Zimmerman Mark, Terrill Douglas, D'Avanzato Catherine, Tirpak Julianne Wilner
Department of Psychiatry and Human Behavior, Brown Medical School, and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island.
Corresponding author: Mark Zimmerman, MD, 146 West River St, Providence, RI 02904 (
J Clin Psychiatry. 2021 Mar 16;82(2):20m13815. doi: 10.4088/JCP.20m13815.
Most research evaluating telehealth psychiatric treatment has been conducted in outpatient settings. There is a great lack of research assessing the efficacy of telehealth treatment in more acute, intensive treatment settings such as a partial hospital. In the face of the COVID-19 pandemic, much of behavioral health treatment has transitioned to a virtual format. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the effectiveness of our partial hospital program (PHP).
The sample included 207 patients who were treated virtually from May 2020 to September 2020 and a comparison group of 207 patients who were treated in the in-person partial program a year earlier. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being.
For both the in-person and telehealth methods of delivering partial hospital level of care, patients were highly satisfied with treatment and reported a significant reduction in symptoms and suicidality from admission to discharge. On the modified Remission from Depression Questionnaire, the primary outcome measure, both groups reported a significant (P < .01) improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment (Cohen d > 0.8) was found in both treatment groups. The only significant difference in outcome between the patients treated in the different formats was a greater length of stay (mean ± SD of 13.5 ± 8.1 vs 8.5 ± 5.0 days, t = 7.61, P < .001) and greater likelihood of staying in treatment until completion (72.9% vs 62.3%, χ = 5.34, P < .05) in the virtually treated patients.
Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, suicidal ideation reduction, and improved functioning and well-being. The treatment completion rate was higher in the telehealth cohort, and several patients who were treated virtually commented that they never would have presented for in-person treatment even if there was no pandemic. Telehealth PHPs should be considered a viable treatment option even after the pandemic has resolved.
大多数评估远程医疗精神治疗的研究都是在门诊环境中进行的。在诸如部分住院这样更急性、更密集的治疗环境中，评估远程医疗治疗效果的研究非常匮乏。面对新冠疫情，许多行为健康治疗已转变为虚拟形式。在罗德岛改善诊断评估和服务方法（MIDAS）项目的本报告中，我们研究了部分住院项目（PHP）的有效性。
样本包括2020年5月至2020年9月接受虚拟治疗的207名患者，以及一年前在面对面部分住院项目中接受治疗的207名患者组成的对照组。患者完成了关于患者满意度、症状、应对能力、功能和总体幸福感的自我管理测量。
对于提供部分住院护理水平的面对面和远程医疗方法，患者对治疗高度满意，并报告从入院到出院症状和自杀倾向显著降低。在主要结局指标改良抑郁问卷缓解情况上，两组在功能、应对能力、积极心理健康和总体幸福感方面均有显著（P < 0.01）改善。两个治疗组均发现治疗效果显著（科恩d>0.8）。不同形式治疗的患者之间唯一显著的结局差异是虚拟治疗患者的住院时间更长（平均±标准差为13.5±8.1天 vs 8.5±5.0天，t = 7.61，P < 0.001），以及完成治疗的可能性更大（72.9% vs 62.3%，χ = 5.34，P < 0.05）。
在患者满意度、症状减轻、自杀观念减少以及功能和幸福感改善方面，远程医疗部分住院治疗与面对面治疗同样有效。远程医疗队列的治疗完成率更高，一些接受虚拟治疗的患者表示，即使没有疫情，他们也绝不会选择面对面治疗。即使在疫情结束后，远程医疗部分住院项目也应被视为一种可行的治疗选择。
