Abstract
Background: Prompt professional care for postpartum depression (PPD) is difficult to obtain in China. Though online consultations improve accessibility and reduce stigma, the quality of services compared to in-person consultations is unclear.
Methods: Five trained, undisclosed “standardized patients” (SPs) made “asynchronous webchats” visits and in-person visits with psychiatrists. Visits were made to 85 psychiatrists who were based in 69 hospitals in ten provincial capital cities. The care between online and in-person consultations with the same psychiatrist was compared, including diagnosis, guideline adherence, and patient-centeredness. False discovery rate (FDR) was used to adjust p values. Third visits using asynchronous webchats were made to psychiatrists who offered discrepant diagnoses. Thematic content analysis was used for the discrepancies.
Findings: The proportion of diagnostic accuracy was lower for online than in-person visits (76.5% [65/85] vs 91.8% [78/85]; pFDR = 0.0066), as were the proportions of completing questions involving clinical history (16.6% vs 42.7%; pFDR < 0.0001), and management decisions (16.2% vs 27.5%; pFDR < 0.0001) consistent with recommended guidelines. Patient-centeredness was lower online than in-person (pFDR < 0.0001). Fifteen of 16 psychiatrists completed third visits, most of them considered lack of nonverbal information online as a key barrier.
Interpretation: Online consultations using asynchronous webchats were inferior to in-person consultations, with respect to diagnostic accuracy, adherence to recommended clinical guidelines, and patient-centeredness. To fully realise the potential benefits of online consultations and to prevent safety issues, there is an urgent need for major improvement in the quality and oversight of these consultations.
Funding: China Medical Board, National Natural Science Foundation of China, and Swiss Agency for Development and Cooperation Global Cooperation Department.
Methods: Five trained, undisclosed “standardized patients” (SPs) made “asynchronous webchats” visits and in-person visits with psychiatrists. Visits were made to 85 psychiatrists who were based in 69 hospitals in ten provincial capital cities. The care between online and in-person consultations with the same psychiatrist was compared, including diagnosis, guideline adherence, and patient-centeredness. False discovery rate (FDR) was used to adjust p values. Third visits using asynchronous webchats were made to psychiatrists who offered discrepant diagnoses. Thematic content analysis was used for the discrepancies.
Findings: The proportion of diagnostic accuracy was lower for online than in-person visits (76.5% [65/85] vs 91.8% [78/85]; pFDR = 0.0066), as were the proportions of completing questions involving clinical history (16.6% vs 42.7%; pFDR < 0.0001), and management decisions (16.2% vs 27.5%; pFDR < 0.0001) consistent with recommended guidelines. Patient-centeredness was lower online than in-person (pFDR < 0.0001). Fifteen of 16 psychiatrists completed third visits, most of them considered lack of nonverbal information online as a key barrier.
Interpretation: Online consultations using asynchronous webchats were inferior to in-person consultations, with respect to diagnostic accuracy, adherence to recommended clinical guidelines, and patient-centeredness. To fully realise the potential benefits of online consultations and to prevent safety issues, there is an urgent need for major improvement in the quality and oversight of these consultations.
Funding: China Medical Board, National Natural Science Foundation of China, and Swiss Agency for Development and Cooperation Global Cooperation Department.
| Original language | English |
|---|---|
| Article number | 101053 |
| Number of pages | 12 |
| Journal | The Lancet regional health. Western Pacific |
| Volume | 45 |
| Early online date | 28 Mar 2024 |
| DOIs | |
| Publication status | Published - Apr 2024 |
Bibliographical note
Acknowledgments:This work was supported by the China Medical Board (CMB) Open Competition Program (Grant No. 20-368), National Natural Science Foundation of China (Grant No. 82273643 and No. 81973059), and Swiss Agency for Development and Cooperation Global Cooperation Department (No. 81067392). The authors gratefully acknowledge the five SPs for participating in this study and the key advice for establishing the script and quality checklist for PPD from psychiatric specialists (Ming Cheng, Yihua Chen, Wenjuan Jiang, Mei Liao, Yongsheng Tong, Li Zhang). We are grateful for the support of Dong Xu for the design of the study and the revision of the first draft. We thank the assistance of specialists in epidemiology and health statistics (Yiyuan Cai and Jing Deng) with study design and statistical analysis, as well as the advice for the plan of data analysis from Wenjun He. We also thank the efforts of Yiqing Cai and He Zhang in information searching and schedules of visits making.
Keywords
- Telemedicine
- Postpartum depression
- Standardized patients
- Quality of Health Care
- Comparative Study