Ward Marcia M, Bhagianadh Divya, Carter Knute D, Ullrich Fred, Marcin James P, McCord Carly, Law Kari Beth, Nelson Eve-Lynn, Merchant Kimberly A S
Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA.
School of Social Work, Rutgers University, New Brunswick, New Jersey, USA.
Telemed J E Health. 2024 Mar;30(3):677-684. doi: 10.1089/tmj.2023.0220. Epub 2023 Sep 25.
Background:Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of modality crossovers during behavioral health treatment.
Methods:The nonrandomized, prospective, multisite research design involved two active treatment groups-a telehealth treatment cohort and an in-person treatment cohort. Treatment modality (telehealth or in person) during each encounter was compared overall and across two time periods (pre- and during the COVID-19 pandemic) between the telehealth cohort and the in-person cohort.
Results:Overall, modality crossovers were relatively uncommon (6.3%). However, patients in the in-person treatment cohort were more than twice as likely to have an encounter through telehealth (8.5%) than patients in the telehealth treatment cohort were to have an in-person encounter (3.4%) even though they had the same average number of encounters. The occurrence of off-mode encounters was particularly influenced by the onset of the COVID-19 pandemic.
Conclusions:In this multisite usual care study comparing telehealth and in-person behavioral health treatment, modality crossovers were more common in the in-person cohort than the telehealth cohort, especially during the COVID-19 pandemic. Because telehealth availability has increased, crossovers are likely to increase in patients receiving multiple encounters for behavioral or chronic conditions and their occurrence should be noted by both researchers and practitioners.
当开始一种治疗方式后又采用另一种不同的治疗方式时，就会出现治疗方式转换。治疗方式转换在随机对照试验中经常被研究，但在常规护理治疗研究中很少被提及或进行定量评估。本分析的目的是研究行为健康治疗期间治疗方式转换的程度。
非随机、前瞻性、多中心研究设计涉及两个积极治疗组——远程医疗治疗队列和面对面治疗队列。比较了远程医疗队列和面对面队列在每次就诊时的治疗方式（远程医疗或面对面），并在两个时间段（COVID-19大流行前和期间）进行了总体比较。
总体而言，治疗方式转换相对不常见（6.3%）。然而，面对面治疗队列中的患者通过远程医疗进行就诊的可能性（8.5%）是远程医疗治疗队列中的患者进行面对面就诊可能性（3.4%）的两倍多，尽管他们的平均就诊次数相同。非模式就诊的发生尤其受到COVID-19大流行开始的影响。
在这项比较远程医疗和面对面行为健康治疗的多中心常规护理研究中，治疗方式转换在面对面队列中比在远程医疗队列中更常见，尤其是在COVID-19大流行期间。由于远程医疗的可及性增加，接受多次行为或慢性病就诊的患者中治疗方式转换可能会增加，研究人员和从业者都应注意其发生情况。
