Rady School of Medicine, University of Manitoba, 750 Bannatyne Ave., Winnipeg, MB, Canada.
Crisis Response Centre, 817 Bannatyne Ave., Winnipeg, MB, Canada.
BMC Psychiatry. 2022 Aug 4;22(1):527. doi: 10.1186/s12888-022-04166-w.
The coronavirus pandemic necessitated the rapid transition to virtual care. At a 24-h walk-in mental health Crisis Response Centre (CRC) in Winnipeg, Canada we adapted crisis mental health assessments to be offered virtually while the crisis centre also remained open to in person visits. Little is known about the sustainability of virtual visits in the presence of comparable in person care, and which visits are more likely to be done virtually, particularly in the crisis setting.
An analysis of visits to the CRC from the first local lockdown on March 19, 2020 through the third local wave with heightened public health restrictions in June 2021. Analysis of Variance was used to compare the proportion of visits occurring virtually (telephone or videoconference) during the first wave of heightened public health restrictions (lockdown 1) and subsequent lockdowns as well as the in-between periods. A binary logistic regression examined visit, sociodemographic and clinical factors associated with receipt of a virtual visit compared to an in person visit over the first year of the pandemic.
Out of 5,357 visits, 993 (18.5%) occurred virtually. There was a significant difference in proportion of virtual visits across the pandemic time periods (F(4, 62) = 8.56, p < .001). The proportion of visits occurring virtually was highest during lockdown 1 (mean 32.6% by week), with no differences between the other time periods. Receipt of a virtual visit was significantly associated with daytime weekday visits, age, non-male gender, living further away from the CRC, no prior year contact with the CRC, and visits that did not feature suicidal behaviour, substance use, psychosis or cognitive impairment.
A large proportion of virtual care occurring at the outset of the pandemic reflects public anxiety and care avoidance paired with health system rapid transformation. The use of virtual visits reduced over subsequent pandemic periods but was sustained at a meaningful level. Specific visit, sociodemographic and clinical characteristics are more likely to be present in visits occurring virtually compared to those in person. These results can help to inform the future planning and delivery of virtual crisis care.
冠状病毒大流行促使医疗服务迅速转向虚拟模式。在加拿大温尼伯的一家 24 小时步行式心理健康危机应对中心 (CRC)，我们调整了危机心理健康评估的方式，使其可以通过虚拟途径提供，同时该危机应对中心仍然对面对面访问开放。在提供面对面护理的同时，很少有人了解虚拟访问的可持续性，以及哪些访问更有可能通过虚拟途径进行，尤其是在危机环境中。
对 2020 年 3 月 19 日当地首次封锁至 2021 年 6 月第三次当地疫情高峰期期间访问 CRC 的情况进行分析。采用方差分析比较了在第一次公共卫生限制增强期间（封锁 1）以及随后的封锁期间和其间进行虚拟访问（电话或视频会议）的比例。二元逻辑回归检查了在大流行第一年期间，与面对面访问相比，接受虚拟访问的就诊、社会人口统计学和临床因素。
在 5357 次就诊中，有 993 次（18.5%）是通过虚拟途径进行的。在整个大流行期间，虚拟就诊的比例存在显著差异（F(4, 62) = 8.56，p < .001）。封锁期间虚拟就诊的比例最高（平均每周 32.6%），而其他时间段没有差异。接受虚拟就诊与白天工作日就诊、年龄、非男性性别、离 CRC 较远、前一年与 CRC 无接触以及就诊时没有自杀行为、药物使用、精神病或认知障碍显著相关。
在大流行初期，虚拟护理的比例很高，反映了公众的焦虑和对护理的回避，以及医疗系统的快速转型。随后的大流行期间，虚拟就诊的使用有所减少，但仍保持在一个有意义的水平。与面对面就诊相比，虚拟就诊更有可能出现特定的就诊、社会人口统计学和临床特征。这些结果有助于为未来的虚拟危机护理规划和提供提供信息。
