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org/ICOT/
From

sigtelemental.htm

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Chair Vice-Chair
Terry Rabinowitz, MD, FAPA, FAPM Lisa J. Roberts, PhD
Associate Professor of Psychiatry & Family Business Manager,
Medicine Health Innovations and Grants
Director Telepsychiatry Viterion TeleHealthcare
University of Vermont Fletcher Allen Health Care 10042 Main Street, Suite 401
Burlington, VT Bellevue, WA 98004
Phone: 802-847-2112 Phone: 425-417-8209
Fax :802-847-3090 fax Email:[email protected]
Email:[email protected]

• SIG Goals for 2006-2007 (word)

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New SIG information coming soon.

• Minutes from Telemental Health SIG Conference Call

September 4, 2007
• Minutes from Telemental Health SIG Conference Call
February 7, 2007
• Minutes from Telemental Health SIG Conference Call
January 7, 2007
• Minutes from Telemental Health SIG Conference Call
November 1, 2006
• Telemental Health SIG Forum Minutes (pdf)
ATA 2004, Tampa, Florida, May 3, 2004
• Telemental SIG Conference Call Summary (pdf)
January 9, 2004
• Telemental SIG Group Meeting Report
June 4, 2002
• Telemental SIG Group Meeting Report
June 2, 2001

2006 – San Diego, CA

• The Role of Mental Health in Disaster Response - Lessons Learned from Hurricane
Katrina
Eugene F. Augusterfer, LCSW
Global Mental Health Network, McLean, VA
• Riley Children's Hospital - Telemedicine Applications in Pediatric Mental Health
Greg A. Beck1, MHA, David Dunn2, MD
1Riley Children's Hospital, Indianapolis, IN; 2Indiana University, Indianapolis, IN
• Evaluation From a Diagnostic Efficacy Trial of Child Telepsychiatry
Eve-Lynn Nelson, Sharon Cain, Poonam Khanna, Ryan Spaulding
Kansas University Medical Center, Kansas City, KS
• Regional Health Information Organizations (RHIO's) and Telemedicine - Lessons to
Be Learned
Peter M. Yellowlees, MBBS, MD
UC Davis Medical Center, Sacramento, CA
• An Economic Evaluation of Telehealth SCID Interviews with American Indians
Elizabeth Brooks, MS, Jay Shore, MD, MPH, Daniel Savin, MD, Spero Manson, PhD,
Anne Libby, PhD
University of Colorado Health Sciences Center, Aurora, CO
• The eMental Health Project at UC Davis - A Consultation Liaison Primary Care
Program with Excellent Clinical Outcomes
Peter M. Yellowlees, MBBS, MD, James Bourgeois, MD, Donald M. Hilty, MD,
 Jonathan Neufeld, PhD, Hattie Cobb
UC Davis Medical Center, Sacramento, CA
• If At First You Don't Succeed: Rebuilding a Telepsychiatry Program
Andy D Kroeker1, BSc, MPA, Kim Timleck1, BSW, MHSc, CHE, Sharon Sanders2
1VideoCare, London, Ontario, Canada; 2Regional Mental Health Care, London,
Ontario, Canada
• Using Technology to Increase Access to Evidence-Based Mental Health Services
Lisa J. Roberts, PhD
Viterion TeleHealthcare, LLC, Bellevue, WA
• Using Video Conferencing to Improve Best Practices
Robert K. White , LCPC, David Pruitt, MD
University of Maryland Psychiatry, Baltimore, MD
• Psychiatry Resident Training Program Utilization of Telepsychiatry
Eve-Lynn Nelson, PhD, Barry Liskow, Ryan Spaulding
Kansas University Medical Center, Kansas City, KS
• Symptom Relief in Veterans with PTSD via Telephone or Videophone Therapy
Mary K. Roberts, PhD
Department of Veterans Affairs Medical Center, Salt Lake City, UT
• Forensic Telepsychiatry in the U.S. Army
Brett J. Schneider, MD
Walter Reed Army Medical Center, Washington, DC
• Diagnostic Reliability of Telepsychiatry in American Indian Veterans
Jay H. Shore, MD, MPH, Daniel Savin, MD, Heather Orton, MS, Jan Beals, PhD,
Spero M. Manson, PhD
American Indian and Alaska Native Programs, University of Colorado at Denver and
Health Sciences Center, Aurora, CO
• Support Groups by Videoconferencing for Women with Breast Cancer
Kate Collie, PhD,1 Mary Anne Kreshka, MA,2 Speranza Avram,3 Rebecca Parsons,
LCSW4, Susan Ferrier, BSN,3 Kathy Graddy, Cheryl Koopman, PhD1
1Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford,
CA; 2Sierra College, Rocklin, CA; 3Northern Sierra Rural Health Network, Nevada
City, CA; 4Sierra Nevada Cancer Center, Grass Valley, CA sh.com
• Jason Cafer MD, Iconic Health's HomePsych.com's communication platform for
online telecounseling and telepsychiatry integrated with an electronic health record
specialized for mental health
• Patient Satisfaction With Mental Health Telemedicine in Rural Arkansas
Cathy A. Irwin, PhD, RN, Ann B. Bynum, EdD
Rural Hospital Program, University of Arkansas for Medical Sciences
Little Rock, AR
• Counseling Center Based Student Tele-Mental Health at a Rural University
Ellen N.Emerson, PhD,1 Wendy L.Wolfe, PhD,1 Elena V.Khasanshina, MD, PhD,2
Stewart A.Shevitz, MD,2 David P Matthews, PhD,1 Peter F Buckley, MB, BCh, BAO,2
Max E Stachura, MD2
1Georgia Southern University, Statesboro, GA; 2Medical College of Georgia,
Augusta, GA
• Mental Health Outcomes: A Comparison Study of Home-Based Telehealth Versus
Traditional Home Health Services
Pamela G. Forducey, PhD, ABPP,1 Victoria Phillips, DPhil,2 Teresa Tisdell, OTR/L,
MPH,1 Andrew Heuser, PT,1 Stephen Dawson, PT,1 Dana DuRoy, OTR/L, MBA1
1INTEGRIS TeleHealth, Oklahoma City, OK; 2Emory University, Rollins School of
Public Health, Atlanta, GA
2005 – Denver, CO
• Pediatric Telemental Health: Reimbursement
Katherine Flynn, RN, MS1, Dennis Wilbert, MC1, Kathleen Myers, MD, MPH1,2,
 Stephen Sulzbacher, PhD1,2, Sanford Melzer MD, MBA1,2
1Children's Hospital & Regional Medical Center, Seattle, WA; 2University of
Washington School of Medicine, Seattle, WA
• Pediatric Telemental Health: Juvenile Corrections
Deborah Thurber, MD1,2, Kathleen Myers, MD, MPH1,2, Dennis Wilbert1, Eric
Trupin, PhD1, Roxanne Morganthaler1, Katherine Flynn, RN, MS1, Sanford Melzer,
MD, MBA1,2
1Children's Hospital & Regional Medical Center, Seattle, WA; 2University of
Washington School of Medicine, Seattle, WA
• Pediatric Telemental Health: Outpatient Care
Deborah Thurber, MD1,2, Kathleen Myers, MD, MPH1,2, Stephen Sulzbacher,
PhD1,2, Dennis Wilbert1, Katherine Flynn RN, MS1, Sanford Melzer MD, MBA1,2,
1Children's Hospital & Regional Medical Center, Seattle, WA; 2University of
Washington School of Medicine, Seattle, WA
• Telehealth Treatment of Depression-Translating Research Findings into Practice
Eve-Lynn Nelson, PhD
Center for TeleMedicine, Kansas University Medical Center, Kansas City, KS
• Telemental Health, Technology and Care Coordination: Initial Program Outcomes
Anita S. Urdiales, RN, MSN, CNS1, Jeff Lowe, MSW, LCSW2
1VHA Eastern Colorado Health Care System, Denver, CO; 2VHA Rocky Mountain
Network VISN9 1, Denver, CO
• Diagnosis and Treatment of Delirium in Elders From a Distance
Terry Rabinowitz, MD, DDS1,2, Pamela L. Blume, RN3, Katharine M. Murphy, PhD,
RN4, Michael Caputo, MS1,2, Michael Ricci, MD1,2
1University of Vermont College of Medicine, Burlington, VT; 2Fletcher Allen Health
Care, Burlington, VT; 3Alice Hyde Nursing Home, Malone NY; 4Hebrew
Rehabilitation Center for Aged, Boston, MA
• Technology Use in a Child Behavioral Health Clinic
COL Ryo Sook Chun, MC, USA, Sona P. Patel, MPH, BS, MAJ(P) Robert Forsten, MC,
USA, LTC Nancy Black, MC, USA
Walter Reed Army Medical Center, Washington, DC
• Next Generation of the Tele-Behavioral Health System and Statistical Analysis Usage
Grigoriy Gadiyak, PhD1, Valeriya Gadiyak, PhD1, COL Ryo S Chun, MC2, COL Ronald
K Poropatich, MD1, Daisy DeWitt, MS1
1North Atlantic Regional Command, Telemedicine Directorate, Washington, DC;
2Walter Reed Army Medical Center, Washington, DC
• Co-location of Mental Health Services and Primary Care using Telemedicine
Oscar Boultinghouse, MD, John Allen, MBA
University of Texas Correctional Managed Care, Galveston, TX
• Child and Adolescent Psychiatric Consultations for American Indian Children
Douglas K. Novins, MD1, Daniel Savin, MD, Mark Garry, MD1,2, Jay H. Shore, MD,
MPH1, Spero M. Manson, PhD1
1American Indian and Alaska Native Programs-University of Colorado Health
Sciences Center, Denver, CO; 2Sioux San Indian Health Service Hospital, Rapid
City, SD
• Telemental Health Treatment for American Indian Veterans
Jay H. Shore, MD, MPH, Spero M. Manson, PhD
American Indian and Alaska Native Programs, University of Colorado Health
Sciences Center, Denver, CO
• Store and Forward Based Telemedicine Platform for Treatment of Autism
R. Oberleitner1, S. Pharkute, MS2, S. Laxminarayan, PhD2, J. Ball, EdD3, J.
Harrington, MD4, R. Naseef, PhD5
1Princeton Autism Technology, Princeton, NJ; 2Idaho State University, Pocatello,
ID; 3Autism Education Services, Youth Consultation Services/Sawtelle, Montclair,
 NJ; 4Department of Pediatrics, New York Medical College, Valhalla, NY; 5Special
Needs Families Resource Center, Philadelphia, PA
• Constraints on Effectiveness of Psychological Telemedicine in Older Adults
Neil Charness
Florida State University, Tallahassee, FL
• Electronic Behavioral Health Screening in a Military Environment
COL Gregory A. Gahm, PhD, Barbara Lucenko, PhD
Army Behavioral Health Technology Office, Tacoma, WA
• Parent's Perspective of Therapeutic Alliance: Video Teleconferencing versus Face-To-
Face
LTC Nancy B. Black, MD, Sona P. Patel, MPH, COL Stephen J. Cozza, MD
Walter Reed Army Medical Center, Washington, DC
2004 – Tampa, FL
• A Statewide Second Opinion Child Psychiatry Telemedicine Service
Peter Yellowlees1, MD, BSc, MBBS, FRANZCP, MRC(Psych), MAPsS, MRACMA,
FACHI, Andrew Hockey1, BA(Hons), Psych, Stephen Murphy2, MBBS, FRANZCP
1Centre for Online Health, The University of Queensland, Brisbane, Australia; 2Royal
Children's Hospital, Brisbane, Australia
• Telepsychiatry: Improving Access in Rural Northern Idaho
Sue Fox, MPH
North Idaho Rural Health Consortium, Bonner General Hospital, Sandpoint, ID
• An Evaluation of Telepsychiatry from a Training Perspective
Barry Liskow, MD, Eve-Lynn Nelson, PhD, Sharon Cain, MD, Poonam Khanna, DO,
Paula Baum, RN
Kansas University Medical Center, Kansas City, KS
• Minimum Data Set Facilitates Telepsychiatry Consultations for Nursing Home
Residents
Terry Rabinowitz1,2, MD, FAPM, Michael A. Ricci1,2, MD, Michael P. Caputo, Jr. 1,
MS, Katharine M. Murphy3, PhD, RN
1University of Vermont College of Medicine, Burlington, VT; 2 Fletcher Allen Health
Care, Burlington, VT; 3Hebrew Rehabilitation Center for Aged, Boston, MA
• Expansion of eHealth Services and Indian Health Care in California
Barbara Johnston, MSN
The California Telemedicine & eHealth Center (CTEC), Sacramento, CA
• Telepsychiatry: Where the Medium Supports the Process, a Case Study
George Brandt, MD
Walter Reed Army Medical Center, Washington, DC
• Using Automation to Screen for Depression in Primary Care Clinics
LTC Paulette Williams, AN, MSN, DrPH, LTC Susan Emanual, MC, LTC Simon Pincus,
MC
Tripler Army Medical Center, Honolulu, HI
• Effectiveness of Telemedicine as a Mental Health Consultative Procedure
Peggy Keilman, PhD, FPPR
University of New Mexico, Albuquerque, NM
• Development of a Flexible Telemedicine Decision Analysis Tool
Gregory L Thelen1,2, MD, Sandra K. Schmunk, BS, MT-ASCP, MA
1VA Midwest Health Care Network, Minneapolis, MN; 2Mental Health Service Line,
University of Minnesota
• The Impact of Mental Health Telemedicine on Patients' Cost Savings
Cathy A. Irwin, PhD, RN, CS, Ann B. Bynum, EdD, Joseph A. Banken, MA, PhD,
HSPP
University of Arkansas for Medical Sciences, Little Rock, AR
• An Expert System for Behavioral Health Risk Assessment
Gregory Gahm, PhD, Tracy L. Hartford
 Army Behavioral Health Technology Office, Madigan Army Medical Center, Tacoma,
WA
• Telepsychiatry Research Project in Michigan: Outcomes and Impacts
Pamela Whitten, PhD
Michigan State University, East Lansing, MI
• Telepsychiatry and Research: Lessons Learned
LTC Nancy B. Black, MD, COL Stephen J. Cozza, MD, Sona P. Patel, MPH
Walter Reed Army Medical Center, Washington, DC
• Florida Initiative in Telemedicine and Education Improves Health Status of Children
with Diabetes
Toree Malasanos1, MD, Muir2, A., Dubault3, R., Molinari3, S., Geffken1, G.,
Burlingame1, J., Greco1, J., Hruska1, E., Watson4, D., Ketterson1, T., Glueckauf1,
R., Patel1, B., Klein1, J., Sloyer4, P.
1University of Florida, Gainesville, FL; 2Medical College of Georgia, Augusta, GA;
3Florida Center for Medicaid Issues, University of Florida, Gainesville, FL;
4Department of Health, Children's Medical Services, Gainesville, FL
2003 – Orlando, FL
• Best Practices: Ethics and Professionalism in the Provision of Telemedicine
Tracy Gunter, MD
Department of Neuropsychiatry, University of South Carolina School of Medicine,
Columbia, SC

• A Randomized Trial Delivering Psychotherapy via Telemedicine

James E. Mitchell, MD1,2, Stephen Wonderlich, PhD1,2, Ross Crosby, PhD1,2, Tricia
Myers, PhD1,2, Lorraine Swan-Kremeier, PsyD1,2, Kathy Lancaster1
1Neuropsychiatric Research Institute, Fargo, ND; 2Department of Neuroscience
University of North Dakota School of Medicine and Health Sciences, Fargo, ND

• Development of an Electronic Behavioral Health Record

Mitra Rocca, MSc1, John Pajak, BS1, Gregory Gahm, PhD2, Jessica Oehlrich, BS2
1United States Army Medical Research & Materiel Command (USAMRMC),
Telemedicine and Advanced Technology Research Center (TATRC), Fort Detrick, MD;
2Madigan Army Medical Center, Tacoma, WA

• Web-based Automated Mental Health Intake System (WAMHIS): Examining

Parent and Provider Satisfaction
COL Ryo Sook Chun, MD1, Donna Edison, DO1, MAJ Anthony Cox, MS2, LTC(P)
Stephen Cozza, MD1, Grigorii Gadiyak, PhD1, Valeriya Gadiyak, PhD1, William
Parker, MS1, Scott Mann, JD1, COL Ronald Poropatich, MD1, Daisy DeWitt1, Sarah
Rosquist, BS1
1Walter Reed Army Medical Center, Washington, DC; 2US Army Center for Health
Promotion & Preventive Medicine, Washington, DC

• Telemedicine for Pediatric Mental Health in Rural Areas

Kathleen Myers, MD, MPH1,2, Stephen Sulzbacher, PhD1,2, Sandor Melzer, MD,
MBA2,3
1University of Washington, Seattle, WA; 2Chidren's Hospital & Regional Medical
Center, Seattle, WA; 3Children's Health Access Regional Telemedicine (CHART)
Program, Seattle, WA

• Telepsychiatry in a Rural Women's Shelter: Addressing Domestic Violence

Christopher R. Thomas, MD
University of Texas Medical Branch, Galveston, TX
 • Considerations in Treating Severe Mental Health Conditions via
Telemedicine
John Kennedy, MD
National Naval Medical Center, Bethesda, MD

• Telepsychiatry Consultation to School

Tracy D. Gunter, MD1, Christopher R. Thomas, MD2, R. Andrew Harper, MD3
1University of South Carolina School of Medicine, Columbia, SC; 2University of
Texas Medical Branch, Galveston, TX; 3University of Texas Medical School at
Houston, Houston, TX

• Telepsychiatry in the Forensic Setting

Tracy D. Gunter, MD
University of South Carolina and the South Carolina Department of Mental Health,
Columbia, SC

• Emergency Telemental Health - Canada's First

Krisan Palmer, RN1, Rose Montgomery, BN1, Annette Harland2
1Atlantic Health Sciences Corporation, Saint John, New Brunswick, Canada; 2
Community Mental Health Services, St.Stephen, New Brunswick, Canada

• Telepsychopharmacology: An Application in Telepsychiatry

Norman Alessi, MD
University of Michigan Medical School, Ann Arbor, MI

• Telepsychiatry Service Versus Face-to-Face Psychiatry Service - A

Preliminary Outcome Study
COL Swarnalatha Prasanna, MD
Telepsychiatry & Community Mental Health, Walter Reed Army Medical Center,
Washington, DC
• Development of a Web-Based Behavioral Health Record System
Grigoriy Gadiyak, PhD, Valeriya Gadiyak, PhD, William Parker, MS, COL Ronald K.
Poropatich, MD, COL Ryo S. Chun, MC, COL Swarnalatha Prasanna, MD, MAJ
Anthony Cox, MS, LTC Steve Cozza, MC, Donna Edison, DO, Sarah Rosquist
Walter Reed Army Medical Center, Washington, DC
2002 – Los Angeles
• Internet Enabled Neuropsychological Assessment
MAJ Mark R. Baggett, PhD1, Mark P. Kelly, PhD1, CPT Daniel K. Christensen, PhD1,
LTC Gregory A. Gahm, PhD2, Robert L. Kane, PhD3,4, CPT John D. Via, PhD5, CPT
Victoria M. Ingram, PsyD1, Linda Whitby, MD1, Zhengi Y. Sun1, Daisy T. Dewitt1,
Lisa M. Korenman, MA1,
1Walter Reed Army Medical Center, Washington, DC; 2Madigan Army Medical
Center, Tacoma, WA; 3VA Maryland Heath Care System, College Park, MD;
4University of Maryland, College Park, MD; 5Fort Sam, Houston, TX
• Student Mental Health Outreach Using Online Support
Iverson C. Bell, Jr., MD
Morehouse College, Morehouse School for Medicine, Atlanta, GA
• Virtual Reality In Healthcare
Peter M. Yellowlees, MD, BSc, MB, BS, FRANZCP, MRC, MAPsS, MRACM
Centre for Online Health, The University of Queensland, Brisbane, Australia
• A Comparison Of Innovation Adopters And Non-Adopters Within A
Telemedicine Initiative: An Evaluation Of Innovation Attributes To Explain
Telemedicine Diffusion
David J. Cook, PhD, Gary C. Doolittle, MD, Ashley Spaulding, Debbi Swirczynski
 Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas
City, KS
• Adolescent Telepsychiatry
Norman E. Alessi, MD, Gary Wautier, PhD
University of Michigan Healthcare System, Ann Arbor, MI
• Access And Outcomes Through The Michigan Telepsychiatry Project
Pamela Whitten, PhD1, Zora Ziazi, MA1, Linda Marion, MD2
1Michigan State University, East Lansing, MI; 2Lifeways, Jackson, MI
• Linkages For Increasing Access To Psychiatric Care In Rural MUA
Glenda Walker, RN, DSN1, Ben G. Raimer, MD2, Jeanette Hartshorn, PhD, RN,
FAAN2, Nancy Speck, PhD2, Rowdy Stovall2
1Stephen F. Austin State University, Nacagdoches, TX; 2University of Texas Medical
Branch, Galveston, TX
• Web-Based Automated Mental Health Intake System (WAMHIS)
COL Ryo S. Chun, MD, LTC Steve Cozza, MD, Donna L. Edison, DO
Walter Reed Army Medical Center, Washington, DC
• Behviorial Health Window Of Opportunity
Holly E. Russo, RN, MS1, Marlene Maheau, PhD2, Harvey Komet, MD3
1Telemedcine Solutions/Telehealth Works, Juno Beach, FL; 2Alliant University &
Selfhelpmagazine.com, San Diego, CA; 3Cyber-Care, Boynton Beach, FL
• Behavioral Telehealth For Pain Management: Efficacy And Consumer
Satisfaction
Philip R. Appel, PhD, Joseph Bleiberg, PhD, John Noiseux, MS
National Rehabilitation Hospital, Washington, DC
2001 – Ft. Lauderdale
• The Capacity to Adapt, Turning Connections Into Relationships via Video
Teleconferencing (55.0KB)
LCDR Brian J. Grady, MD
National Naval Medical Center, Bethesda, MD

If you are interested in participating in the Telemental Health Special Interest Group simply
contact the chair of the SIG or email ATA at [email protected] or call ATA
at 202.223.3333.

The effectiveness of telepsychiatry:

https://www.cpa-apc.org/Publications/Archives/Bulletin/2003/october/hilty.asp

Donald M. Hilty, MD
Associate Professor of Clinical Psychology, University of California, Davis, Sacramento,
California.
Weiling Liu, BS, Shayna Marks, BS
Postgraduate Researcher, University of California, Davis, Sacremento, California.
Edward J. Callahan, PhD
Professor of Family and Community Medicine, University of California, Davis, Sacramento,
California.

Abstract: Effectiveness must be determined for each new technology because it may have
advantages and disadvantages over what is currently offered. We reviewed the literature to
synthesize information on whether telepsychiatry is effective. Based on the literature, we
suggest that the effectiveness of telepsychiatry be evaluated on access to care, quality of
care (that is, outcomes, reliability, satisfaction and comparison with in-person care), costs
and empowerment. Further, we discuss other factors that influence effectiveness (for
example, technology, administrative coordination and financial support). Telepsychiatry
appears effective, and recommendations are offered for further evaluation of its
effectiveness.
Key Words: telepsychiatry, effectiveness, rural, mental health, review
Telepsychiatry, in the form of videoconferencing, has been well received in terms of
increasing access to care and user satisfaction (1–4). Questions persist, however, about its
effectiveness; there are few clinical outcome studies, cost data and randomized trials. There
may also be a positive reporting bias in the literature.
“Effectiveness,” from the Latin origin of the word, is defined as “having the power to
produce an effect . . . a decisive effect; efficient; as . . . an effective . . . remedy” (5).
Ideally, effectiveness should be considered for the patient, provider, program, community
and society. In telemedicine and telepsychiatry, authors have rarely discussed the idea of
effectiveness (6,7). However, they have discussed the subject indirectly with respect to
quality of care, clinical outcomes and costs (8).
Frameworks proposed for telepsychiatry assessment have information that applies to the
concept of effectiveness, including what technology is used (9–11), how tele- psychiatry is
integrated with other services (9,11), what it costs (6,7,9–11), how it compares with
previous services and its quality (for example, whether it enhances diagnosis and whether it
compares favourably with in-person care) (9–11).
This article discusses telepsychiatry’s effectiveness for clinicians, clinical educators and
clinical researchers. It focuses individually on the parameters of access, quality of care (that
is, outcomes, reliability and comparison with in-person care), satisfaction, costs, education
and empowerment. It is obvious that the parameters affect the assessment of one another
(6). We offer recommendations for further evaluation.

Methods

We conducted a comprehensive review of the telepsychiatry literature from 1965 to June

2003, using Medline, PubMed, PsycINFO, Embase, Science Citation Index, Social Sciences
Citation Index and Telemedicine Information Exchange databases. The Journal of Telehealth
and Telecare was also hand searched for the years during which it was not included on
Medline. Key words included telepsychiatry, telemedicine, video- conferencing,
effectiveness, efficacy, access, outcomes, satisfaction, quality of care and costs. The first
author reviewed article titles and abstracts to decide whether they applied to the theme of
effectiveness. Selected articles were pulled, and references were reviewed for potential
additional articles.
The data were categorized, based on the key words used for the initial search. In addition,
we used a standard qualitative method based on grounded theory analysis to explore the
prevalent trends in the literature to identify additional key, recurrent themes (12). Ideas
were recorded by analytic memos and were identified as highly recurrent (that is, reaching
theoretical saturation) according to a coding scheme that organized them into meaningful
categories (12). Education and empowerment were identified as categories.

Measures of Effectiveness

Access to Care
Access to care is determined by geographic, economic, cultural and (or) social barriers to
needed care. Access to psychiatric care has increased to rural (13,14), suburban (15) and
urban areas (16). Telepsychiatry links academic health centres with health-care
professionals in shortage areas (17). Points of service are theoretically limitless. A full range
of evaluation (general, forensic and neuro- psychological), consultation, treatment
(medication and therapy) and case management services have been provided (2).
Telepsychiatry programs worldwide have been described in surveys (18,19) and in
telepsychiatry research reviews (1,18,19).
Quality of Care
Outcomes. There is a small but growing literature with respect to telepsychiatry
inerventions (Table 1). Most patients are referred for diagnostic evaluation and (or)
treatment recommendations, with the view that two opinions are better than one (6,20,21).
Indeed, in a study of specialty consultation including telepsychiatry, specialists changed the
diagnosis and medications in 91 per cent and 57 per cent of cases, respectively; primary
care interventions led to clinical improvements in 56 per cent of cases (22). Similarly, nurse
telecare improved patient depression, mental health functioning and satisfaction (23).
Quality of care may also be defined as avoiding unnecessary evaluations, procedures and
transfers in emergencies (24), as reducing waiting times (25) and as more appropriately
using psychiatric intensive care units (26). Cognitive-behavioural therapy for children with
depression was as successful at 128 kilobytes (KBS) per second by telepsychiatry as in-
person care (27). No difference was found between Global Assessment of Function over 6
months by telepsychiatry at 128 KBS and a control group (28). Similarly, no improvement
occurred over the course of 12 months in another study (29).
Table 1 Quality of care: summary of outcome and cost studies
Study n Patients KBS/frames Location Comment(s)
Outcome
Doze and others (20) 90 Adult outpatients 128–384/NS Canada Specialists assisted with
diagnosis and treatment; no
outcomes measured
Graham (75) 39 Adult outpatients 768/NS U.S. Reduction in hospitalizations
Haslam and McLaren(26) 2 Adult and geriatric 128/NS U.S. More appropriate use of inpatient
outpatients services
Hunkeler and others (23) 302 Adult outpatients in NS U.S. Nurse telecare improves
primary care depressive symptoms,
functioning and satisfaction vs.
usual care
Johnston and Jones (76) 40 Nursing facility residents 128/adjusted U.S. Elimination of travel and more
to 5-inch contact between patients and
square staff
Kennedy and Yellowlees (29) 32 Adult patients 128/NS U.S. No improvement
Lyketsos and others (58) NAP Geriatric dementia NS/20 U.S. Reduction in psychiatric
patients hospitalization
Nelson and others (27) 28 Childhood depression 128/NS U.S. Substantial clinical change,
equivalent to in-person care
Nesbitt and others (22) 164 Adult patients with 128–384/30 U.S. Change in diagnosis in 91% of
specialist consultations cases and clinical improvement in
including psychiatry 56% of cases
Zaylor (28) 49 Adult outpatients with 128/NS U.S. No difference in GAF scores at
depression or schizo- 6-month follow-up vs. in-person
affective disorder
Cost
Alessi and others (53) NAV Adult forensic inpatients NAV/NAV U.S. Telepsychiatry is cost-effective
Doze and others (20) 90 Adults 336–384/NS Alberta Costs break even at 7.6
consultations
 Hailey and others (9) NAP Adults NAP/NAP U.S. Reduced costs to rural patients
Mielonen and others (55) 14 Adult inpatients NS Finland Savings in health-care costs,
reduction in travel and ease and
speed of consultation
Simpson and others (38) 379 Adult outpatients 128–384 Canada Costs break even at 224
consultations/year; less if also
used for administration
Trott and Blignault (54) 50 Adult and child NS Australia Substantial savings in health care
outpatients costs from reduction in travelling
and patient transfers
KBS = kilobytes per second; NAV = not available; NAP = not applicable; NS = not specified.
Reliability. Studies on the reliability of telepsychiatry have been conducted—almost all with
good results— generally at transmission speeds of 128 KBS to 384 KBS (1,2). Diagnoses
have been made reliably, with good interrater reliability, for a wide range of psychiatric
disorders for children, adults and geriatric patients. Limitations have included patients’
difficulties in hearing and decreased attention (30).
Comparison with In-person Care. Telemedicine’s ability to simulate real-time experiences in
terms of audio and video quality is important. Terrestrial transmission at 128 KBS provides
a good picture with a 0.3-second signal delay, but words are “cancelled out” if spoken
simultaneously. Satellite transmission involves a delay of 0.5 to 1.0 second, as seen on
worldwide broadcasts. Low KBS (that is, 56 KBS plus or minus 128 KBS) and satellite use
may interfere with the building of rapport, detection of nonverbal cues (31) and
depersonalized content (32), a task-oriented focus and a turn-taking conversation (33). No
problems, however, were found with development of rapport in a small cohort comparing
signal delays of 0, 0.3 and 1.0 second (34). Transmission at 384 KBS to 768 KBS has little-
to-no delay. A review of randomized controlled trials, comparing telemedicine (not
telepsychiatry) with in-person care showed no detrimental effects in outcomes and
satisfaction (35).
Patient and Provider Satisfaction
A systematic review of the satisfaction literature in tele- medicine (not telepsychiatry)
revealed limitations that included small sample sizes, informal evaluations and a lack of
randomized trials (36). Table 2 summarizes tele- psychiatry satisfaction. Patients have
expected a less satisfactory interaction than in a traditional physician–patient encounter
(37), but overall satisfaction has been very high (2,36). Interestingly, high satisfaction has
been reported despite equipment problems (38). Thus far, reduced time to travel (8,20,39),
less absence from work (20), reduced waiting time (25,36) and more patient choice and
control (20) have been reported. Other potential predictors are frames per second (FPS)
(for example, 30 FPS is television quality) (40), demographic factors (for example, age, sex
or ethnicity) (41), state- and trait-dependent factors (for example, acute depression vs.
depression in remission) (41), cost, satisfaction with and availability of local services (42),
and provider qualities (43).
Table 2 Summary of telepsychiatry key satisfaction studies
Study n Patients KBS/frames Location Comments
Baer and others (77) 26 Patients with 128/NS U.S. Average to better than in-
obsessive–compulisve person care
disorder
Baigent and others (78) 63 Adult state hospital inpatients 128/NS Australia Many patients were satisfied
and preferred it instead of in-
person
Ball and McLaren (30) 6 Adult inpatients Low-cost system/NS U.K. Also measured satisfaction
with in-person, telephone,
and hands-free telephone
Blackmon and others (45) 43 Child outpatients NS/NS U.S. Parent satisfaction was also
very good
Bratton and Cody (48) 20 Geriatric patients in a 128/NS U.S. Satisfied despite hearing and
retirement community poor image problems

Callahan and others (44) 93 Adult primary care 128/15 U.S. Satisfaction equal to a
outpatients nonpsychiatric population
Chae and others (79) 30 Adult outpatients 33/NS Korea Equal to usual, in-person
care
Clarke (80) 32 Nurses and providers in rural 128/NS Australia Nurse satisfaction was
clinics greater than physician
satisfaction
Dongier and others (46) 50 Adult, child outpatients Closed circuit TV/NS Canada Equal to usual, in-person
care
Doze and others (20) 90 Adult outpatients 128–384/NS Canada Positive because of less
travel and less absence from
work; negative perceptions
Elford and others (32) 23 Children 336/NS U.S. Diagnosis and treatment
recommendations equal to
usual, in-person care
Graham (75) 39 Adult outpatients 768/NS U.S. Positive patient acceptance of
telepsychiatry aftercare (90%
positive ratings)
Hilty and others (41) 40 Adult primary care 384/15 U.S. Satisfaction equal for in-
outpatients person and telepsychiatric
care, if patient given the
choice
Johnston and Jones (76) 40 Nursing facility 128/NS U.S. Patients and families
residents expressed appreciation for
the service
McCloskey (39) 236 Adult outpatients 128/NS U.S. Rural Montana; would have
had to travel significantly
Mielonen and others (55) 14 Adult inpatients NS/NS Finland High patient satisfaction (80%
considered it to have been
useful)
Ruskin (81) NAV Geriatric outpatients NAV U.S. Geriatric satisfaction similar
to adult satisfaction
Simpson and others (25) 230 Adult outpatients 384 Canada High level of satisfaction with
the service and equipment
Simpson and others (38) — Adult outpatients 384 Canada High level of satisfaction with
the service and equipment
despite equipment problems
in 17% of cases
Trott and Blignault (54) 50 Adult and child outpatients NS/NS Australia High level of acceptance by
patients and mental health
professionals
Dongier and others (46) NS Primary care providers and Closed circuit Canada Lower satisfaction in terms of
psychiatrists ease, ability to express
oneself, and quality of the
relationship
Hilty and others (49) NS; 200 Primary care providers 128–384/30 U.S. High satisfaction (for
pts example, 4.5 on 5-point
 scale) on all parameters;
improved over time with
increased use
Elford and others (32) 2 Child psychiatrists 336/NS U.S. High satisfaction except for
rare technical problems
McCloskey (39) 1 Adult psychiatrist 128 KBS U.S. High satisfaction (for
example, 6.6 on 8-point
scale)
Hilty and others (21) 3 Adult psychiatrists 128–384/30 U.S. High satisfaction (for
example, 6.8 on 8-point
scale)
Doze and others (20) NS Adult psychiatrists 128–384/NS Canada Generally pleased to evaluate
patients before condition
became more severe;
efficient
Several interesting themes have emerged from the literature. First, most patients speak
freely when using tele-psychiatry, will use it again, and rate their experiences with providers
as positive. Satisfaction with telepsychiatry is similar to other specialty care provided via
telemedicine (44). For evaluation and follow-up care, satisfaction with telepsychiatry care
equalled that for in-person consultation (41). Patients of all ages have reported high
satisfaction (32,45,46), even those with occasional trouble hearing or discomfort using the
equipment (47,48).
Consultee and psychiatrist satisfaction has been less consistently positive. Consultee (that
is, nurse and psychologist) satisfaction with telepsychiatry was lower than for in-person
consultation with respect to ease with the process, ability to express oneself and quality of
the interpersonal relationship (46). Satisfaction, however, with another consultation-liaison
service was high (that is, over 4.5 on a scale of 1 [poor] to 5 [excellent]) and increased
after 2 or more consultations over a 1-year period. Rural primary care providers had
significantly higher satisfaction than did suburban or urban providers (49). Although
problems were rare, child psychiatrists indicated that technical problems (for example,
unclear picture and video freeze) affected their ability to assess patients (32). One study
raised concerns about the ease of the process, the ability to express oneself and the quality
of the interpersonal relationship (46). Two other studies rated overall satisfaction with
telepsychiatry highly (for example, 6.6 on a scale of 8) (21,39).
Cost Studies
This article reports cost studies briefly, because little information has been collected in a
standard, prospective fashion (9). Ideally, both direct and indirect costs should be
considered for patients, clinics, providers and society at large. Direct costs include
equipment, installation of lines and other supplies. Fixed costs also include the rental of
lines, as well as salary and wages and administrative expenses. Variable costs include data
transmission costs, fees for service, and maintenance and upgrades of equipment.
Studies have reported cost data (Table 1), and recommendations have been made to
improve evaluation. A meta-analysis of cost data found that only 38 of 551 articles
contained any quantifiable data, leading to a conclusion that it was premature to assume
that telemedicine is cost-effective (50). Telepsychiatry is cheaper than travel for patients
(8,25,51,52). With respect to programs, tele- psychiatry service has been shown to be
cheaper (14,52–55), equivalent (9) and more expensive than outreach in-person services
(42,48,56,57). When expensive transfers are involved, it may be cost-effective
(26,53–55,58). Break-even analyses demonstrated that a telepsychiatry service needs
approximately seven consultations weekly (20,38,51). Guidelines offer suggestions to
improve data that are related to costs (9,10,59–62), mainly through cost-effectiveness and
cost–benefit analysis (63,64).
Education
Telemedicine has been used for several educational initiatives, including provider education
(65,66), clinical consultation (15) and supervision (67). It has successfully linked academic
centres with rural areas for continuing medical education in North America and
internationally (17,65). Clinical consultations also reduce provider isolation, provide case-
based learning (68,69) and help with decision support (70), particularly when providers sit
in for the evaluation (71). Outcomes of interventions by telepsychiatry have been assessed
in only one study (22).
Empowerment
Patients have reduced travelling time (8,20,39), less time absent from work (20), reduced
waiting time (25) and more choice and control (20). Primary care providers have access to
specialists for patient care and education, are able to “keep” treating their patients, rather
than referring (49), and feel good about their practice. Communities have “kept” their
patients, reduced costs for transfers (54,55) and retained dollars that would otherwise have
been lost to suburban centres upon referral (72).
Communities presumably also benefit from providing a higher quality of care, from having
more opportunities for staff education, from experiencing greater ease with recruitment and
from having greater ease with accreditation.
Other Factors Affecting Effectiveness
Technology. The most important issue is having adequate bandwidth for the task at hand
and alternative plans if a limitation exists. The transmission speed in KBS and picture
quality in FPS are important determinants of the interaction quality between the provider
and the patient (2,73).
Administrative Coordination. Coordination is necessary to initiate and maintain a
telepsychiatry program, particularly for clinical protocols, staffing time and technical
assistance. Financial support is necessary from within the institution or from local, regional
or federal agencies.

Recommendations and Conclusions

Telepsychiatry appears effective, based on the preliminary data on access to care, quality of
care (that is, outcomes, diagnosis and ability for users to communicate), satisfaction and
education. It also empowers patients, providers and communities. It is premature to claim
that telepsychiatry is cost-effective (21). Technology and program coordination are
important determinants to its short- and long-term viability.
The results of this article appear similar to a review of 66 studies that compared
telemedicine with a comparison group with respect to administrative changes, patient
outcomes and economic issues (8). Thirty-seven (56 per cent) suggested that telemedicine
had advantages over the alternative approach; 24 (36 per cent) found negative issues or
were unable to draw conclusions, and five (eight per cent) found alternatives to be superior.
Further assessment of telepsychiatry’s effectiveness is needed (1,2,6,8,35,51,52). However,
frameworks have been proposed (6,7,9–11), and Table 3 summarizes key aspects according
to the parameters discussed in this article with regard to effectiveness. All parameters could
benefit from further assessment, particularly in terms of outcomes and costs. RCTs with
telemedicine are feasible, enable recruitment of patients and maintain enrolment (74). It is
desirable to include a cost–effectiveness or cost–benefit analysis.
Table 3 Recommendations for evaluating the effectiveness of telepsychiatry
Access
Assessment of whether or not there was increased access to care and a description of the kind of care
Services specific to the need (for example, consultation-liaison to primary care)
Quality of Care
Study methods Studies: randomized controlled trials with prospective data collection
 Longitudinal data collection, as applicable and feasible
Comparison group and (or) baseline data
Systematic collection of surveys and other data
Large sample size
Reliabililty Diagnostic ability
Detection of limitations, if any
Outcomes Diagnostic quality
Changes in clinical health status
Changes in disease management
Effect on patient quality of life
Satisfaction
Systematic collection of patient (lack of travel and lost work time), provider (assistance or education for decision-making) and
specialist (potential lack of travel) satisfaction related to service: baseline, longitudinal, compared with alternative service options
Costs
Complete analysis with inclusion of all key components and broad focus: patient costs (lack of travel and lost work time), provider
costs (application of skills to other patients), specialist costs (potential lack of travel, increased orders for tests), initial program
investment costs (increased treatment costs), operational costs (including staff time) and societal costs
Realistic estimates of costs
Presence of a cost analysis, preferably cost-effectiveness or cost–benefit analysis: short-term (period of study or project) and long-
term (estimated, if not literally collected)
Education
Interventions: didactics, case-based teaching and (or) others
Change in knowledge and (or) skill set at time of intervention; whether or not the change, if any, is preserved on follow-up
Change in patient outcomes
Empowerment

Patients: reduced time to travel, less absence from work, reduced waiting time and more choice and control
Primary care providers: access to specialists, education and able to “keep” their patients
Community: able to “keep” their patients, higher quality of care, more opportunities for staff education, greater ease with recruitment
and greater ease with accreditation
Miscellaneous
Technology Adequate description of equipment, bandwidth, frames per second, and other parameters used
Data on failures, problems (for example, reliability)
Administration Coordination to initiate and maintain a program at each site and between sites
Financial support from institutional, local, regional, or federal grant agencies
Other Reporting of positive and negative findings in the literature
Acknowledgement of need to publish positive findings and other potential biases
Sensitivity analysis to “fit” findings of one study or program to others

This article is only a preliminary exploration of the effectiveness of telepsychiatry, with

potential indicators of effectiveness being proposed. There are other potential parameters of
effectiveness. In addition, this article has looked at the parameters individually as a starting
point, although in fact, many, if not all, of the parameters bear on one another.

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Telemedicine and Telehealth Articles

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Mental Health Care for the Rural Elderly: A Bibliography
January, 2005
The following references are from an article in the Telehealth Practice Report by Terry
Rabinowitz, M.D., F.A.P.A., F.A.P.M. and Katharine M. Murphy, Ph.D., R.N. Dr Rabinowitz is
at the Departments of Psychiatry and Family Medicine, University of Vermont College of
Medicine and Fletcher Allen Health Care, Burlington, Vermont; Dr. Murphy is at Hebrew
SeniorLife, Boston, Massachusetts. The article was entitled A Review of Telepsychiatry
Services for Rural Elders: It's Time... We Think!(Vol 9 #6 12-13 2005) The following is an
extensive list of references on mental health care for the rural elderly, including telehealth
and face-to-face care. They are numbered sequentially as they appear in the article text.
1. Kumar V, Acanfora M, Hennessy CH, Kalache A. Health status of the rural elderly. J
Rural Health 2001;17(4):328-31
2. Lau SC, Lee LL, Lin BJ, Liu YH, Yu SM, Tang SH, Sheng PC. The health status of
rural and urban ambulatory elderly in Taipei County. Chang Gung Med J
2001;24(8):492-501
3. Coburn AF, Keith RG, Bolda EJ. The impact of rural residence on multiple
hospitalizations in nursing facility residents. Gerontologist 2002;42(5):661-6
4. Neese JB, Abraham IL, Buckwalter KC: Utilization of mental health services among
rural elderly. Archives of Psychiatric Nursing 1999;13(1):30-40
5. Lambert D, Agger MS. Access of rural AFDC Medicaid beneficiaries to mental health
services. Health Care Financing Review 1995;17(1):133-45
6. Mueller KJ, Patil K, Ullrich F. Lengthening spells of uninsurance and their
consequences. J Rural Health 1997;13(1):29-37
7. Eberhardt MS, Ingram DD, Makuc DM. Urban and rural health chartbook: Health
United States 2001. Hyattsville, MD, National Center for Health Statistics, 2001
8. Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE (eds). Reducing suicide: a
national imperative. Washington, DC, National Academy Press, 2002
9. Wagenfeld MO, Murray JD, Mohatt DF, DeBruyn JC (eds). Mental health and rural
America: 1980-1993: an overview and annotated bibliography. Washington, DC, U.
S. Government Printing Office, 1994
10. Strahan G. An overview of nursing homes and their current residents: data from the
1995 National Nursing Home Survey. Advance data from vital and health statistics;
no. 280. Hyattsville, Maryland, National Center for Health Statistics, Public Health
Service, 1997, pp 3
11. Zimmer JG, Watson N, Treat A. Behavioral problems among patients in skilled
nursing facilities. Am J Public Health 1984; 74(10):1118-21
12. Rovner BW, Kafonek S, Filipp L, Lucas MJ, Folstein MF. Prevalence of mental illness
in a community nursing home. Am J Psychiatry 1986; 143(11):1446-9
13. Borson S, Liptzin B, Nininger J, Rabins P. Psychiatry and the nursing home. Am J
Psychiatry 1987; 144(11):1412-8
14. New Freedom Commission on Mental Health, Subcommittee on rural issues:
background paper. Rockville, MD, DHHS, 2004; see p. 9
15. New Freedom Commission on Mental Health: Achieving the Promise: Transforming
Mental Health Care in America, DHHS Pub. No. SMA-03-3832 (web site accessed Oct
15, 2004). Rockville, MD: 2003
16. The American Geriatrics Society and American Association for Geriatric Psychiatry
recommendations for policies in support of quality mental health care in U.S.
nursing homes. J Am Geriatr Soc 2003;51(9):1299-304
17. Katz IR, Lesher E, Kleban M, Jethanandani V, Parmelee P. Clinical features of
depression in the nursing home. International Psychogeriatrics 1989; 1(1):5-15
18. Parmelee PA, Katz IR, Lawton MP. Depression among institutionalized aged:
assessment and prevalence estimation. Journals of Gerontology 1989; 44(1):M22-9
19. Rovner BW, German PS, Brant LJ, Clark R, Burton L, Folstein MF. Depression and
mortality in nursing homes. Journal of the American Medical Association 1991;
265(8):993-6
20. Richardson J, Bedard M, Weaver B. Changes in physical functioning in
institutionalized older adults. Disabil Rehabil 2001; 23(15):683-9
21. Heeren O, Borin L, Raskin A, Gruber-Baldini AL, Menon AS, Kaup B, Loreck D,
Ruskin PE, Zimmerman S, Magaziner J. Association of depression with agitation in
elderly nursing home residents. J Geriatr Psychiatry Neurol 2003;16(1):4-7
22. Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, 3rd, Alexopoulos GS, Bruce
ML, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee
P. Diagnosis and treatment of depression in late life. Consensus statement update.
Jama 1997;278(14):1186-90
23. Revicki DA, Simon GE, Chan K, Katon W, Heiligenstein J. Depression, health-related
quality of life, and medical cost outcomes of receiving recommended levels of
antidepressant treatment. J Fam Pract 1998; 47(6):446-52
24. Covinsky KE, Fortinsky RH, Palmer RM, Kresevic DM, Landefeld CS. Relation
between symptoms of depression and health status outcomes in acutely ill
hospitalized older persons. Ann Intern Med 1997;126(6):417-25
25. Koenig HG, Kuchibhatla M. Use of health services by medically ill depressed elderly
patients after hospital discharge. American Journal of Geriatric Psychiatry
1999;7(1):48-56
26. Parmelee PA, Katz IR, Lawton MP. Depression and mortality among institutionalized
aged. Journal of Gerontology 1992;47(1):P3-10
27. Rovner BW. Depression and increased risk of mortality in the nursing home patient.
American Journal of Medicine 1993;94(5A):19S-22S
28. Osgood NJ. Environmental factors in suicide in long-term care facilities. Suicide Life
Threat Behav 1992;22(1):98-106
29. Alexopoulos GS, Bruce ML, Hull J, Sirey JA, Kakuma T. Clinical determinants of
suicidal ideation and behavior in geriatric depression. Archives of General Psychiatry
1999; 56(11):1048-53
30. Streim JE, Oslin DW, Katz IR, Smith BD, DiFilippo S, Cooper TB, Ten Have T. Drug
treatment of depression in frail elderly nursing home residents. American Journal of
Geriatric Psychiatry 2000;8(2):150-9
31. Magai C, Kennedy G, Cohen CI, Gomberg D. A controlled clinical trial of sertraline in
the treatment of depression in nursing home patients with late-stage Alzheimer's
disease. American Journal of Geriatric Psychiatry 2000;8(1):66-74
32. McCurren C, Dowe D, Rattle D, Looney S. Depression among nursing home elders:
testing an intervention strategy. Applied Nursing Research 1999;12(4):185-95
33. Fitzsimmons S. Easy rider wheelchair biking. A nursing-recreation therapy clinical
trial for the treatment of depression. J Gerontol Nurs 2001;27(5):14-23
34. Rosen J, Rogers JC, Marin RS, Mulsant BH, Shahar A, Reynolds CF, 3rd. Control-
relevant intervention in the treatment of minor and major depression in a long-term
care facility. American Journal of Geriatric Psychiatry 1997 5(3):247-57
35. Zerhusen JD, Boyle K, Wilson W. Out of the darkness: group cognitive therapy for
depressed elderly. J Psychosoc Nurs Ment Health Serv 1991;29(9):16-21
36. Santmyer KS, Roca RP. Geropsychiatry in long-term care: a nurse-centered
approach. J Am Geriatr Soc 1991;39(2):156-9
37. Llewellyn-Jones RH, Baikie KA, Smithers H, Cohen J, Snowdon J, Tennant CC.
Multifaceted shared care intervention for late life depression in residential care:
randomised controlled trial. Bmj 1999;319(7211):676-82
38. Tyrrell J, Couturier P, Montani C, Franco A. Teleconsultation in psychology: the use
of videolinks for interviewing and assessing elderly patients. Age Ageing
2001;30(3):191-5
 39. Johnston D, Jones BN, 3rd Telepsychiatry consultations to a rural nursing facility: a
2-year experience. J Geriatr Psychiatry Neurol 2001;14(2):72-5
40. Sumner CR. Telepsychiatry: challenges in rural aging. J Rural Health
2001;17(4):370-3
41. Tang WK, Chiu H, Woo J, Hjelm M, Hui E Telepsychiatry in psychogeriatric service: a
pilot study. Int J Geriatr Psychiatry 2001;16(1):88-93
42. Ball C. Telemedicine and old age psychiatry, in Telepsychiatry and e-mental health.
Edited by Wootton R, Yellowlees P, McLaren P. London, England, Royal Society of
Medicine Press, 2003, pp 183-196
43. Kropf NP, Grigsby RK. Telemedicine for older adults. Home Health Care Serv Q
1999; 17(4):1-11
44. Wittson CL, Duton R: A new tool in psychiatric research. Ment Hosp 1956;7:11-14
45. Hassol A, Gaumer G, Grigsby J, Mintzer CL, Puskin DS, Brunswick M. Rural
telemedicine: a national snapshot. Telemed J 1996;2(1):43-8
46. Lipson LR, Henderson TM. State initiatives to promote telemedicine. Telemedicine
Journal 1996;2(2):109-21
47. Bratton RL, Cody C. Telemedicine applications in primary care: a geriatric patient
pilot project. Mayo Clin Proc 2000;75(4):365-8
48. Chae YM, Heon Lee J, Hee Ho S, Ja Kim H, Hong Jun K, Uk Won J. Patient
satisfaction with telemedicine in home health services for the elderly. Int J Med Inf
2001;61(2-3):167-73
49. Stroetmann KA, Erkert T. 'HausTeleDienst'--a CATV-based interactive video service
for elderly people. Stud Health Technol Inform 1999;64:245-52
50. Gustke SS, Balch DC, West VI, Rogers LO. Patient satisfaction with telemedicine.
Telemed J 2000;6:5-13
51. Mair F, Whitten P. Systematic review of studies of patient satisfaction with
telemedicine. Bmj 2000;320(7248):1517-20
52. Hui E, Woo J, Hjelm M, Zhang YT, Tsui HT. Telemedicine: a pilot study in nursing
home residents. Gerontology 2001;47(2):82-7
53. Nakamura K, Takano T, Akao C. The effectiveness of videophones in home
healthcare for the elderly. Med Care 1999;37(2):117-25
54. Montani C, Billaud N, Couturier P, Fluchaire I, Lemaire R, Malterre C, Lauvernay N,
Piquard JF, Frossard M, Franco A. 'Telepsychometry': a remote psychometry
consultation in clinical gerontology: preliminary study. Telemedicine Journal 1996;
2(2):145-50
55. Ball C, Puffett A. The assessment of cognitive function in the elderly using
videoconferencing. J Telemed Telecare 1998;4 Suppl 1:36-8
56. Montani C, Billaud N, Tyrrell J, Fluchaire I, Malterre C, Lauvernay N, Couturier P,
Franco A. Psychological impact of a remote psychometric consultation with
hospitalized elderly people. J Telemed Telecare 1997;3(3):140-5
57. Shores MM, Ryan-Dykes P, Williams RM, Mamerto B, Sadak T, Pascualy M, Felker
BL, Zweigle M, Nichol P, Peskind ER. Identifying undiagnosed dementia in residential
care veterans: comparing telemedicine to in-person clinical examination. Int J
Geriatr Psychiatry 2004;19(2):101-8
58. Loh PK, Ramesh P, Maher S, Saligari J, Flicker L, Goldswain P. Can patients with
dementia be assessed at a distance? The use of Telehealth and standardised
assessments. Intern Med J 2004;34(5):239-42

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