Telepsychiatry in post-pandemic India: A mixed methods exploration of patient perspectives and preferences toward telemedicine versus in-person consultations

Abstract

Background

Telepsychiatry saw wide acceptance during the COVID-19 pandemic, when traditional healthcare facilities were inaccessible. Post-pandemic, however, user preferences for the service remain uncertain. This study explores user perceptions of telepsychiatry, particularly focusing on those who discontinued its use, to identify factors influencing service satisfaction and barriers to continued use.

Methodology

A mixed methods study was conducted on interviews with 165 patients who had utilised telepsychiatry services at a tertiary care teaching hospital in north India. Quantitative data were collected on telepsychiatry dropout rates, and bivariate analyses identified differences between continuing users and discontinuers. Qualitative data were gathered via semi-structured interviews, thematically analysed, and coded to examine personal, illness-related, and socio-environmental determinants of service choice.

Results

Analysis revealed a telepsychiatry dropout rate of 56.4 %, once physical OPDs became operational. Eight major themes - convenience, cost & time, therapeutic relationship, technological difficulty, service limitation, treatment outcome and privacy, affected telepsychiatry usage. Patients valued telepsychiatry for its convenience and time savings, while challenges such as brief consultations, frequent changes in doctors, and lack of privacy at home or work, prevented continued use. Technological barriers, especially for elderly and rural patients, and higher medication costs at local pharmacies were significant deterrents.

Conclusion

Telepsychiatry service use is dependent on a dynamic interplay between clinical condition, resource availability with user, service quality and available alternatives. Addressing these challenges remain crucial for integrating telepsychiatry into primary healthcare and ensuring its long-term sustainability.