Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape

Shotaro Kinoshita^{1

2}, Kelley Cortright¹, Allison Crawford^{3

4}, Yuya Mizuno⁵, Kazunari Yoshida^{1

6}, Donald Hilty^{7

8}, Daniel Guinart^{9

10}, John Torous¹¹, Christoph U Correll^{9

10

12}, David J Castle^{13

14}, Deyvis Rocha¹⁵, Yuan Yang¹⁶, Yu-Tao Xiang¹⁶, Pernille Kølbæk^{17

18}, David Dines¹⁷, Mohammad ElShami¹⁹, Prakhar Jain²⁰, Roy Kallivayalil²¹, Marco Solmi^{22

23}, Angela Favaro^{22

23}, Nicola Veronese²⁴, Soraya Seedat²⁵, Sangho Shin⁵, Gonzalo Salazar de Pablo^{26

27}, Chun-Hung Chang²⁸, Kuan-Pin Su^{28

29}, Hakan Karas³⁰, John M Kane^{9

10}, Peter Yellowlees³¹, Taishiro Kishimoto^{1

9

10}

Affiliations

¹ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
² Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan.
³ Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁴ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁵ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁶ Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁷ Mental Health, Northern California Veterans Administration Health Care System, Mather, CA, USA.
⁸ Department of Psychiatry & Behavioral Sciences, University of California Davis, Sacramento, CA, USA.
⁹ Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
¹⁰ Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹¹ Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹² Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹³ Department of Psychiatry, University of Melbourne, Parkville, Australia.
¹⁴ Department of Psychiatry, St Vincent's Hospital, Fitzroy, Australia.
¹⁵ Psychoses Unit, Ambulatório de Psiquiatria Dra. Jandira Masur, São Paulo-SP, Brazil.
¹⁶ Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau Special Administrative Region, China.
¹⁷ Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
¹⁸ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁹ Shezlong, Inc., Cairo, Egypt.
²⁰ Department of Psychiatry, Grant Government Medical College, Mumbai, India.
²¹ Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India.
²² Department of Neuroscience, University of Padua, Padua, Italy.
²³ Padova Neuroscience Center (PNC), University of Padua, Padua, Italy.
²⁴ Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
²⁵ Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
²⁶ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
²⁷ Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
²⁸ An Nan Hospital, China Medical University, Tainan, Taiwan.
²⁹ College of Medicine, China Medical University, Taichung, Taiwan.
³⁰ Department of Psychology, Istanbul Gelişim University, Istanbul, Turkey.
³¹ Department of Psychiatry, University of California Davis, Sacramento, CA, USA.

PMID: 33243311
PMCID: PMC7750654
DOI: 10.1017/S0033291720004584

Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape

Shotaro Kinoshita et al. Psychol Med. 2022 Oct.

. 2022 Oct;52(13):2606-2613.

doi: 10.1017/S0033291720004584. Epub 2020 Nov 27.

Authors

Affiliations

¹ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
² Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan.
³ Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁴ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁵ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁶ Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁷ Mental Health, Northern California Veterans Administration Health Care System, Mather, CA, USA.
⁸ Department of Psychiatry & Behavioral Sciences, University of California Davis, Sacramento, CA, USA.
⁹ Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
¹⁰ Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹¹ Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹² Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹³ Department of Psychiatry, University of Melbourne, Parkville, Australia.
¹⁴ Department of Psychiatry, St Vincent's Hospital, Fitzroy, Australia.
¹⁵ Psychoses Unit, Ambulatório de Psiquiatria Dra. Jandira Masur, São Paulo-SP, Brazil.
¹⁶ Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau Special Administrative Region, China.
¹⁷ Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.
¹⁸ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁹ Shezlong, Inc., Cairo, Egypt.
²⁰ Department of Psychiatry, Grant Government Medical College, Mumbai, India.
²¹ Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India.
²² Department of Neuroscience, University of Padua, Padua, Italy.
²³ Padova Neuroscience Center (PNC), University of Padua, Padua, Italy.
²⁴ Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
²⁵ Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
²⁶ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
²⁷ Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
²⁸ An Nan Hospital, China Medical University, Tainan, Taiwan.
²⁹ College of Medicine, China Medical University, Taichung, Taiwan.
³⁰ Department of Psychology, Istanbul Gelişim University, Istanbul, Turkey.
³¹ Department of Psychiatry, University of California Davis, Sacramento, CA, USA.

PMID: 33243311
PMCID: PMC7750654
DOI: 10.1017/S0033291720004584

Abstract

Background: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.

Methods: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.

Results: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.

Conclusions: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.

Keywords: COVID-19; government regulation; health insurance reimbursement; telemedicine; telepsychiatry.

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Conflict of interest statement

Christoph U. Correll has been a consultant and/or advisor to, or has received honoraria from: Alkermes, Allergan, Angelini, Boehringer-Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He has received grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma. David Dines reported receiving financial support from Lundbeck. Mohammad ElShami works in a Shezlong telepsychiatry company as a medical director, and is a co-founder of the company. Daniel Guinart has been a consultant for and/or has received speaker honoraria from Otsuka America and Janssen Pharmaceuticals. Hakan Karas is a co-founder of a Steto telemedicine company. Yuya Mizuno reported receipt of grants/fellowships, manuscript fees, and consultant fees from Japan Society for the Promotion of Science, Astellas Foundation for Research on Metabolic Disorders, Japanese Society of Clinical Neuropsychopharmacology, Mochida Memorial Foundation for Medical and Pharmaceutical Research, Sumitomo Dainippon Pharma, Signant Health, and WCG MedAvante-ProPhase. Gonzalo Salazar de Pablo reported receiving financial support from the Alicia Koplowitz Foundation. John Torous reported receiving research support from Otsuka Pharmaceutical. Kazunari Yoshida reported receiving manuscript fees from Sumitomo Dainippon Pharma, fellowship grants from the Japan Research Foundation for Clinical Pharmacology and Azrieli Adult Neurodevelopmental Centre Postdoctoral Fellowship at CAMH, and consultant fees from Signant Health and VeraSci. Taishiro Kishimoto reported receiving consultant fees from Dainippon Sumitomo, Novartis, and Otsuka, and speaker's honoraria from Eli Lilly, Dainippon Sumitomo, Janssen, Lundbeck, Novartis, Otsuka, and Pfizer. He has received grant support from Dainippon-Sumitomo and Otsuka. The rest of the authors report no financial interests or potential conflicts of interest.

References

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Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape

Affiliations

Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape

Authors

Affiliations

Abstract

Conflict of interest statement

References

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