Advanced Practice Registered Nurses Using Synchronous Telepsychiatry: An Integrative Systematic Review

BACKGROUND: Despite wide-spread use, telepsychiatry use among psychiatric mental health advanced practice nurse practitioners (PMH APRNs) has not been systematically explored in the literature. OBJECTIVE: Systematically review the PMH APRN usage of live-time, synchronous telepsychiatry including audiovisual teleconferencing technology. METHOD: A comprehensive, systematic search was performed with no publication date restriction across CINAHL, the Cochrane Library, Embase, Google Scholar, PsycINFO, PubMed, Scopus, and Web of Science on July 30, 2019, by a medical librarian. Each citation was blinded and independently reviewed by three reviewers, and consensus was reached for inclusion. Eligible articles were peer-reviewed research or quality improvement articles available in full-text, written in English, including real-time, synchronous, audiovisual telepsychiatry services with PMH APRN providers. Discussion articles and literature reviews were excluded. Article quality and bias were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment tool. RESULTS: The search yielded a total of 342 articles, and only nine articles met full inclusion criteria. Overall, risk of bias was high in all studies, and the GRADE rating consisted of three “very low,” five “low,” and one “medium” quality article. However, considering the collectively positive outcomes from PMH APRN telepsychiatry use, the overall GRADE recommendation was to “probably do it” for seven studies and “do it” for two studies. DISCUSSION: Though existent literature is low quality and sparse, evidence supports that PMH APRNs can feasibly and successfully provide telepsychiatry services across a wide range of demographic patients and locations. CONCLUSION: PMH APRNs should contribute more original evidence to guide telepsychiatry implementation and adoption as the service expands.