ABSTRACT
There is growing concern about the availability of health care services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health (MH) conditions in North America. Using the Preferred Reporting Items for Systematic Reveiws and Meta-Analyses guidelines, we used four electronic databases (Pubmed, Cochrane, APA PsycInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus nonrural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle-Ottawa Scale was used. Our initial search returned 491 studies, and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), posttraumatic stress disorder (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities, while 11 (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates, and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in-person outreach to these rural communities may be alternative to impact these outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This critical review of the literature highlights that health disparities such as suicide rates/ideation, access to care, and utilization of mental health services are essential factors that put some subsets of rural patients compared to urban patients at a disadvantage. There is still a significant need for more research post COVID-19 on the use of telepsychiatry and rural health populations with mental health conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Introduction: Given the increasing use of telepsychiatry and to serve as a reference point informing future research, our team evaluated the literature on the use of telepsychiatry for medication adherence promotion prior to the COVID-19 pandemic among patients with psychotic disorders. Methods: A search of PubMed, Cochrane, Web of Science, CINAHL, and PsycINFO was conducted using PRISMA guidelines to identify telepsychiatry interventions to enhance medication adherence in patients with primary psychotic disorders. Both quantitative and qualitative data were extracted from the identified articles including study characteristics, interventions, and outcomes. Results: In total, 230 articles were obtained through electronic literature search, and 4 articles were eventually retained that met inclusion criteria. All 4 articles were randomized controlled trials, were adjuncts to in-person usual care, used telephone platforms and targeted medication adherence. Compared to treatment as usual, 3 out of 4 studies found medication adherence was improved and 2 out of 4 studies found improved medication attitudes. Telepsychiatry appeared to be acceptable to patients with psychotic disorders. Discussion: In the pre-Covid-19 literature, telepsychiatry appears promising as an adjunct to usual care for increasing medication adherence among individuals with schizophrenia/schizoaffective disorder. However, given the limited number of papers and exclusive use on telephone-only to deliver telepsychiatry, additional research specific to telepsychiatry for patients with psychosis is needed.