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. 2021 Jul 20;23(7):e26492. doi: 10.2196/26492

Table 3.

Implementation outcomes.

Outcome Study Assessment or treatment Main diagnosis Intervention (number of studies) Comparator (number of studies) Results
Assessment comparability

Drago et al (2016) [27] Assessment and treatment Multiple Videoconferencing (n=24) Face-to-face (n=23); no comparator (n=1) Assessment was found to be highly consistent between remote and face-to-face settings; correlation coefficient=0.73 (95% CI 0.63-0.83).

Muskens et al (2014) [32] Assessment Multiple Telephone diagnostic interviewing (n=16) Face-to-face diagnostic interviewing (n=16) There were a few studies that were properly performed to draw conclusions regarding the comparability of telephone and face-to-face interviews for psychiatric morbidity. Telephone interviewing for research purposes in depression and anxiety may however be a valid method.
Fidelity and competence of therapists Turgoose et al (2018, veterans) [38] Treatment PTSDa Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) Face-to-face (n=41) High levels of fidelity and therapist competence (n=3), with no significant differences compared with face-to-face settings.
Patient adherence to intervention

Bolton and Dorstyn (2015) [24] Treatment PTSD Internet-based CBTb with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) Qualitative feedback revealed that the comprehension of the therapy materials was high, with participants completing a set of homework tasks (n=5).

Dorstyn et al (2013, ethnic minorities) [21] Treatment Depression Telephone CBT (n=2); telephone supportive counseling (n=1); telephone structural ecosystems therapy (n=1); internet-based CBT with weekly individual sessions (n=2); internet telepsychiatry (n=1); internet supportive counseling and personalized email correspondence (n=1) Face-to-face (n=1); treatment as usual (n=3); minimal support control or waitlist (n=2); no control (n=2) Most studies reported good treatment adherence with rates of completion of 75-97%.

Garcia-Lizana and Munoiz-Mayorga (2010) [28] Assessment and treatment Multiple Videoconferencing for diagnosis and follow-up (n=3); video-based evaluation of competency to stand trial (n=1); nonspecific video-based CBT (n=5); video-based psychoeducation and counseling (n=1) Face-to-face (n=10) Across two studies, mixed results were found for treatment adherence, with one study finding no difference and another reporting better adherence in the face-to-face group.
Patient attendance

Dorstyn et al (2013, ethnic minorities) [21] Treatment Depression Telephone CBT (n=2); telephone supportive counseling (n=1); telephone structural ecosystems therapy (n=1); internet-based CBT with weekly individual sessions (n=2); internet telepsychiatry (n=1); internet supportive counseling and personalized email correspondence (n=1) Face-to-face (n=1); treatment as usual (n=3); minimal support control or waitlist (n=2); no control (n=2) One study reported difficulty reaching participants by telephone resulting in fewer sessions completed.

Christensen et al (2019, older adults) [25] Treatment Depression or a range of diagnoses including depression Video consultations for telepsychiatry (n=21) Face-to-face (11), no control (10) Video consultations increased access to care and removed barriers such as having to travel (n=4).

Lin et al (2019) [30] Treatment Substance use disorders Video- or telephone-based psychotherapy (n=10); remote medication management (n=3; patient presents at local clinic with nurse and are connected to a physician at a distant site via videoconference) Face-to-face psychotherapy (n=7); telephone (n=2); treatment as usual (n=1); no control (n=3) Most studies reported increased retention in telemental health groups (n=4); however, no difference in in number of sessions attended was sometimes reported (n=2). One alcohol addiction study reported lower dropout in the telemental health group, and more patients in this group were still in treatment at 6 months and one year. Two opioid addiction studies found that videoconference interventions resulted in a better retention of participants up to one year as compared with those receiving in-person care. Another opioid study found >50% retention at 12 weeks but did not have a comparison group. However, another two studies found no difference between videoconference-delivered psychotherapy and in-person psychotherapy in the number of sessions attended.

Turgoose et al (2018 veterans) [38] Treatment PTSD Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) Face-to-face (n=41) In the majority of cases, there were no differences between teletherapy and in-person treatments on dropout or attendance. There was some indication that teletherapy may help to increase uptake.
Safety

Bolton and Dorstyn (2015) [24] Treatment PTSD Internet-based CBT with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) Client safety was deemed satisfactory.

Turgoose et al (2018, veterans) [38] Treatment PTSD Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) Face-to-face (n=41) There might be some occasions where veterans have concerns about exposure tasks due to the lack of physical presence of the therapist; however, overall, it was established that these can be used just as effectively remotely. If appropriate steps are taken to manage safety, then episodes of acute suicidality can also be managed.
Technical difficulties

Bolton and Dorstyn (2015) [24] Treatment PTSD Internet-based CBT with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) Minimal technical difficulties were encountered (n=1); participants reported that they would have preferred different forms of media, for example, a mobile app, to supplement support (n=1).

Christensen et al (2019, older adults) [25] Treatment Depression or a range of diagnoses including depression Video consultations for telepsychiatry (n=21) Face-to-face (11), no control (10) Challenges such as mistrust in technology were reported frequently (n=4).

Turgoose et al (2018, veterans) [38] Treatment PTSD Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) Face-to-face (n=41) Commonly reported technical difficulties were low-image resolution on videoconferencing technology, not being able to connect, and audio delays.

aPTSD: posttraumatic stress disorder.

bCBT: cognitive behavioral therapy.