2.38], P = 0.19; I2 = 75%, six trials, n = 539).
Conclusions:
The meta-analysis presents results supporting that TM is equivalent to IP treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. According to the GRADE approach, certainty in evidence regarding efficacy was rated as “moderate”. Further high-quality RCTs are needed to strengthen the evidence base for treatment provided via TM within psychiatry. Individual patient data (IPD) meta-analysis is suggested for future studies to personalize TM.
Citation
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Copyright
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