According to a new analysis, the quick switch from in-person care to telemedicine consultations at the onset of the COVID-19 pandemic did not have a negative impact on the quality of care—and actually enhanced some areas of care—for patients with serious depression in a significant integrated health system. A unique “Virtual Visits” supplement to Medical Care includes the study.
“A rapid shift to virtual behavioral health care was possible without compromising healthcare-related practices,” according to the new research, led by Nancy S. Weinfield, Ph.D., of Kaiser Permanente (KP) Mid-Atlantic Permanente Research Institute, Rockville, Md. The study is one of 10 original research papers examining the implementation and impact of telemedicine in the new supplement.
In March 2020, telemedicine quickly replaced in-person appointments in healthcare systems across the United States. The unusual transition to virtual visits during the pandemic had the potential to alter treatment practices and results, maybe notably in patient populations who were more vulnerable. This was true even though many providers had been developing their telemedicine skills.
The new studies look at how the shift to telemedicine affected the quality, utilization, and patient experience of care. “The supplemental issue of Medical Care aims to advance evidence about how health care organizations and systems can best support telemedicine implementation,” according to an introduction by Guest Editor Hector P. Rodriguez, Ph.D., MPH, of the University of California, Berkeley.
Seven publications evaluate the use of telemedicine in three KP system regions, look at telemedicine utilization trends, and contrast the effects of telemedicine and in-person consultations on ailments like UTI, back and neck pain, and depression. Some studies emphasize the importance of telemedicine in preserving the continuity of primary care and the caliber of diabetic care by concentrating on vulnerable populations, such as Medicare and Medicaid recipients and patients getting care in community health centers.
Dr. Weinfield and colleagues examined how the KP system’s switch to virtual visits influenced the treatment of patients with depression. In approximately 29,000 first telemedicine follow-up behavioral health visits by patients with serious depression, the researchers examined electronic health record data.
When accounting for patient characteristics, two out of three KP regions revealed modest but significant decreases in the number of antidepressant prescriptions written during the peak pandemic transition to virtual treatment (April to June 2020). But, during the recovery phase, which starts in the summer of 2020, medicine prescriptions were restored to pre-pandemic levels. The rates of prescription fulfillment remained constant during the three times.
In the meantime, during the height of the pandemic and throughout the recovery phase, rates of patient completion of depressive symptom screening tools considerably increased in all three regions. The researchers write that greater adherence to measurement-based care practices during the changeover and following adjustment phase instead signaled a potential new capability for the delivery of virtual health care.
During the pandemic recovery era, behavioral health for major depression was still mostly provided by telemedicine, in contrast to the conditions examined in earlier KP research. Dr. Weinfield and co-authors conclude: “Within these three regions of KP, the fact that care has not rebounded to include substantial in-person visits suggests that virtual visits have proven to be a successful model for providers and patients.”
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