Exploring the Normalisation of Telepsychiatry Practice Among Private Psychiatrists in Australia: A Convergent Mixed Methods Study.

Objective: The widespread use of telepsychiatry requires a better understanding of its integration into routine practice. Using the normalisation process theory (NPT), we aimed to measure and explore Australian psychiatrists' normalisation of telepsychiatry into private practice. Methods: This convergent parallel-mixed methods study consists of an online survey of private psychiatrists using the Normalisation Measures Development (NoMAD) instrument and semistructured in-depth interviews of private psychiatrists. We measured normalisation levels by the NPT constructs. We used logistic regression analyses to examine individual (psychiatrist) and practice factors for higher telepsychiatry patient load. We also thematically analysed the interviews according to the NPT. Finally, we integrated the quantitative and qualitative findings and drew inferences on factors for greater telepsychiatry integration. Results: We surveyed 110 respondents. Higher cognitive participation and collective action were associated with greater telepsychiatry use (> 50% patient load). The high-load group was less likely to view telepsychiatry as different from usual work practice. Solo practices, and practices covering nonmetropolitan areas, were associated with a higher telepsychiatry load. Thirteen interviews were conducted. Telepsychiatry was largely regarded as equivalent, accessible, flexible and efficient. A conducive environment (resources, policy frameworks and general acceptance) promoted adoption. Telepsychiatry's adverse effects on work quality and well-being and its limitations and potential misuse were noted. In implementing telepsychiatry, perceived similarity to conventional consultations, bottom-up initiatives tailored to individual needs, confidence and skills and personal appreciation of its benefits were important. Conclusions: Telepsychiatry is a useful tool that can be successfully integrated into routine private practice with adequate support.