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Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module

BACKGROUND & OBJECTIVES: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatri...

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Autores principales: Malhotra, Savita, Chakrabarti, Subho, Shah, Ruchita, Sharma, Minali, Sharma, Kanu Priya, Malhotra, Akanksha, Upadhyaya, Suneet K., Margoob, Mushtaq A., Maqbool, Dar, Jassal, Gopal D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761029/
https://www.ncbi.nlm.nih.gov/pubmed/29265020
http://dx.doi.org/10.4103/ijmr.IJMR_757_15
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author Malhotra, Savita
Chakrabarti, Subho
Shah, Ruchita
Sharma, Minali
Sharma, Kanu Priya
Malhotra, Akanksha
Upadhyaya, Suneet K.
Margoob, Mushtaq A.
Maqbool, Dar
Jassal, Gopal D.
author_facet Malhotra, Savita
Chakrabarti, Subho
Shah, Ruchita
Sharma, Minali
Sharma, Kanu Priya
Malhotra, Akanksha
Upadhyaya, Suneet K.
Margoob, Mushtaq A.
Maqbool, Dar
Jassal, Gopal D.
author_sort Malhotra, Savita
collection PubMed
description BACKGROUND & OBJECTIVES: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. METHODS: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. RESULTS: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. INTERPRETATION & CONCLUSIONS: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.
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spelling pubmed-57610292018-01-31 Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module Malhotra, Savita Chakrabarti, Subho Shah, Ruchita Sharma, Minali Sharma, Kanu Priya Malhotra, Akanksha Upadhyaya, Suneet K. Margoob, Mushtaq A. Maqbool, Dar Jassal, Gopal D. Indian J Med Res Original Article BACKGROUND & OBJECTIVES: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. METHODS: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. RESULTS: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. INTERPRETATION & CONCLUSIONS: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites. Medknow Publications & Media Pvt Ltd 2017-08 /pmc/articles/PMC5761029/ /pubmed/29265020 http://dx.doi.org/10.4103/ijmr.IJMR_757_15 Text en Copyright: © 2017 Indian Journal of Medical Research http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Malhotra, Savita
Chakrabarti, Subho
Shah, Ruchita
Sharma, Minali
Sharma, Kanu Priya
Malhotra, Akanksha
Upadhyaya, Suneet K.
Margoob, Mushtaq A.
Maqbool, Dar
Jassal, Gopal D.
Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module
title Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module
title_full Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module
title_fullStr Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module
title_full_unstemmed Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module
title_short Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliability of diagnostic module
title_sort telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: validity & reliability of diagnostic module
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761029/
https://www.ncbi.nlm.nih.gov/pubmed/29265020
http://dx.doi.org/10.4103/ijmr.IJMR_757_15
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