JMIR Publications

ABSTRACT

Background:

Timely follow-up is crucial for youth whose first mental health contact is through a hospital; virtual care could facilitate this.

Objective:

To examine the association between the significant expansion of virtual care in Ontario and follow-up mental health care rates for these youth.

Methods:

We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified first-contact ED visits or hospital admissions for self-harm, mood disorders, or psychosis from Mar/01/2009-Feb/29/2024 among Ontario youth (10-24). Virtual care was expanded in March 2020; we examined two expansion stages (temporary and permanent). ARIMA analyses estimated level and slope changes (vs. pre-virtual care) in age-sex standardized monthly rates of 7-day mental health follow-up. Subgroup analyses examined rurality and socioeconomic status.

Results:

We identified 42,208 first-contact ED visits and 17,701 first-contact hospital admissions. Pre-virtual care mean follow-up rates were 17.6 [SD: 2.97] and 21.9 [5.05] per 100. Temporary expansion was associated with immediate increases in follow-up that declined (level changes: 4.81 [95% CI: 2.82-6.81] and 7.51 [4.41-10.60]; slope changes: -0.31 [-0.42 to -0.21] and -0.32 [-0.48 to -0.15]). Permanent expansion was associated only with a level decrease in ED visit follow-up (-3.81 [-6.70 to -0.92]), significant in rural (-1.06 [-1.93 to -0.184]) but not urban (0.44 [-0.179 to 1.06]) areas; results were otherwise similar between subgroups.

Conclusions:

Virtual care was not associated with sustained changes or equity improvements in mental health follow-up for high-acuity youth, representing a missed opportunity to extend physician reach and address barriers. Further research and quality improvement is needed.