Most patients access telepsychiatry via video, but age affects preferences
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Patient age was linked to virtual visit type preference for telepsychiatry during the COVID-19 pandemic, with older adults preferring telephone visits over video visits, according to study results published in JMIR Formative Research.
“A few weeks into the COVID-19 pandemic, we understood that it served as the catalyst for more rapid acceptance of virtual care out of necessity,” Jennifer Severe, MD, of the department of psychiatry at the University of Michigan, told Healio Psychiatry. “What remained unclear were patient reception and adoption of the COVID-19-related changes in health care delivery. Being one of the first three psychiatrists who piloted a telepsychiatry initiative in the Michigan Medicine Outpatient Psychiatry Clinic before the pandemic, I was impressed by the widespread uptake of virtual care, a departure from the preexisting status of virtual care in our department.”
According to Severe and colleagues, telepsychiatry was a novel and unfamiliar method of engaging in care at the onset of the pandemic, and little remains known about factors that affect patients’ decisions to use telepsychiatry during a public health crisis.
To address this research gap, the investigators aimed to evaluate these factors after stay-at-home orders were issued in Michigan, patients’ initial choice of virtual care modality and their anticipated participation in telepsychiatry following reopening of clinics for in-person visits. They conducted a telephone-based survey between June 2020 and August 2020 using a questionnaire with two qualitative and 14 quantitative items as part of a quality improvement initiative. They received responses from 244 individuals with an in-person appointment date scheduled for the first few weeks after the Michigan governor’s stay-at-home order, which thus warranted converting to virtual visits or deferment of in-person care. Further, they reported individual survey responses using descriptive statistics, and they used multivariable logistic regression to evaluate the association between patient characteristics and chosen visit type and future telepsychiatry participation.
Results showed most (82.8%) participants initially chose video visits for receiving psychiatric care, whereas 33 (13.5%) chose telephone visits and three (1.2%) chose to postpone care until in-person visits became available. The researchers noted an association between patient age and chosen visit type, with those aged 44 years or older more likely than those aged 44 years or younger to choose telephone visits (relative risk reduction [RRR] = 1.2; 95% CI, 1.06-1.35). They observed no statistical relevance for patient sex, race, type of insurance and number of previous visits to the clinic. Nearly half of participants reported being likely to continue with telepsychiatry even after in-person visits became available. Those who accessed telepsychiatry via the telephone were less likely than video visit users to anticipate future participation in telepsychiatry (RRR = 1.08; 95% CI, 0.97-1.2). Most users reported having their expectations met or exceeded by virtual visits.
“We were pleased to see nearly all the patients in the study group who had a virtual visit said it went as well as they had expected, or better,” Severe said. “Logistically and clinically, we need to keep this satisfaction alive and continue to improve but also we need to ensure we have capacity to meet the demands for the number of Michigan residents (54% of patients in our survey) who are likely to continue with telepsychiatry visits after clinics fully re-open for traditional care.
“As we look toward the future, I envision a blended care model bridging traditional psychiatric face-to-face visits with telepsychiatry as deemed appropriate,” Severe added.