Health-care–Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the COVID-19 Pandemic

Abstract

Background: The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression. Methods: This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019–March 2020), peak-pandemic shift to virtual care (April 2020–June 2020), and recovery of health care operations (July 2020–June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care. Results: Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period. Conclusions: A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.

Development of a Common Data Model for a Multisite and Multiyear Study of Virtual Visit Implementation

“…: These datasets represent additional visit details, including ancillary services orders and fulfillments, for clinical conditions selected for focused study on variation in provider ordering behavior, and patient fulfillment behavior, for related ancillary services: NBP, UTI, and DEP. [10][11][12][13] Further details of each of the CDM datasets are presented in the Supplement (Tables S4-S9, Supplemental Digital Content 1, http://links.lww.com/MLR/C605). Key decisions that informed contents of specific CDM datasets are summarized in the Supplement (Table S10, Supplemental Digital Content 1, http://links.lww.com/MLR/C605).…”

“…This dataset is primarily sourced through HealthConnect tables. VV_ENC_NBP_DB, etc. : These datasets represent additional visit details, including ancillary services orders and fulfillments, for clinical conditions selected for focused study on variation in provider ordering behavior, and patient fulfillment behavior, for related ancillary services: NBP, UTI, and DEP 10–13 …”

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

“…Racial-ethnic disparities in telemedicine use were found within KP; adults identifying as Black, Asian, or Hispanic were less likely to use virtual care 6. The KP research studies also tackle new areas in telemedicine research by comparing the impact of telemedicine and in-person visits on ancillary services utilization, including medication, laboratories, and imaging, for urinary tract infections7 neck and back pain,8 and depression 9. These studies found that although ancillary service orders resulting from telemedicine visits were generally high, orders from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, 7 neck and back pain, 8 but there were no significant changes in patient fulfillment of ordered antidepressant medications 9.…”

“…The KP research studies also tackle new areas in telemedicine research by comparing the impact of telemedicine and in-person visits on ancillary services utilization, including medication, laboratories, and imaging, for urinary tract infections7 neck and back pain,8 and depression 9. These studies found that although ancillary service orders resulting from telemedicine visits were generally high, orders from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, 7 neck and back pain, 8 but there were no significant changes in patient fulfillment of ordered antidepressant medications 9. The KP findings highlight the importance of prior use of mail-order pharmacy options in promoting the fulfillment of prescribed medication orders, irrespective of visit mode 10.…”

“…9 These studies found that although ancillary service orders resulting from telemedicine visits were generally high, orders from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, 7 neck and back pain, 8 but there were no significant changes in patient fulfillment of ordered antidepressant medications. 9 The KP findings highlight the importance of prior use of mail-order pharmacy options in promoting the fulfillment of prescribed medication orders, irrespective of visit mode. 10 The results suggest that health care system investments in patient portal implementation can support ancillary service orders resulting from telemedicine visits, and potentially improve chronic care management.…”