Health-care-Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the COVID-19 Pandemic.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
entrez:
9
3
2023
pubmed:
10
3
2023
medline:
14
3
2023
Statut:
ppublish
Résumé
The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression. This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019-March 2020), peak-pandemic shift to virtual care (April 2020-June 2020), and recovery of health care operations (July 2020-June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care. Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period. A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.
Sections du résumé
BACKGROUND
The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression.
METHODS
This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019-March 2020), peak-pandemic shift to virtual care (April 2020-June 2020), and recovery of health care operations (July 2020-June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care.
RESULTS
Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period.
CONCLUSIONS
A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.
Identifiants
pubmed: 36893418
doi: 10.1097/MLR.0000000000001815
pii: 00005650-202304001-00009
pmc: PMC9994573
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
S47-S53Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Myers US, Coulon S, Knies K, et al. Lessons learned in implementing VA video connect for evidence-based psychotherapies for anxiety and depression in the Veterans Healthcare Administration. J Technol Behav Sci. 2021;6:320–326.
Rosen CS, Morland LA, Glassman LH, et al. Virtual mental health care in the Veterans Health Administration’s immediate response to coronavirus disease-19. Am Psychol. 2021;76:26.
Donelan K, Barreto EA, Sossong S, et al. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019;25:40–44.
Giovanetti AK, Punt SE, Nelson EL, et al. Teletherapy versus in-person psychotherapy for depression: a meta-analysis of randomized controlled trials. Telemed J E Health. 2022;28:1077–1089.
Drago A, Winding TN, Antypa N. Videoconferencing in psychiatry, a meta-analysis of assessment and treatment. Eur Psychiatry. 2016;36:29–37.
Shigekawa E, Fix M, Corbett G, et al. The current state of telehealth evidence: a rapid review. Health Aff. 2018;37:1975–1982.
Busch AB, Huskamp HA, Raja P, et al. Disruptions in care for medicare beneficiaries with severe mental illness during the COVID-19 pandemic. JAMA Netw Open. 2022;5:e2145677.
Zhang J, Boden M, Trafton J. Mental health treatment and the role of tele-mental health at the Veterans Health Administration during the COVID-19 pandemic. Psychol Serv. 2022;19:375–385.
Lewis CC, Boyd M, Puspitasari A, et al. Implementing measurement-based care in behavioral health: a review. JAMA psychiatry. 2019;76:324–335.
Duncan BL, Reese RJ, Lengerich AJ, et al. Measurement-based care in integrated health care: a randomized clinical trial. Fam Syst Health. 2021;39:259.
Guo T, Xiang YT, Xiao LE, et al. Measurement-based care versus standard care for major depression: a randomized controlled trial with blind raters. Am J Psychiatry. 2015;172:1004–1013.
Gondek D, Edbrooke-Childs J, Fink E, et al. Feedback from outcome measures and treatment effectiveness, treatment efficiency, and collaborative practice: a systematic review. Adm Policy Ment Health. 2016;43:325–343.
Friedman AB, Gervasi S, Song H, et al. Telemedicine catches on: changes in the utilization of telemedicine services during the COVID-19 pandemic. Am J Manag Care. 2022;28:e1–e6.
Poeran J, Cho LD, Wilson L, et al. Pre-existing disparities and potential implications for the rapid expansion of telemedicine in response to the coronavirus disease 2019 pandemic. Med Care. 2021;59:694–698.
Whaley CM, Pera MF, Cantor J, et al. Changes in health services use among commercially insured US populations during the COVID-19 pandemic. JAMA Netw Open. 2020;3:e2024984.
Ritzwoller DP, Goodrich G, Tavel H, et al. Patient factors associated with use of adult primary care and virtual visits during the COVID-19 pandemic. Med Care. 2023;61(suppl 1):S12–S20.
Centers for Medicare and Medicaid Services. COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers. March 13, 2020, updated May 14, 2021. Accessed April 27, 2022. https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf
McCracken CE, Gander JC, McDonald B, et al. Impact of COVID-19 on trends in outpatient clinic utilization: a tale of 2 departments. Med Care. 2023;61:S4–S11.
Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613.
Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–1097.
Posner K, Brown GK, Stanley B, et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266–1277.
Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–1251.
Knighton AJ, Savitz L, Belnap T, et al. Introduction of an Area Deprivation Index measuring patient socioeconomic status in an integrated health system: implications for population health. EGEMS (Wash DC). 2016;4:1238.
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34:3661–3679.
Uscher-Pines L, Parks AM, Sousa J, et al. Appropriateness of telemedicine versus in-person care: a qualitative exploration of psychiatrists’ decision making. Psychiatr Serv. 2022;73:849–855.