Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD.
Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO.
Med Care. 2023 Apr 1;61(Suppl 1):S47-S53. doi: 10.1097/MLR.0000000000001815. Epub 2023 Mar 9.
The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression.
This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019-March 2020), peak-pandemic shift to virtual care (April 2020-June 2020), and recovery of health care operations (July 2020-June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care.
Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period.
A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.
在 COVID-19 大流行期间突然转向虚拟护理，有可能扰乱虚拟行为健康访视中的护理实践。我们研究了随着时间的推移，在虚拟行为健康护理相关实践方面，患有重度抑郁症的患者就诊情况的变化。
本回顾性队列研究使用了 3 个综合医疗保健系统的电子健康记录数据。使用逆概率治疗加权法，在 3 个时期（2019 年 1 月至 2020 年 3 月，大流行前）、向虚拟护理的大流行高峰转移期（2020 年 4 月至 2020 年 6 月）和医疗保健业务恢复期（2020 年 7 月至 2021 年 6 月）调整协变量。分析了在大流行事件发生后首次进行虚拟随访的行为健康部门访视，考察了这 3 个时期在开出抗抑郁药物的比率和完成情况，以及完成患者报告的症状筛查方面的差异，这些是为实现基于测量的护理而服务的。
在 3 个系统中的 2 个系统中，在高峰大流行期间，抗抑郁药物的开具数量略有但显著下降，但在恢复期间有所反弹。患者对开具的抗抑郁药物的完成情况没有显著变化。在大流行高峰期，所有 3 个系统中的症状筛查完成率都显著增加，并且在随后的时期内继续显著增加。
虚拟行为医疗保健的快速转移是可能的，而不会影响与医疗保健相关的实践。相反，过渡和随后的调整期的特点是，虚拟访视中基于测量的护理实践的依从性得到了改善，这表明虚拟医疗保健提供方面可能出现了新的能力。
