Fairchild Roseanne Moody, Ferng-Kuo Shiaw-Fen, Rahmouni Hicham, Hardesty Daniel
Richard Lugar Center for Rural Health, Union Hospital, Terre Haute, Indiana, USA.
Department of Applied Health Sciences, Indiana State University, Terre Haute, Indiana, USA.
Telemed J E Health. 2020 Nov;26(11):1353-1362. doi: 10.1089/tmj.2019.0253. Epub 2020 Feb 3.
Targeted research efforts in implementation and evaluation of telemental health care for U.S. youth are needed to increase accessibility to care. Before telehealth, children and families may wait weeks for psychiatric evaluation. Increasing numbers of pediatric patients are reporting the need for mental health care when they present to region's rural emergency departments (EDs). Outcomes of telemental health services were evaluated, with a focus on treatment throughput and referral. Observational 18-month program evaluation of outcomes for children age <18 years (N = 87) who received physical and mental health assessment by an ED physician. Children who subsequently received a mental health diagnosis were treated by a psychiatrist via telemental health visits (September 2017-May 2019) in 4 rural EDs. The majority of children (ages 5-17) presented with depression- or anxiety-related disorders (49%) or suicidal ideation/attempt or self-harm (46%), with substance abuse accounting for 5% of cases. Mean ED wait times were 29 min [95% CI: 6-52 min] for children admitted to inpatient (IP) care compared with 33 min [95% CI: 22-43 min] for those discharged to outpatient (OP) care. Mean length of stay (LOS) of 8 h 56 min [95% CI: 166-906 min] was observed for children admitted to IP care compared with mean LOS of 6 h 58 min [95% CI: 382-454 min] for those discharged to OP care (p = 0.072). For suicidality cases, children who were subsequently admitted to IP care experienced a significantly longer mean LOS of 12 h 30 min [95% CI: 279-1221 min] compared with a mean LOS of 7 h 13 min [95% CI: 346-520 min; p = 0.015] for children discharged to OP care. Mean total payor reimbursements were significantly lower than actual ED costs (p < 0.001). ED wait times and LOS were lengthy overall. Future evaluation of an evidence-based peds mental health triage screening tool is needed to support rural ED providers in peds mental health treatment. Additional resources and strategic policy supports are needed to bridge the mental health care treatment gap for rural children to address critical prevention, screening, and reimbursement needs.
需要在美国青少年远程心理健康护理的实施和评估方面开展有针对性的研究工作，以提高医疗服务的可及性。在远程医疗出现之前，儿童及其家庭可能需要等待数周才能获得精神科评估。越来越多的儿科患者在前往该地区的农村急诊科就诊时表示需要心理健康护理。对远程心理健康服务的结果进行了评估，重点是治疗流程和转诊情况。对18个月内年龄小于18岁（N = 87）且由急诊科医生进行身心健康评估的儿童的结果进行了观察性项目评估。随后被诊断患有精神疾病的儿童由精神科医生通过远程心理健康就诊进行治疗（2017年9月至2019年5月），涉及4个农村急诊科。大多数儿童（5至17岁）患有与抑郁或焦虑相关的疾病（49%）或自杀意念/企图或自我伤害（46%），药物滥用病例占5%。住院治疗的儿童在急诊科的平均等待时间为29分钟[95%置信区间：6至52分钟]，而出院接受门诊治疗的儿童平均等待时间为33分钟[95%置信区间：22至43分钟]。住院治疗的儿童平均住院时长为8小时56分钟[95%置信区间：166至906分钟]，而出院接受门诊治疗的儿童平均住院时长为6小时58分钟[95%置信区间：382至454分钟]（p = 0.072）。对于自杀相关病例，随后住院治疗的儿童平均住院时长显著更长，为12小时30分钟[95%置信区间：279至1221分钟]，而出院接受门诊治疗的儿童平均住院时长为7小时13分钟[95%置信区间：346至520分钟；p = 0.015]。支付方的平均总报销金额显著低于急诊科的实际成本（p < 0.001）。总体而言，急诊科的等待时间和住院时长都很长。未来需要对基于证据的儿科心理健康分诊筛查工具进行评估，以支持农村急诊科医生进行儿科心理健康治疗。还需要额外的资源和战略政策支持，以弥合农村儿童心理健康护理的治疗差距，满足关键的预防、筛查和报销需求。
