Nursing home telepsychiatry.

Practicing psychiatry by remote access (telepsychiatry) is not a new development. Two-way interactive television has been used on an experimental basis since 1959 in Nebraska, and it has spread to other states as well. Its acceptance and efficacy was evaluated in several studies. In a study using questionnaires, patients’ evaluations of the interview was the same in control and experimental groups, and evaluation of consultants and consultees was only slightly lower in the experimental group than in control group.1 In a study using the Brief Psychiatric Rating Scale investigators compared patient’s verbal reports and observational items using 2-way computer system. They found that although there was good agreement in both rating, the agreement was higher for verbal reports than for observational items.2 They ascribed the lower agreement between observational items to low quality of the computer image. A randomized study compared face-to-face and telepsychiatry consultation in 495 patients. Clinical outcomes were equivalent in both groups, and patients expressed similar levels of satisfaction with the service.3 A recent literature review concluded that telepsychiatry appears to be a viable option that is well accepted by patients, including those having dementia.4 Telepsychiatry may be especially suitable for nursing homes, which do not have a geriatric psychiatrist on their staff. Prevalence of mental disorders in nursing home residents is higher than prevalence of mental disorders in community dwelling individuals of the same age.5 This is caused by a high percentage of nursing home residents with cognitive impairment because at least 1 neuropsychiatric symptom was found in 82% of the residents with dementia.6 However, individuals with severe mental illness without dementia, including patients diagnosed with schizophrenia, other psychosis, personality disorder, and bipolar disorder are also admitted to nursing homes.7 Thus, nursing homes need psychiatric services for their residents. However, although nursing home populations is increasing and is expected to reach 3.2 million people by 2030, the number of geriatric psychiatry fellows is steadily declining and in 2010 was only one half of the number of fellows in 2005.8 Therefore, many nursing homes will not have available on-site services of a geriatric psychiatrist. General acceptance of telepsychiatry is indicated by existence of several companies offering telepsychiatric services.9e13 Most of them offer services of both psychiatrists and psychiatric nurse practitioners