JMIR Publications

ABSTRACT

Background:

Due to public health restrictions, the COVID-19 pandemic required significant changes in the delivery of mental health services. The use of virtual care for balancing access with treatment needs requires a shared decision between clients, caregivers, and clinicians. One aspect for consideration is the length of treatment and whether it differs by treatment modality. Therefore, it is essential to quantify and compare episodes of care conducted virtually and in-person, while accounting for individual and system level factors that may influence length of episodes.

Objective:

To operationalise a means of measuring episodes of care using administrative data to improve our understanding of how treatment modality impacts treatment duration for children and adolescents accessing Community Mental Health & Addictions services at IWK Health.

Methods:

Episodes of care were created using administrative data collected by the IWK Mental Health and Addictions program. A multilevel mixed-effects negative binomial model and time-to-event analysis were used to model the association between treatment modality and treatment duration, both in visits and days, adjusting for client and system characteristics. A zero-inflated negative binomial model was used to analyze the association between treatment modality and the ratio of days to visits within an episode of care.

Results:

Virtual episodes of care had more visits compared to in-person episodes between April 1, 2020, and March 31, 2021, whereas between April 1, 2022, and March 31, 2023 virtual episodes of care were associated with fewer visits. These patterns were consistent after adjusting for client and system characteristics. Additionally, there was no significant difference in the ratio of days to visits between the virtual and in-person treatment modalities throughout each time period, indicating intersession wait times were not driving any differences in the treatment lengths in days between the modalities.

Conclusions:

To our knowledge, this is the first study to examine the association between treatment modality and treatment duration. While initially longer than in-person episodes of care, over time the average length of episodes conducted mainly virtually has attenuated, perhaps due to growing comfort with the technology or client factors not adequately captured in administrative data. This information can be valuable to clinicians, clients, and their families regarding expected treatment timelines and aid in informing service planning.