Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.

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使用远程精神病学的障碍：临床医生作为看门人。

远程精神病学是有效的，并且已经产生了希望和希望，可以通过合理的成本控制来改善访问和提高护理质量。临床医生和组织可以通过指南了解有关临床，技术和行政方面的远程精神病学障碍，但是有许多实际的患者和临床医生因素会减慢实施速度并破坏可持续性。文献描述了使用远程精神病学的障碍。日期限制为1959年1月1日至2019年4月25日的PubMed搜索词，包括远程精神病学，远程医疗，远程心理健康，视频会议，基于视频，互联网，同步，实时，双向，限制，限制，障碍，障碍，挑战，问题，实施，利用，采用，观点，看法，态度，信念，意愿，可接受性，可行性，文化/文化，结果，满意度，质量，有效性和功效。根据相关性选择了要纳入的文章。从患者和临床医生的角度描述了障碍。病人和临床医生对远程精神病学非常满意，但是对建立融洽关系，隐私，安全和技术限制的担忧减慢了远程精神病学的接受度。临床医生还担心报销/财务，法律/法规，执照/资格证书以及教育/学习问题。这些问题指向系统和政策问题，再加上其他行政问题，引发了有关系统设计/工作流程，临床护理效率以及组织文化变化的问题。尽管远程精神病学服务为患者提供了便利，从临床医生的角度来看，存在许多障碍，因为它们是远程精神病学服务的实施和可持续性的守门人。这表明克服障碍的解决方案必须首先解决临床医生的关注并增强临床工作流程。