A year ago, trying to get patients at Michigan Medicine to agree to telehealth for their mental health appointments was a challenge.
The academic medical centre associated with the University of Michigan had only 26 video appointments in a six month period compared with 30 thousand in person visits.
COVID-19 changed all that.
“Like for many health institutions, virtual care failed to gain traction at the Michigan Medicine Outpatient Psychiatry Clinic pre-pandemic. In the first three weeks of the Michigan Stay-at-Home Order to minimize the spread of the COVID-19 virus, we saw a rapid uptake in virtual care when patients were asked to change their in-person appointments,” Dr. Jennifer Severe, a psychiatrist who assisted in the launch of a test of telehealth initiatives in the U-M's outpatient psychiatry clinic told Theravive.
On March 23, all non-urgent health care in Michigan was shut down and video appointments or phone appointments became the only way the majority of patients could interact with their psychiatrists or psychologists.
Now a study led by Severe has found that more than half of patients would want to continue with virtual mental health care even after the pandemic ends.
The convenience of not having to leave home, avoiding exposure to COVID-19 and a patient’s early experiences with telehealth were all factors that lead to such a preference.
“It was apparent that for most patients this was an unfamiliar way of engaging in care. We needed to understand why patients initially declined or accepted a virtual visit, factors influencing their decisions, the ease with which they were able to adapt to virtual visits and whether their interests in virtual care will persist after face-to-face visits are made available,” Severe said.
In undertaking the research, Severe undertook a phone survey of 244 patients or parents of patients who had appointments during the first weeks of the shutdown. Almost 83 per cent of patients chose to have their appointments, or their child’s appointment via video chat instead of in person.
“A minority of patients (13.5 %), more likely to be over 45, initially chose to receive psychiatric care through telephone calls. They were also much less likely to want to receive mental health care remotely in the future when clinics re-open for in-person visits compared to video visits users. Patient age was the only factor that was associated with the choice of video or telephone visit,” Severe said.
“Overall, nearly all the patients in the study group who had a virtual visit said it went as well as they had expected, or better. We don’t know how long the pandemic will last. Therefore, we sought to understand reasons for which patients may feel comfortable to return in-person for their outpatient mental healthcare during the pandemic. Almost half of the patients indicated that they were comfortable in returning to in-person visits and clinic ability to ensure COVID-19 protection played a crucial role in such a decision.”
The pandemic has changed the landscape of telepsychiatry. More than half of those surveyed say they will continue with virtual appointments when the pandemic is over.
“The landscape of telepsychiatry is changing and with it, our understanding of new ways of engaging in mental healthcare. We were curious to understand whether patients would want to continue with virtual care in the future when we go back to business as usual. Most respondents stated that they were likely to do so (54%). The main reason cited was convenience (39%). After the pandemic, ongoing fear of contracting the virus in healthcare settings could be another motivating factor for ongoing use of virtual care. It will be of utmost importance to address the pre-pandemic payment and regulatory challenges to meet the new demand for virtual care services,” Severe said.
Going forward, Severe says the pandemic may serve as a catalyst to improve access to mental health care and continuity of care. She says her study may assist government agencies and health insurers make choices about how to pay mental health providers for virtual appointments.
Insurers covered phone appointments for mental health care for some of 2020, but this may not last. But Severe says some patients would benefit from continued virtual appointments, and as such should receive similar reimbursements from insurers as in person appointments.
“In the virtual care world, telepsychiatry has been one of the oldest applications and have showed great benefits for patients, clinicians and the healthcare system overall. Its widespread adoption during the COVID-19 pandemic is multifactorial. For both patients and clinicians, the pandemic may have served as a catalyst for more rapid acceptance of virtual care out of necessity. Furthermore, in our study, many participants indicated initial hesitation with virtual visits that ultimately resolved with experience. The annulment of payment and regulatory challenges pertaining to virtual care is also of significance.”
Elizabeth Pratt is a medical journalist and producer. Her work has appeared on Healthline, The Huffington Post, Fox News, The Australian Broadcasting Corporation, The Sydney Morning Herald, News.com.au, Escape, The Cusp and Skyscanner. You can read more of her articles here. Or learn more about Elizabeth and contact her via her LinkedIn and Twitter profiles.