Bormann Nicholas L, Stoppel Cindy J, Arndt Stephan, Oesterle Tyler S
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA.
Subst Abuse Rehabil. 2024 Oct 25;15:223-232. doi: 10.2147/SAR.S481447. eCollection 2024.
Telehealth use has grown tremendously since the onset of the COVID-19 pandemic. While the benefits of virtual care delivery are numerous, little is known about patient experiences in group treatment settings when members join both virtually and in person with the counselor (a hybrid model). We sought to fill this gap by comparing patient survey data across care delivery models.
Adult patients with a substance use disorder enrolled at one of seven intensive outpatient (IOP) programs in rural Minnesota voluntarily completed a questionnaire assessing patient satisfaction, perceived therapeutic alliance, group cohesion, and insight gained from treatment. Starting 7/1/2021, groups were either all virtual, all in-person, or a hybrid model. The survey began on 1/1/2022. Analysis of covariance (ANCOVA) tested for differences among treatment groups. Separate models were used for each survey question, where the dependent variable was the survey response, the test of interest being treatment group-type, with covariates of length of stay and age. Model estimates and model-based standard deviations were used to calculate the Cohen's d effect size.
Survey results from a total of 1037 individuals were included, one survey per respondent. Data was deidentified upon receipt of the survey, preventing specific demographic comparisons. For the hybrid groups, no significant differences were noted with survey responses relative to in-person, with negligible to small effect sizes seen. When comparing virtual to in-person, virtual was rated as significantly worse than in-person on 6 of the 8 questions; effect size estimates exceeded the small effect size cut-off, and the 95% CI exceeded the moderate cut-off.
Creating a group model where patients can attend both virtually and in-person together appears to improve perceived therapeutic alliance, group cohesion, and treatment insight, compared to virtual-only groups, which may have a negative effect relative to in-person.
自新冠疫情爆发以来，远程医疗的使用量大幅增长。虽然虚拟护理服务有诸多益处，但对于患者在团体治疗环境中，即成员通过虚拟方式和亲自与咨询师一起参与（混合模式）时的体验，我们了解甚少。我们试图通过比较不同护理服务模式下的患者调查数据来填补这一空白。
在明尼苏达州农村地区七个强化门诊（IOP）项目之一登记的患有物质使用障碍的成年患者自愿完成了一份问卷，评估患者满意度、感知到的治疗联盟、团体凝聚力以及从治疗中获得的领悟。从2021年7月1日起，团体治疗模式分为全虚拟、全面对面或混合模式。调查于2022年1月1日开始。协方差分析（ANCOVA）用于检验治疗组之间的差异。每个调查问题都使用单独的模型，其中因变量是调查回复，感兴趣的检验是治疗组类型，协变量是住院时间和年龄。模型估计值和基于模型的标准差用于计算科恩d效应量。
共纳入了1037人的调查结果，每人一份调查。在收到调查时对数据进行了去识别处理，以防止进行具体的人口统计学比较。对于混合组，与面对面组相比，调查回复未发现显著差异，效应量可忽略不计或较小。在将虚拟模式与面对面模式进行比较时，在8个问题中的6个问题上，虚拟模式的评分明显低于面对面模式；效应量估计值超过了小效应量的临界值，且95%置信区间超过了中等效应量的临界值。
与仅虚拟模式的团体相比，创建一种患者可以同时通过虚拟方式和亲自参与的团体模式，似乎能改善感知到的治疗联盟、团体凝聚力和治疗领悟，仅虚拟模式相对于面对面模式可能有负面影响。
