ABSTRACT
BACKGROUND: Telepsychiatry is now common practice. Within consultation-liaison psychiatry (CLP), previous work has shown that telepsychiatry is feasible and satisfactory. To date, there has not been qualitative work done within CLP to describe the clinician's experience with telepsychiatry. OBJECTIVE: This study aimed to perform a thematic analysis of clinicians' perceived benefits and limitations of providing telepsychiatry in CLP. METHODS: An anonymous clinician survey querying demographics, education, training, technological experience, and practice characteristics was distributed via social media and professional listservs, the quantitative results of which are presented elsewhere. Two questions (What was the best/worst aspect of adapting to telepsychiatry?) required free-text responses; comments were allowed elsewhere. We performed a thematic analysis of the text responses because of its flexibility and ability to develop new insights. We synthesized and generated a codebook iteratively. Initial coding was completed by 3 co-authors independently, followed by discussion to build consensus. We used qualitative content analysis to better understand common trends and frequencies in the data. Saturation of themes was reached. RESULTS: A total of 333 behavioral health clinicians completed the survey, including 197 CLP participants. Most respondents (98.5%) responded to at least 1 open-answer question, with 314 reporting the worst aspects of telepsychiatry and 315 reporting the best aspects. Respondents made insightful comments about boundaries, public health implications, and the need for training. We categorized the results into implications for practice, therapeutic relationship, and uniquely affected populations. CONCLUSIONS: These results show that telepsychiatry has both unique benefits and limitations within CLP. Our work examines and describes these nuances. We believe that future use of telepsychiatry will be synergistic with in-person care and that the 2 modalities will be used together to maximize benefits. A public health focus on improving Internet access and simplifying interstate licensure would improve equitable access and utilization of outpatient telepsychiatry. Telepsychiatry can be successful for inpatient Consultation-Liaison work but requires thoughtful triage and teamwork.
ABSTRACT
OBJECTIVE: Male adolescents frequently present to the emergency department (ED) and many participate in behaviors increasing their risk of sexually transmitted infections and unintended pregnancies. Although the ED visit may represent an intervention opportunity, how best to design and deliver a sexual health intervention matching the preferences of adolescent male users is unclear. Our objective was to explore receptivity to and preferences for sexual health interventions among adolescent male ED patients. METHODS: In this qualitative study, we asked sexually active male ED patients aged 14 to 21 years about their attitudes toward ED-based sexual health interventions and preferences for intervention modalities. Participants interacted with an early prototype of a digital intervention to gather specific feedback. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo. RESULTS: Participants (n = 42) were predominantly 18 to 21 years (63%) and Hispanic (79%). Although most (71%) had sex in the prior 3 months, 45% did not use a condom at last intercourse and 17% had impregnated a partner. Participants viewed the ED visit as unused time without distracting influences, suitable for educational sexual health interventions. They considered ED-based digital interventions a reliable and confidential source of information. Engaging interventions allowed user control and provided novel and relatable content. CONCLUSIONS: Adolescent male ED patients are receptive to ED-based digital sexual health interventions. These identified preferences should be considered when designing future user-informed sexual health interventions for the ED setting.
