Title: Psychiatric intervention in a telemedicine setting: A feasibility study in a long-care facility
Abstract:
Background: In gerontopsychiatric long-term care settings, regular access to psychiatric specialist care is often not consistently ensured, highlighting the need to explore telemedical solutions. Mental health care in this context requires both planned and short-notice consultations to enable timely assessment and intervention. Acute psychiatric deteriorations create a high demand for rapid specialist support to relieve nursing staff and enable medication adjustments and clinical reassessments, while structured follow-up and systematic assessment remain essential.
Objective: This project aimed to implement and evaluate a telemedical application in long-term care facility, focusing on feasibility, usability, acceptance, and perceived effects on workflows, staff experience and resident outcomes.
Methods: This mixed-methods project was conducted in a long-term care facility in Vienna, Austria. Over an 11-week period, 57 teleconsultation-based case discussions were carried out in addition to standard monthly on-site psychiatric visits. Teleconsultations were conducted via video and involved the psychiatrist (remote), the facility psychologist, and the responsible registered nurses. Quantitative data were collected using short questionnaires completed immediately after each consultation by nurses, the psychiatrist, and the psychologist, assessing satisfaction, usability, and perceived impact. These data were complemented by qualitative interviews with nursing staff, psychologist and psychiatrist.
Results: Findings from six qualitative interviews indicated that initial staff skepticism shifted toward high acceptance after early implementation challenges were resolved. Teleconsultations were perceived as enabling comprehensive case discussions, timely decision-making, and high-quality documentation, with the tool functioning reliably. Staff reported increased feelings of security, preparedness, and attentiveness toward residents compared to the previous model of monthly psychiatric visits. Reported resident-related effects included faster medication adjustments, improved management of side effects, reduced behavioural disturbances, and perceived improvements in well-being. Hospital admissions appeared to decrease, although causal attribution remains uncertain due to the increased frequency of psychiatric contacts. Telepsychiatry was consistently described as a complementary addition to in-person care, with initial face-to-face contact considered essential. A key success factor was the presence of a dedicated on-site coordinator with clinical expertise and in-depth knowledge of residents and institutional workflows. Identified challenges included the need for earlier stakeholder communication, clearer documentation processes, and targeted training strategies. The quantitative analyses revealed that the most frequent consultation reasons were clinical follow-up and medication adjustments (n=53; 30.3% and n=45; 25.7%), followed by psychotic symptoms and aggressive behaviour (each n=18; 10.3%), based on a total of 175 reported indications (multiple responses possible). Commonly co-occurring symptom clusters included medication adjustment with follow-up (n=43), medication adjustment with aggression (n=18), and follow-up with aggression (n=17). The most frequently implemented measures were medication adjustments (n=21) and enhanced observation/monitoring (n = 19). Importantly, regarding organizational and timing effort respondents indicated only little change compared to standard care (mean organizational effort =3.2, mean time effort = 3.74, 5-point Likert scale; 1=lower, 5=higher) highlighting the feasibility of the telemedical approach.
Conclusion: Telepsychiatric consultations in gerontopsychiatric long-term care are feasible, well accepted, and beneficial when implemented as a structured supplement to on-site care. Clear coordination roles, interdisciplinary collaboration, and integration into existing workflows are critical. Long-term adoption further depends on organizational and financial feasibility.
