JMIR Publications

ABSTRACT

Background:

Telepsychiatry allows patients to establish or maintain care during the COVID-19 pandemic. Little is known about factors influencing patient initial decisions for participation in telepsychiatry in the midst of a public health crisis.

Objective:

This paper seeks to examine factors influencing patient initial decisions to accept or decline telepsychiatry immediately after the Michigan Stay-at-Home Order, initial choice of virtual care modality (video or telephone), and anticipated participation in telepsychiatry once clinics reopen for in-person visits.

Methods:

Between June and August 2020, we conducted a telephone-based questionnaire comprising 14 quantitative and two qualitative items as part of a Quality Improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Governor’s Stay-at-Home Order and necessitated conversion to virtual visit or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression.

Results:

A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of Michigan’s Stay-at-Home Order completed the phone survey. Majority of respondents (n=202, 83%) initially chose to receive psychiatric care through video visits, while 14% (n=33) chose telephone visits and 1% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P < .001; 95% CI=.02–.06). Patients aged 44 years and older were more likely than patients aged 0-44 years to opt for telephone visits (RRR, 1.2; 95% CI, 1.06-1.35). Patient sex (P = .99), race (P = .06), type of insurance (P = .08), or number of previous visits to the clinic (P = .63) were not statistically relevant. About half (n = 114, 47%) of respondents were likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI=.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users.

Conclusions:

In this cohort, patient age correlates with choice of virtual visit type, with older adults more likely to choose telephone over video visit. Understanding challenges to patient-facing technologies will help advance health equity and guide best practices for engaging patients and families through telehealth.