JMIR Publications

ABSTRACT

Background:

Serious mental illness is personally and financially costly. Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and in-patient psychiatric hospitalization. During the Covid-19 pandemic, care continuity increasingly attempted with telemedicine services, despite the lack of efficacy data in this population. SMI patients are challenging to enroll and sustain in randomized, controlled trials over time due to fluctuations of disease exacerbation. Capturing and examining the utilization and efficacy data in Community Mental Health Clinic (CMHC) SMI patients during the pandemic is a unique opportunity to inform future clinical and policy decision making.

Objective:

This research aims to identify and describe characteristics of CMHC patients challenged by serious mental illness experiencing treatment interruptions and who utilized telemedicine during the pandemic.

Methods:

This retrospective, observational study of treatment interruptions and telemedicine use during 12/2019-6/2020 (compared to 12/2018-6/2019) in New Hampshire (NH) CMHC patients included all 16,030 Medicaid beneficiaries with SMI engaged in treatment three months prior to the declared COVID-19 State of Emergency. Chi-square test of independence and logistical regression analysis explored associations between treatment interruptions and variables of gender, age, rurality, and diagnosis. Telemedicine utilization was categorized into <25% of services, 25-75% of services, and >75% of services. Cohorts of low, medium, and high telemedicine use are described by variables of gender, age, rurality, and diagnosis.

Results:

Despite the worst pandemic in 100 years, NH CMHCs demonstrated only a 4.9% increase in treatment interruptions as compared to the year prior. Patients who were male (OR 1.27, P<.001), under the age of 18 (OR 1.37, P <.001 ages 0-12; OR 1.49, P <.001 ages 13-17), or among the milder diagnostic categories, such as anxiety disorders (OR 3.77, P <.001) and PTSD (OR 3.69, P <.001), were most likely to experience treatment interruptions. Females (OR .89, CI .65-.74), those 18-34 years old (OR .74, CI .70-.79), or among the milder diagnostic categories such as anxiety disorder (OR .69, CI .65-.74), PTSD (OR .77, CI .72-.83), and major depressive disorder (OR .73, CI .68-.78) were less likely to be in the low utilization telemedicine group.

Conclusions:

Telemedicine integration supported care continuity for most CMHC patients. Yet, retention varied by sub-population, as did telemedicine utilization. Development of polices and clinical practice requires empirical evidence evaluating the effectiveness and limitations of telemedicine in patients with SMI.