Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey

Abstract

Background Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients’ initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective This paper seeks to examine factors influencing patients’ initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor’s stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8%) initially chose to receive psychiatric care through video visits, while 13.5% (n=33) chose telephone visits and 1.2% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95% CI 0.02-0.06). Patients aged ≥44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth.

Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review

“…This correlates with findings that not all staff and service users would want to continue using remote methods of care after the pandemic ends. However, there are some aspects of remote working that both clinicians and service users would like to keep in the future in combination with face-to-face care (eg, [ 93 , 104 ]), as this approach has benefits such as being more efficient, flexible, and enabling access for certain groups (eg, [ 7 , 60 , 62 ]).…”

Implementation, adoption and perceptions of telemental health during the COVID-19 pandemic: a systematic review

“…However, there are some aspects of remote working that both clinicians and service users would like to keep in the future in combination with face-to-face care e.g. (94, 105), as this approach has benefits such as being more efficient, flexible, and enabling access for certain groups e.g. (7, 61, 63).…”

How did women with breast cancer experience the first wave of the COVID-19 pandemic? A qualitative study

“…While video-based telehealth was implemented rapidly in the early pandemic in some facilities providing medical cancer care [ 10 , 17 ] and mental health services [ 8 , 19 ], we found no data specifically on the rate of redeployment of psycho-oncology services to telehealth. However, reports of experiences in psychiatric departments and mental health services have pinpointed significant disparities in terms of access to digital mental health care related to older age and geographical (e.g., no access to broadband), financial (e.g., not owning a computer or smartphone), technical (e.g., lack of comfort with technology), and language barriers [ 20 , 22 ]. Hence, other modalities should be offered as well including telephone-based interventions and in-person appointments when telehealth is not possible or desirable.…”