Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
Psychiatry, IWK Health, Halifax, Nova Scotia, Canada.
BMJ Open. 2023 Dec 18;13(12):e074803. doi: 10.1136/bmjopen-2023-074803.
To describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service.
A pragmatic mixed-methods approach using routinely collected administrative data between 1 April 2020 and 31 March 2022 and semi-structured interviews with clients, caregivers, clinicians and staff. Interview data were coded according to the Consolidated Framework for Implementation Research (CFIR) and examined for patterns of similarity or divergence across data sources, respondents or other relevant characteristics.
Child and adolescent outpatient mental health service, Nova Scotia, Canada.
IWK Health clinicians and staff who had participated in virtual mental healthcare following its implementation in March 2020 and clients (aged 12-18 years) and caregivers of clients (aged 3-18 years) who had received treatment from an IWK outpatient clinic between 1 April 2020 and 31 March 2022 (n=1300). Participants (n=48) in semi-structured interviews included nine clients aged 13-18 years (mean 15.7 years), 10 caregivers of clients aged 5-17 years (mean 12.7 years), eight Community Mental Health and Addictions booking and registration or administrative staff and 21 clinicians.
During peak pandemic activity, upwards of 90% of visits (first or return) were conducted virtually. Between waves, return appointments were more likely to be virtual than first appointments. Interview participants (n=48) reported facilitators and barriers to virtual care within the CFIR domains of 'outer setting' (eg, external policies, client needs and resources), 'inner setting' (eg, communications within the service), 'individual characteristics' (eg, personal attributes, knowledge and beliefs about virtual care) and 'intervention characteristics' (eg, relative advantage of virtual or in-person care).
Shared decision-making regarding treatment modality (virtual vs in-person) requires consideration of client, caregiver, clinician, appointment, health system and public health factors across episodes of care to ensure accessible, safe and high-quality mental healthcare.
描述儿童和青少年服务中虚拟和门诊心理健康服务的使用模式，以及可能影响模式选择的因素。
采用实用混合方法，使用 2020 年 4 月 1 日至 2022 年 3 月 31 日期间收集的常规管理数据和对客户、照顾者、临床医生和工作人员的半结构化访谈。访谈数据根据实施研究综合框架（CFIR）进行编码，并根据数据源、受访者或其他相关特征检查相似性或差异模式。
儿童和青少年门诊心理健康服务，加拿大新斯科舍省。
IWK 卫生保健工作者，他们在 2020 年 3 月实施虚拟心理健康护理后参与其中，以及在 2020 年 4 月 1 日至 2022 年 3 月 31 日期间在 IWK 门诊诊所接受治疗的客户（12-18 岁）和客户的照顾者（3-18 岁）（n=1300）。半结构化访谈的参与者（n=48）包括 9 名 13-18 岁的客户（平均年龄 15.7 岁）、10 名 5-17 岁客户的照顾者（平均年龄 12.7 岁）、8 名社区心理健康和成瘾预约和登记或行政工作人员和 21 名临床医生。
在疫情高峰期，超过 90%的就诊（首次或复诊）都是虚拟进行的。在波之间，复诊比初诊更有可能是虚拟的。访谈参与者（n=48）报告了在 CFIR 的“外部环境”（例如，外部政策、客户需求和资源）、“内部环境”（例如，服务内的沟通）、“个体特征”（例如，虚拟护理的个人属性、知识和信念）和“干预特征”（例如，虚拟或面对面护理的相对优势）领域内虚拟护理的促进因素和障碍。
关于治疗模式（虚拟与面对面）的共同决策需要考虑客户、照顾者、临床医生、预约、卫生系统和公共卫生因素，以确保获得可及、安全和高质量的心理健康护理。
