Transitioning from In-Person to Telemedicine Within Primary Care Behavioral Health During COVID-19

Rene, Rachelle; Cherson, Mollie; Rannazzisi, Angelo; Felter, Jeanne; Silverio, Alexis; Cunningham, Amy

doi:10.1089/pop.2021.0292

Cited by 8 publications

(14 citation statements)

References 31 publications

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“…Studies considered patients with a range of health conditions (ie, mental illnesses [ 36 , 40 , 42 , 53 ]; urgent and nonemergent conditions [ 33 , 44 ]; overweight and obesity [ 31 , 58 ]; lower back pain [ 32 ]; alcohol use disorders [ 54 ]; nicotine dependence [ 55 ]; hard-to-heal ulcers [ 57 ]; and acute, nonurgent conditions [ 37 ]). The remaining studies (17/30, 57%) considered primary care users in general.…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review

Campbell,

Greenfield,

et al. 2023

J Med Internet Res

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Background The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. Objective This study aims to evaluate the impact of virtual consultations on the quality of primary care. Methods A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. Results In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients’ perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. Conclusions Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.

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Section: Resultsmentioning

confidence: 99%

“…In almost all studies, the consultations were the first in an episode of care. Other studies consisted follow-up consultations, including behavioral therapy [ 42 , 53 , 58 ], motivational interviewing [ 54 ], and smoking cessation counseling [ 55 ].…”

Section: Resultsmentioning

confidence: 99%

The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review

Campbell,

Greenfield,

et al. 2023

J Med Internet Res

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“…Importantly, past research indicates that most PCBH patients (∼66%) attend only one session (Bryan et al, 2012). It is not clear if the results of the Rene et al (2022) study generalize to the broader population of PCBH patients. It is possible that both the primary care clinics and patients seen at these clinics were able to transition smoothly to telehealth for several reasons (e.g., good access to technology such as smartphones and laptops, strong infrastructure in the community that made broadband access available).…”

Section: Primary Care Behavioral Health In Fqhcsmentioning

confidence: 98%

“…To our knowledge, the first study to examine the transition to telehealth for behavioral health care in a PCBH setting specifically was published by Rene et al (2022). These researchers found telehealth sessions resulted in similar patient-reported symptom declines as in-person sessions and patients generally saw the transition to telehealth as acceptable.…”

Section: Covid-19 and A Shift To Telehealth Service Delivery In The U...mentioning

confidence: 99%

“…It is possible that both the primary care clinics and patients seen at these clinics were able to transition smoothly to telehealth for several reasons (e.g., good access to technology such as smartphones and laptops, strong infrastructure in the community that made broadband access available). Notably, though patient socioeconomic status was not reported in the Rene et al (2022) article, there is evidence to suggest that the PCBH settings and patient population they examined were economically privileged (U.S. Census Bureau, 2021a, 2021b, 2021c.…”

Section: Covid-19 and A Shift To Telehealth Service Delivery In The U...mentioning

confidence: 99%

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Telebehavioral health at a federally qualified health center pre- and peri-COVID-19.

Bridges¹,

Steggerda²,

Guzman³

et al. 2024

Psychological Services

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Federally Qualified Health Centers (FQHCs) are a safety net for low-income individuals needing mental and/or physical health care. The COVID-19 pandemic required FQHCs (and other health organizations) to pivot rapidly to telehealth. In theory, telehealth services can expand access to needed care. The COVID-19 pandemic provides a natural opportunity to "test" this assumption. We compared sociodemographic differences in patients accessing behavioral health services pre-and peri-COVID-19 at an FQHC. We also investigated potential patient sociodemographic disparities in telebehavioral health service use during the first year of the COVID-19 pandemic. Data were collected from a single FQHC (13 sites, 4 integrated primary care medical clinics) in the southern United States. Participants included 5,190 patients (69.2% female, 59.7% persons of color) attending a total of 16,474 behavioral health sessions across 2 years (one pre-and one peri-COVID-19). Before the COVID-19 pandemic, 100% of behavioral health visits were conducted in person. During the pandemic, nearly half of behavioral health visits were conducted via telehealth. Telehealth visits were most frequently attended by adults, non-Latinx Whites, women, and people making ≤200% of the federal poverty level. A combination of in-person and telehealth service delivery models should be used by FQHCs to maximize access to care for different demographic groups. FQHCs should consider key factors (e.g., access, ableism, technology facility, and language) to increase patients' ability to take advantage of telehealth services where available. Impact StatementThe COVID-19 pandemic offered an opportunity to test whether telehealth services could expand patient access to behavioral health care. We found some demographic groups frequently used telehealth services but key barriers to access remained for other groups. We encourage readers, policymakers, and directors of primary care behavioral health clinics to consider factors such as access, ableism, technology facility, and language to increase patients' telehealth service use.

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Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review

Hatef,

Wilson,

Zhang

et al. 2024

npj Digit. Med.

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In this systematic review, we compared the effectiveness of telehealth with in-person care during the pandemic using PubMed, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from March 2020 to April 2023. We included English-language, U.S.-healthcare relevant studies comparing telehealth with in-person care conducted after the onset of the pandemic. Two reviewers independently screened search results, serially extracted data, and independently assessed the risk of bias and strength of evidence. We identified 77 studies, the majority of which (47, 61%) were judged to have a serious or high risk of bias. Differences, if any, in healthcare utilization and clinical outcomes between in-person and telehealth care were generally small and/or not clinically meaningful and varied across the type of outcome and clinical area. For process outcomes, there was a mostly lower rate of missed visits and changes in therapy/medication and higher rates of therapy/medication adherence among patients receiving an initial telehealth visit compared with those receiving in-person care. However, the rates of up-to-date labs/paraclinical assessment were also lower among patients receiving an initial telehealth visit compared with those receiving in-person care. Most studies lacked a standardized approach to assessing outcomes. While we refrain from making an overall conclusion about the performance of telehealth versus in-person visits the use of telehealth is comparable to in-person care across a variety of outcomes and clinical areas. As we transition through the COVID-19 era, models for integrating telehealth with traditional care become increasingly important, and ongoing evaluations of telehealth will be particularly valuable.

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Transitioning from In-Person to Telemedicine Within Primary Care Behavioral Health During COVID-19

Cited by 8 publications

References 31 publications

The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review

The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review

Telebehavioral health at a federally qualified health center pre- and peri-COVID-19.

Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review

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