Background: The shortage of medical providers in rural areas is one of the greatest barriers to accessing healthcare in the United States. Mental healthcare providers are especially limited in numbers and availability in rural areas. Although all individuals living rurally have challenges with receiving care, one group that demonstrates an exceptional deficiency with access to care is veterans. The numbers of veterans living rurally are significantly higher than vets living close to urban or suburban centers of care. Considering the shortages of mental health providers, alternatives to traditional in-person therapy are needed in order to adequately address the needs of rurally located veterans. Recently, psychotherapy via video teleconferencing has been suggested as a way of reaching a greater number of veterans. But is this approach equivalent to in-person therapy in the treatment of PTSD?
Methods: An exhaustive search was conducted using Medline-OVID, CINAHL, and Google Scholar using the keywords: mental health, veterans, rural, and telemedicine. Relevant articles were assessed for quality using GRADE.
Results: Three studies met the search criteria and were included in this systematic review. The first study, Frueh et al, is a randomized controlled study (RCT) to compare the efficacy of psychotherapy delivered via video teleconferencing or in-person therapy for combat-related PTSD. This study showed a comparable treatment effect and patient satisfaction between the two different methods. The second study, Morland et al, is a non-inferiority-designed RCT comparing anger management therapy delivered either by video teleconferencing or same-room therapy to veterans with PTSD. This study demonstrated similar satisfaction in both groups and an improvement in both anger and PTSD symptoms in the video teleconferencing group. The third study, Ziemba et al, is a two-arm RCT with either active-duty or veterans of Operation Enduring Freedom or Operation Iraqi Freedom comparing psychotherapy administered via video teleconferencing or in-person. This study indicated equivalence between the two types of therapies.
Conclusion: Psychotherapy administered to veterans with PTSD living in rural areas via video teleconferencing has been shown to be equivalent to traditional in-person therapy. Multiple studies show promise for a broader application of psychotherapy via video teleconferencing to help with the shortage of mental health providers in rural areas; however, further studies are needed to investigate the extent to which telemedicine can be used effectively.
Keywords: Mental health, telemedicine, video teleconferencing, veterans.
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