背景:COVID-19大流行影响了大多数精神卫生提供者的实践,并导致向提供远程医疗服务的快速过渡,可能与居家政策有关的变化以及对服务需求的增加。
目的:这项研究的目的是检查在整个COVID-19大流行过程中,这些实践变化是否持续,以及精神卫生提供者的类型和背景是否存在差异。我们假设,在2020年春季大流行初期激增以及随后停止居家政策之后,当面就诊的患者人数将会增加,尽管在各个环境中持续实施远程医疗服务。
方法:这项研究调查了903名心理健康提供者中的235名,他们在2020年春季(时间点1)和2021年春季(时间点2)进行了为期1年的随访。实践中的差异调整,与远程健康相关的因素,并检查了不同提供者类型的患者数量(社会工作者,心理学家,神经心理学家)和设置(学术医疗中心[AMC],社区心理健康,私人执业,和退伍军人事务医院)。
结果:从时间点1到时间点2,正在实施远程医疗的提供者总数略有但显着增加(191/235,81%至204/235,87%,P=0.01),取消或重新安排的任命显着下降(2020年为25%-50%,2021年为3%-7%,P<.001)。在AMC工作的心理学家和提供者报告说,远程医疗实施的难度降低(P<.001),在AMC和私人执业环境中工作的提供者表示,他们更有可能在2021年春季之后继续提供远程医疗服务(P<.001)。远程工作的时间百分比总体下降(78%至59%,P<.001),这在在AMC工作的神经心理学家和提供者中最为明显。与大流行早期相比,每周平均患者人数总体上有所增加(平均4.3至8.7,P<.001),通过远程医疗就诊的患者数量没有变化(平均9.7至9.9,P=0.66)。
结论:这些结果表明,在2020年春季COVID-19大流行开始时,向远程健康的快速过渡在第二年得以持续,尽管个人就诊的患者数量总体上有所增加。尽管更多的提供商报告称返回现场工作,超过50%的供应商继续使用混合模式,许多医疗服务提供者报告说,他们更有可能在2021年春季之后继续进行远程医疗。这表明,在急性大流行阶段之后,对远程医疗服务的持续重要性和依赖性,并对规范患者远程医疗服务可用性的未来政策产生影响。
BACKGROUND: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services.
OBJECTIVE: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings.
METHODS: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital).
RESULTS: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66).
CONCLUSIONS: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.