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Medicina clínica y social

On-line version ISSN 2521-2281

Med. clín. soc. vol.5 no.3 Santa Rosa del Aguaray Dec. 2021 


Telepsychiatry as a training tool for Psychiatry Residents in Paraguay during the COVID-19 pandemic: A Faculty and Trainees viewpoint

Julio Torales1  2

João Mauricio Castaldelli-Maia3  4

Antonio Ventriglio5

Nicolás Ayala-Servín1  2

Rodrigo Navarro1  2

José Almirón-Santacruz1

Noelia Ruiz Díaz1  2

Iván Barrios1

Oscar García1

Marcelo O’Higgins1  2

1Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra de Psiquiatría, San Lorenzo, Paraguay.

2Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.

3Fundação do ABC, Department of Neuroscience, Santo André, SP, Brazil.

4University of São Paulo, Department of Psychiatry, São Paulo, SP, Brazil.

5University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy.

Since the outbreak of the COVID-19 pandemic, more than a year ago, a debate has been proposed regarding the way psychiatrists should have delivered their therapeutic interventions in the context of emergency and in the future1,2. Leading experts considered different scenarios in order to implement new strategies to provide medical services to patients in the course of pandemic3. Telepsychiatry has been proposed as a safe approach to patients avoiding a direct exposure and possible infections between patients and health professionals.

In Paraguay, as in the rest of world, the government issued social distancing policies and restrictions in the early stages of the pandemic in order to contrast the spreading of infections4. This led to changes in the distribution of resources for medical providers as well as clinical interviews and examination of patients in Psychiatry were prohibited, with the exception of emergencies. In San Lorenzo, Paraguay, the Hospital de Clínicas is part of the National University of Asunción and delivers a Psychiatry Training Program to thirteen residents/year in Clinical Psychiatry and two residents/year in Child and Adolescent Psychiatry. Restrictions have limited any training in interviewing skills as well as prescribing. Telepsychiatry was considered despite of the many challenges it implied. A project based on the implementation of Telepsychiatry consults delivered by medical staff and residents was presented to the Board of our medical school and received rapid approval due to the emergency situation in the country. Also, experiences of implementation were shared and developed with colleagues from Brazil and Italy, who reported similar experience in this area.

Limitations of this program included: 1) The lack of technological standards including appropriate hardware and software; 2) A range of disparities in the access to high quality internet services through the country; 3) The lack of knowledge about the impact on patients and their response; and, 4) The lack of appropriate and safe strategies to provide prescriptions to patients in remote areas of the country. Major efforts to collect funds in order to provide new computers to the medical services have been done and an increase of video- calls with patients was recorded. New resources included national scientific funds, institutional funds and even individual contributions. Different video meeting applications have been tested by our medical staff and Google Meet® was considered to be easily accessible by the inhabitants of Paraguay, so it become our standard.

An informative campaign promoted by the University Media Department in order to provide instructions to patients on how to access to the online services has been conducted and reached broad sections of the population. The internet access by the patient and the online prescriptions still are major issues to be addressed. For prescriptions, an agreement with the Mental Health Department of the National Ministry of Health and Social Welfare has been made to facilitate the access to medications. The internet access is a national issue that would require specific investment by the government and private sector in order to secure better internet services across the country.

Psychiatry residents responded positively to the program and recognized benefits for patients. They took part in the design of these strategies as well provided feedback to the faculty on how to improve this approach. Also, these strategies allowed to address issues related to the COVID-19 pandemic and to manage access for parts of the Paraguayan population reporting difficulties before the outbreak. Patients from all the seventeen political divisions of our country plus the capital, are reachable and services of Clinical Psychiatry, Child and Adolescent Psychiatry, and Telepsychology are easily provided. In addition, an assistance program for health professionals in the front-line against COVID-19 is provided because of an increasing amount of mental health needs considering their workload and the lack of resources to treat patients.

With these measures, our Psychiatry Department reported a certain level of “normality” in the delivery of services with similar standards to those recorded before this pandemic. Psychiatry residents reached their own skills standards and were trained properly on the current and future practice of Telepsychiatry. We surveyed a positive acceptance of Telepsychiatry and satisfaction among patients as well as medical staff. Even if this strategy is not new5, the emerging needs related to this pandemic led to the fast employment of Telepsychiatry as a day-to-day resource, at least in Paraguay. It is well accounted that even after the pandemic is over, Telepsychiatry programs will be useful for the clinical practice as well as the training of residents


1. O'Brien M, McNicholas F. The use of telepsychiatry during COVID-19 and beyond. Ir J Psychol Med. 2020;37(4):250-255. 10.1017/ipm.2020.54 [ Links ]

2. Chen JA, Chung WJ, Young SK, Tuttle MC, Collins MB, Darghouth SL, et al. COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future. Gen Hosp Psychiatry. 2020;66:89-95. 10.1016/j.genhosppsych.2020.07.002 [ Links ]

3. Kaufman KR, Petkova E, Bhui KS, Schulze TG. A global needs assessment in times of a global crisis: world psychiatry response to the COVID-19 pandemic. BJPsych Open. 2020;6(3):e48. 10.1192/bjo.2020.25 [ Links ]

4. Torales J, Ríos-González C, Barrios I, O'Higgins M, González I, García O, et al. Self-Perceived Stress During the Quarantine of COVID-19 Pandemic in Paraguay: An Exploratory Survey. Front Psychiatry. 2020;11:558691. 10.3389/fpsyt.2020.558691 [ Links ]

5. Dwyer TF. Telepsychiatry: psychiatric consultation by interactive television. Am J Psychiatry. 1973;130(8):865-869. 10.1176/ajp.130.8.865 [ Links ]

Received: June 26, 2021; Revised: July 30, 2021; Accepted: August 30, 2021

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