Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey

Abstract

Background The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. Objective This study aims to describe the early changes implemented by 22 PCLPSs from the US and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. Methods A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20, 2020 – April 28, 2020 and August 18, 2020 – September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that was not dependent on pre-determined coding themes. Descriptive statistics were calculated using Microsoft Excel. Results 22 academic hospitals in the US and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children’s hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. Conclusions To our knowledge, this is the first multi-center study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multi-site survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.

Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study

“…In contrast, only a small proportion (6%) of paediatricians provided exclusively Findings may be related to personal protective equipment availability or many paediatricians already keeping offices open to deliver immunisations to the relatively large proportion of young children in their practices for vaccine-preventable diseases, or the large proportion of children with neurodevelopmental disorders managed by paediatricians where a physical examination may be warranted. 17 This is supported by the case-mix differences observed by the practice-level proportion of virtual care. More specifically, in exclusively virtual practices, social problems and neurodevelopmental disorders were under-represented.…”

“…In mental healthcare however, in-person physical examinations are not as critical for diagnosis and monitoring, except perhaps for neurodevelopmental disorders. Findings may be related to personal protective equipment availability or many paediatricians already keeping offices open to deliver immunisations to the relatively large proportion of young children in their practices for vaccine-preventable diseases, or the large proportion of children with neurodevelopmental disorders managed by paediatricians where a physical examination may be warranted 17. This is supported by the case-mix differences observed by the practice-level proportion of virtual care.…”

“…The extent of uptake of virtual care for mental healthcare has been variable by jurisdiction, underlying health conditions and type of healthcare providers 1 6 15–17. Patient-level factors associated with use of virtual care include familiarity and trust in the modality and accessibility of supporting technologies, low income status and non-white race 6.…”

“…Patient-level factors associated with use of virtual care include familiarity and trust in the modality and accessibility of supporting technologies, low income status and non-white race 6. Factors contributing to uptake by healthcare providers have been less studied,6 with some early evidence of lower uptake in younger physicians and those practising in rural settings16 17 health system factors, including restrictions on reimbursement and licensing may also contribute to virtual care utilisation. For example, in jurisdictions with little or no physician remuneration for virtual care, uptake is poor 18.…”

Pharmacy-based immunization in rural USA during the COVID-19 pandemic: A survey of community pharmacists from five southeastern states

“…Finally, a wealth of literature exists about healthcare systems' adaptability and response to COVID-19 across a variety of professions and health settings (e.g., hospitals, emergency departments, and psychiatric clinics), however, research on how pharmacy-based immunization in rural areas adapted to COVID-19 is limited [46] , [47] , [48] . Adaptability becomes crucial for businesses to maintain services under unprecedented circumstances including pandemics [49] .…”