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We read with interest the narrative review of telemental health meta-analyses (1). The adoption of telemental health has in our experience been robust, suited to remote primary care and well received by patients.
We provide a combined asynchronous and synchronous mental health service for private UK primary care, offering the access to skilled clinicians, responsive communication and continuity of care that patients require. This approach has been effective and efficient for both assessment and treatment, evidenced by clinical outcomes, testing and patient experience feedback. However, adding another perspective, this form of care is perhaps no cheaper than in-person care given the technology developments needed, and in a private service the additional time needed for initial assessments as compared with NHS primary care.
Relevant to us in the UK are the clinical guidelines for telemental health/telepsychiatry that are primarily from RCPsych and GMC and focus on using videoconference (2). In contrast to all the guidance from the UK and the USA, we have found that the majority of patients choose telephone consultation rather than videoconference, which is similar to the experience of remote NHS primary care. There is very little telemental health guidance on using telephone consultations or on asynchronous care and nothing specific for primary care where the majority of mental health consultations take place. In addition, existing guidelines have little information to support other team members also delivering telemental health consultations such as Nurse Prescribers and Pharmacist Independent Prescribers (3). Our experience is that the extended team with appropriate training in mental health can offer a high standard of care.
We would welcome research into the use of telemental health in primary care including asynchronous care; understanding the use and appropriateness of telephone consultations as this is an easier delivery option than videoconference with fewer technical hurdles; and consideration of how care coordination using a wider range of health professionals is achievable using telemental health.
Neera Dholakia, GP, Mental Health Lead and Safeguarding Advisor, Lemonaid Health. neerad@23andme.com
Christina Hennessey, GP, Chief Medical Officer, Lemonaid Health
1. Telemental health for clinical assessment and treatment, Sugarman, D and Busch, A. BMJ 2023;380:e072398
2. Digital technologies and telepsychiatry, 2022, Oxford Health Biomedical Research Centre https://oxfordhealthbrc.nihr.ac.uk/our-work/oxppl/table-5-digital-techno... accessed 26/01/2023
3. Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies’ guidance, Leone, E et al. bmjopen-2021-055823
Competing interests:
ND and CH work for Lemonaid Health providing private primary care services in the UK through Boots Online Doctor. ND also works in NHS General Practice and is a GP clinical lead for physical health and mental health integration for CNWL FT.
Re: Telemental health for clinical assessment and treatment
Dear Editor
We read with interest the narrative review of telemental health meta-analyses (1). The adoption of telemental health has in our experience been robust, suited to remote primary care and well received by patients.
We provide a combined asynchronous and synchronous mental health service for private UK primary care, offering the access to skilled clinicians, responsive communication and continuity of care that patients require. This approach has been effective and efficient for both assessment and treatment, evidenced by clinical outcomes, testing and patient experience feedback. However, adding another perspective, this form of care is perhaps no cheaper than in-person care given the technology developments needed, and in a private service the additional time needed for initial assessments as compared with NHS primary care.
Relevant to us in the UK are the clinical guidelines for telemental health/telepsychiatry that are primarily from RCPsych and GMC and focus on using videoconference (2). In contrast to all the guidance from the UK and the USA, we have found that the majority of patients choose telephone consultation rather than videoconference, which is similar to the experience of remote NHS primary care. There is very little telemental health guidance on using telephone consultations or on asynchronous care and nothing specific for primary care where the majority of mental health consultations take place. In addition, existing guidelines have little information to support other team members also delivering telemental health consultations such as Nurse Prescribers and Pharmacist Independent Prescribers (3). Our experience is that the extended team with appropriate training in mental health can offer a high standard of care.
We would welcome research into the use of telemental health in primary care including asynchronous care; understanding the use and appropriateness of telephone consultations as this is an easier delivery option than videoconference with fewer technical hurdles; and consideration of how care coordination using a wider range of health professionals is achievable using telemental health.
Neera Dholakia, GP, Mental Health Lead and Safeguarding Advisor, Lemonaid Health. neerad@23andme.com
Christina Hennessey, GP, Chief Medical Officer, Lemonaid Health
1. Telemental health for clinical assessment and treatment, Sugarman, D and Busch, A. BMJ 2023;380:e072398
2. Digital technologies and telepsychiatry, 2022, Oxford Health Biomedical Research Centre https://oxfordhealthbrc.nihr.ac.uk/our-work/oxppl/table-5-digital-techno... accessed 26/01/2023
3. Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies’ guidance, Leone, E et al. bmjopen-2021-055823
Competing interests: ND and CH work for Lemonaid Health providing private primary care services in the UK through Boots Online Doctor. ND also works in NHS General Practice and is a GP clinical lead for physical health and mental health integration for CNWL FT.