From the couch to the network: What is telemedicine?

Telemedicine is known as all those diagnostic or therapeutic activities conducted through an electronic medium that allow the transmission of images or verbal information. This definition implies the absence of face-to-face interview and with it, the do not need to scroll both doctor and patient.

It seems clear that the reduction in the number of visits and medical expenses and probably, the greater comfort and accessibility for both the patient and the doctor, may be advantages attributable to this modality of medicine. Psychiatry does not escape this technological boom, several studies show the effectiveness and the positive cost-benefit of this activity, although there are few studies that support its effectiveness, so it is still highly useful and interesting development.

Telemedicine is the use of telecommunication to provide clinical healthcare from a distance.

Among the benefits that stand out from telepsychiatry are: allowing a provision of quality services at a local level, minimising unnecessary trips for patients, enabling communication with health professionals in remote locations and modernising the working environment of doctors. However, not all patients are ideal for this practice.

It is contraindicated in patients who refuse to participate, violent, unstable, impulsive or very manipulative, with immediate risk of suicide or great danger, or if there is a profile of symptoms that may be exacerbated by the use of technology.

It is also not ideal for transmitting information that needs to be communicated face-to-face, when the patient has an auditory, visual or cognitive deficit that limits him in his use of technology or when decisions have to be made against the will of the patient (restoration of treatment, entry decision, etc.). On the other hand, psychiatric stigma makes this practice a safe environment, to be done in the comfort of the home.

Not all patients are ideal for telemedicine.

In 2008, it was estimated that approximately 20,000 web pages were devoted to healthcare; number far exceeded today. Recently, it has been found that more than 10% of the general population and more than 20% of those with a history of mental illness use the internet as the primary source of information on mental health.

The treatment programmes for mental disorders that have demonstrated effectiveness are complex and integrate multiple components such as education, pharmacotherapy, psychosocial interventions, treatment monitoring, These involve a wide range of health professionals including the advice of specialised professionals.

The results, to date, show that the treatment offered by telepsychiatry services are comparable with the results obtained in face-to-face consultation treatments. As reported by Elford, in 1955 the Nebraska Psychiatric Institute used a closed circuit television system to transmit live therapeutic sessions to students for academic purposes.

During the following two decades, the Institute initiated a project in telepsychiatry, which showed that the group intervened with the new system could be managed appropriately, and managed to include remote monitoring of the consultations made in another hospital.

Telemedicine is expanding far beyond interactions between physicians and patients.

The next experience that opened the way to the development of telepsychiatry occurred in 1968, when psychiatrists at Massachusetts General Hospital used a bidirectional television connection with Logan International Airport for remote consultations. The participating professionals assessed the system positively and indicated the effectiveness of the intervention in some patients, such as children, adolescents and people diagnosed with schizophrenia.

For these patients, it was easier to talk with the ‘television psychiatrist’ than with a psychiatrist in person. The evolution of this practice already has important antecedents that support it, to be seen as a reliable tool with favourable results, providing new opportunities for the doctor and the patient.