Researchers demonstrated the feasibility of using prerecorded videos of patients, along with other patient information, to provide psychiatric consultations to referring primary care clinicians. This process, known as asynchronous telepsychiatry, was developed to increase access to services for people in underserved rural communities.

Researchers, led by Peter M. Yellowlees, M.B.B.S., M.D., at the University of California, were seeking to address the problem of a substantial shortage of mental health providers in rural areas where primary care clinicians are the sole providers for most patients with mental illness. Telepsychiatry with live discussions, using live two-way interactive video transmission, has been used for some time. However, scheduling and technological difficulties limit the use of this approach to telepsychiatry. An asynchronous approach, in which a psychiatrist watches a prerecorded patient interview can make distance care more widely available.

In the study, a nonpsychiatrist research physician conducted 20 to 30-minute interviews with English speaking adults who were believed to have nonemergency psychiatric problems by their primary care physician. The videotaped interviews were sent, along with other patient data, to psychiatrists who provided consultation to the primary care physicians.

Most of the 60 patients participating in the study received a diagnosis of depression, anxiety, or substance use disorder, and many had co-occurring disorders. The consulting psychiatrists recommended additional laboratory tests for 83 percent of the patients and medication changes for 95 percent. They also recommended a range of psychotherapies and provided the primary care clinicians with recommendations for long-term treatment for 95 percent of the patients. One patient was referred for a face-to-face consultation with a psychiatrist.

The consulting psychiatrists provided feedback within two weeks; however, the researchers noted that feedback could be provided within 24 hours if asynchronous telepsychiatry were to become a regular service. Asynchronous telepsychiatry could be suitable for up to 80 percent of patients requiring assessment, according to the study authors.

The authors note that this type of assessment should not replace the face-to-face psychiatric interview and is not suitable for all patients, but it may "be a very helpful additional process that improves access to care and expertise." The approach could be useful in a variety of settings and it "signals the beginning of the true multimedia electronic medical record," the authors conclude.

The study, "A Feasibility Study of the Use of Asynchronous Telepsychiatry for Psychiatric Consultations," appears in the August issue of Psychiatric Services, a journal of the American Psychiatric Association.