Toulany Alene, Kurdyak Paul, Gandhi Sima, Fu Longdi, Grewal Seena, Kulkarni Chetana, Saunders Natasha, Vigod Simone, Guttmann Astrid, Chiu Maria, Pignatiello Antonio
Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario.
ICES, Toronto, Ontario.
Can J Psychiatry. 2022 Jun;67(6):462-469. doi: 10.1177/07067437211043395. Epub 2021 Sep 27.
To describe the characteristics of children and adolescents receiving tele-mental health services in Ontario, Canada and examine access to a psychiatrist, in-person or via tele-mental health services, following a mental health and addictions (MHA)-related emergency department (ED) visit or hospitalization.
Using linked health and administrative data, we described two cohorts: (1) children and adolescents (1-18 years) who used a provincial tele-mental health programme from January 1, 2013 to March 31, 2017, comparing their MHA-related service use (outpatient, ED, hospitalization) in the 1 year prior to and the 1 year following initial consultation; (2) children and adolescents with high mental health service needs, defined as those with an incident MHA-related ED visit or hospitalization between January 1, 2013 and December 31, 2016, examining their 1-year follow-up with telemedicine and other health care utilization.
In the first cohort, 7,216 children and adolescents (mean age 11.8 [±3.8] years) received tele-mental health services. The proportion of MHA-related ED visits [15.1% pre vs. 12.6% post (test statistic 23.57, < 0.001)] or hospitalizations [10.2% pre vs. 8.7% post (test statistic 11.96, < 0.001)] declined in the year following tele-mental health consultation, while local psychiatry visits increased [8.4% pre vs. 17.0% post (test statistic 298.69, < 0.001)]. In the second cohort ( = 84,033), only 1.5% received tele-mental health services, 40.7% saw a psychiatrist in-person, and 32.5% received no MHA-related outpatient care in follow-up.
Tele-mental health services were rarely used in Ontario, even among high-needs children and adolescents, despite their association with increased access to care and less need for acute mental health care.
描述在加拿大安大略省接受远程心理健康服务的儿童和青少年的特征，并调查在因心理健康与成瘾问题（MHA）相关而前往急诊科（ED）就诊或住院后，通过面对面或远程心理健康服务获得精神科医生诊疗的情况。
利用关联的健康和行政数据，我们描述了两个队列：（1）2013年1月1日至2017年3月31日使用省级远程心理健康项目的儿童和青少年（1至18岁），比较他们在初次咨询前1年和初次咨询后1年与MHA相关的服务使用情况（门诊、ED、住院）；（2）有高心理健康服务需求的儿童和青少年，定义为在2013年1月1日至2016年12月31日期间有与MHA相关的首次ED就诊或住院经历的儿童和青少年，调查他们在远程医疗和其他医疗保健利用方面的1年随访情况。
在第一个队列中，7216名儿童和青少年（平均年龄11.8 [±3.8]岁）接受了远程心理健康服务。在远程心理健康咨询后的一年中，与MHA相关的ED就诊比例[之前为15.1%，之后为12.6%（检验统计量23.57，<0.001）]或住院比例[之前为10.2%，之后为8.7%（检验统计量11.96，<0.001）]下降，而当地精神科就诊增加[之前为8.4%，之后为17.0%（检验统计量298.69，<0.001）]。在第二个队列（n = 84033）中，只有1.5%的人接受了远程心理健康服务，40.7%的人面对面看了精神科医生，32.5%的人在随访中没有接受与MHA相关的门诊护理。
尽管远程心理健康服务与增加获得护理的机会以及减少对急性心理健康护理的需求相关，但在安大略省，即使是在高需求的儿童和青少年中，远程心理健康服务的使用也很少。
