Patients Found Less Likely to Cancel Telepsychiatry Visits, Study Shows

Patients with depression who scheduled an appointment to see a psychiatrist between July 2020 and October 2022 were less likely to miss or cancel the appointment if it was virtual compared with in person, according to a report published today in Psychiatric Services.

“Appointment completion was higher for telepsychiatry than for in-person care among all patient characteristics studied,” wrote Catherine K. Ettman, Ph.D., of Johns Hopkins Bloomberg School of Public Health and colleagues. The findings “suggest that telepsychiatry is associated with improved efficiency and continuity of care.”

The researchers examined electronic health records for 12,894 patients aged 10 or older with a diagnosis of depression who scheduled 586,266 psychiatric outpatient appointments at Johns Hopkins Medicine between November 2017 and October 2022. They compared the number of in-person and telepsychiatry appointments that patients completed, cancelled, or failed to show up to before the pandemic with these outcomes of in-person and telepsychiatry appointments scheduled from July 2020 to October 2022. (The researchers did not analyze the appointment trends between March 2020 and June 2020 due to the fall in overall appointment completion rates caused by the pandemic.)

Prior to the pandemic, the number of patients who scheduled and completed in-person appointments vastly outnumbered those who scheduled and completed telepsychiatry appointments. Between July 2020 and October 2022, however, telehealth appointments outnumbered the in-person appointments. During this period, 13.3% of telepsychiatry appointments were canceled compared with 18% of in-person appointments.

Overall, telepsychiatry appointments were 1.30 times more likely to be completed than in-person appointments. Moreover, the likelihood that a telepsychiatry appointment would be completed relative to an in-person appointment increased steadily between July 2020 and October 2022. Ettman and colleagues noted that the increased likelihood of completion of telepsychiatry appointments remained regardless of the patient’s age, gender, race, insurance, or employment status.

“[H]ealth systems may wish to maintain telepsychiatry to optimize delivery of care and to improve patient outcomes,” Ettman and colleagues wrote.

However, they noted that telehealth may not be accessible to all patients and may exacerbate existing disparities. For instance, they found that patients who were younger, female, White, employed, or had higher socioeconomic status or private insurance were significantly more likely to schedule telepsychiatry appointments compared with in-person appointments after the pandemic’s onset.

“These findings merit future study,” they wrote. “Additional research on patient preferences, potential disparities in access to care, and efforts to reduce barriers to telehealth is warranted.”

For related information, see the Psychiatric News article “After the Pandemic: What Will the ‘New Normal’ Be in Psychiatry?”

(Image: iStock/PeopleImages)

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Psychiatry Appointments Often Difficult to Obtain, Study FInds

Considerable attention is being focused on the unmet need for mental health care in this country and how critical it is to improve insurance coverage so more people can enter treatment. But a new study finds that expanded insurance coverage might not be the answer, since even with insurance, treatment for mental illness can be hard to obtain.

Researchers at Maimonides Medical Center in Brooklyn, N.,Y., and Harvard Medical School examined the availability of outpatient psychiatric appointments in three large cities—Boston, Chicago, and Houston. As they reported yesterday in the study "Availability of Outpatient Care From Psychiatrists: A Simulated Patient Study in Three U.S. Cities" in Psychiatric Services in Advance, "Obtaining an outpatient appointment with a psychiatrist was difficult in the three cities we surveyed, and the appointments given were an average of one month away. Our findings add to the growing evidence that the mental health system is difficult for consumers to access. The findings are in line with national data demonstrating that two-thirds of primary care physicians cannot obtain outpatient mental health services for patients who need them."

Posing as patients, researchers called 120 numbers in each of the cities that were listed for individual in-network psychiatrists (as opposed to psychiatric clinics) in a Blue Cross/Blue Shield (BCBS) database. For each city, 40 callers each said they had either BCBS PPO insurance, Medicare, or were self-pay. Only 40% of the calls were answered in the first round of calling, and 16% of the numbers were found to be incorrect. After two rounds of calling, the callers obtained appointments with only 93 psychiatrists, or 26% of the sample. The differences between being in the BCBS PPO, Medicare, or self-pay were insignificant when it came to lining up the psychiatric appointment. There was, however, a significant difference in "success rate" for appointments among the cities, with psychiatrists in Boston least likely to offer an appointment (18%), while in Houston appointments were obtained 34% of the time. Chicago was in the middle at 25%.

The researchers concluded that "Expanding health insurance coverage through the Affordable Care Act may thus do little to change the conditions that made it difficult for us to obtain outpatient appointments with psychiatrists—or worse, expansion of coverage might further overwhelm the capacity of available services from these providers." As remedies, they suggest ways in which psychiatry might be made more attractive to medical students and urge an increase in insurance reimbursement for psychiatric care.

For more on these issues, see the Psychiatric News articles "Knocking Down the Barriers to Care" and "Shift to Population Health Called Critical to Psychiatry's Future."

(image: Anton Prado Photo/shuttterstock)