Chris Ball

A Comparison of Communication Modes in Adult Psychiatry

The process and outcome of clinical tasks in an acute psychiatric unit were compared using four different communication modes: face to face, telephone, hands-free telephone, and a low-cost videoconferencing system. Six doctors and six patients took part in the study. Four assessment measures were used. The videoconferencing system was positively received by both patients and doctors. Both doctors and patients preferred communication modes with visual cues. However, there were few significant differences between communication modes when using single measures; only multiple levels of analysis can adequately assess the differences between such modes of communication.

The assessment of cognitive function in the elderly using videoconferencing

People over the age of 65 were recruited from an inner-city old-age psychiatry service. Subjects had a structured interview (the CAMCOG test) by videoconferencing, and also face to face, by an investigator blind to the results of the test in the other mode. Reassessments were carried out within one week of the initial assessment. Eleven subjects were initially enrolled in the study and eight completed both modes. The number of patients in this study is very small but the results suggest that the CAMCOG test can be used reliably over a videoconferencing system without major modification.

Telemedicine: lessons remain unheeded

Telemedicine, the delivery of health care with the patient and health professional at different locations, has been around for over 30 years. Its driving force has been developments in communications technology, and as new communications systems are developed health applications are proposed such as supporting the delivery of primary health care to geographically remote areas or regions underserved through the maldistribution of professional expertise. Despite rapid technological advances, evaluations of such systems have been largely superficial, and more thorough evaluations have failed to show significant advantages for more advanced and expensive technology over older technology such as the telephone. Methods for evaluating the impact of particular technologies on the health care system need to be developed and clearer benefits shown in terms of improved standards of care.

The tele-assessment of cognitive state: a review

The telephone is used by all mental health professionals and many of their clients. Despite this, the telephone has been formally evaluated only occasionally. This paper reviews the literature on cognitive testing by telephone and by videoconferencing, and summarizes the different strategies employed to do this task. There remain weaknesses in the use of the telephone for cognitive testing but it could certainly be used more extensively in both clinical work and research, although the choice of test must be made with a clear view of what the assessment is designed to achieve and the limitations of the assessment instrument itself. Assessment by videoconferencing remains at an early stage of development, with much work to be done before it can be routinely employed as a clinical tool. However, videoconferencing shows promise for the future because it allows a much wider range of assessment than the telephone.

Scoring written material from the Mini-Mental State Examination: a comparison of face-to-face, fax and video-linked scoring.

We assessed the reliability of scoring written items of the Mini-Mental State Examination (MMSE) using different communication modes: face to face, fax and videoconferencing. A total of 99 MMSEs were recovered from the records of a community mental health team for the elderly. The written parts of the examination (sentence and pentagrams) were scored - in person, using a faxed copy or over the video-link - according to published criteria. Relative to in-person scoring, sentences could be scored reliably when faxed (kappa=0.80), as could pentagrams (kappa=0.71). Sentences could be reliably scored over the videoconferencing link (kappa=0.70), but pentagrams could not (kappa=0.47). Caution is required before accepting the results of scoring such tests over video-links.

Interpersonal communications and telemedicine: hypotheses and methods

Demonstration interviews between a psychiatrist who has used videolinks for a range of clinical interactions and a simulated patient facilitate a better understanding of interpersonal communication, both face to face and mediated. This might allow users to be trained to maximize the use of the available communications technology and provide a source of more rational reassurance for the technophobic professional.

Preliminary evaluation of a low cost videoconferencing system for teaching in clinical psychiatry.

The use of a digitized low cost videoconferencing system (LCVC) for the teaching of clinical medical students on clinical attachment to a psychiatric ward is described. This work was performed as part of the Telemed project which is evaluating the use of the LCVC in a range of tasks in clinical psychiatry. Any move towards greater reliance on communications technology in psychiatry should take account of the requirements of clinical teaching. The case presentation was used as a teaching paradigm in a controlled study comparing teaching face-to-face with teaching mediated via the LCVC. A questionnaire was developed for student evaluation of the case presentation. General user responses to the LCVC are reported. No significant differences were found between the conditions. User responses were favourable, suggesting that remote interactive teaching via the LCVC warrants further investigation.

Videoconferencing and the hard of hearing.

Hearingproblems are commoninthe elderly. More thanhalf of those over 75years of age have some hearing difficulty1. The commonest cause of these problemsisanage-relatedlossof theabilitytoperceive tones over 2000Hz. The frequencies usedinspeechlie between500and6000Hz. Since the majorityof the sense of speechis containedinthe consonants which occupyhigher tones, the changes that come with ageing have adisproportionate effect uponaperson’s ability tounderstandspeech1. Suchphenomenapresentproblemsintheday-to-day clinical practiceofallwhoareinvolvedwiththecareof elderlypeople. It is not yet clear towhat extent these problems mayhave animpact onthe use of videoconferencing for the assessment andmanagement of elderlypersons. Thefollowingcasestudyreportsapair of interviews byvideoconferencing inwhichcommunicationwas extremelydifficult owingto the deafness of the patient; it examines the responses of the participants tothose difficulties andthe theoretical issues raised.

Doctors and nurses : Referrals by general practitioners to different arms of an old age psychiatry service

General practitioners’ referrals to the medical and nursing arms of an old age psychiatry service over a 6‐month period were examined retrospectively. Doctors were referred patients with a past psychiatric history who had been known to the service, did not live alone and in whom first‐line treatments had failed. The nursing team were asked to carry out specific therapies by the GPs. There were no differences in support, diagnosis or medication between the groups. The need for multidisciplinary input to all referrals to services is stressed.