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Pandemic Experience Shows Benefits of Telepsychiatry in Increasing Access to Care

     

One of the challenges for successful mental health treatment is consistent participation in appointments with mental healthcare professionals. The rates of no-shows and cancellations for psychiatric appointments are often high. New research finds that after the shift to mostly remote appointments during the COVID-19 pandemic, attendance at psychiatric appointments increased significantly, potentially leading to more effective treatment. The research was published online in March in Psychiatric Services, a journal of the American Psychiatric Association. 

More than 40% of people with mental illness don’t receive treatment and the unmet need is even greater among low income and Medicaid recipients. Telepsychiatry may help overcome some of the barriers to treatment. 

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Researchers examined the differences in appointment completion rates between telepsychiatry appointments during the COVID-19 pandemic and in-person appointment completion rates during the previous year. The researchers looked at records from NYC Health + Hospitals on more than 25,000 telepsychiatry visits in April and May 2020 during the pandemic, and more than 40,000 in-person visits in the fall of 2019. 

Just as most healthcare organizations, NYC Health + Hospitals needed to shift to primarily telehealth visits early in the COVID-19 pandemic to continue providing services to patients. Federal and state regulations in response to the pandemic allowed for the use of both video and phone only appointments. NYC Health and Hospitals provide a range of services, including consultation, assessment, psychotherapy, group therapy, and medication management. Prior to the pandemic, it had not typically offered telepsychiatry. The shift to remote services offered an opportunity to compare a large volume of data on telepsychiatry use over a short period of time with data on in-person visits.

During the pandemic study period, 71% of the NYC Health and Hospitals behavioral healthcare visits were scheduled to be conducted via telepsychiatry, largely by phone, and of those visits, 74% were completed. The odds of completing a telepsychiatry visit during COVID-19 were three times the odds of completing an in-person visit during the pre-COVID-19 reference period after adjusting for age, sex, race, and insurance enrollment. The study found no difference in appointment participation rates between video appointments and phone-only appointments. 

The authors point out that telepsychiatry, despite generally being more accessible, still often requires both patients and providers have some technology support to set up, and video devices may not always be available. They suggest that the large proportion of Medicare and Medicaid patients in their study strengthens the case for supporting audio-only telepsychiatry services.

The study authors conclude that in this study, outpatient adult mental health clinic telepsychiatry appointments were strongly associated with a higher rate of appointment participation compared with in-person visits during and prior to the COVID-19 pandemic. They suggest that given the findings and relative ease of access to phone rather than video, regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.

 

Reference

Avalone, L., et al. Rapid Telepsychiatry Implementation During COVID-19: Increased Attendance at the Largest Health System in the United States | Psychiatric Services (psychiatryonline.org). Psychiatric Services. Published Online:18 Mar 2021  https://doi.org/10.1176/appi.ps.202000574

     

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