Shifts in inpatient psychiatry utilization patterns at a U.S. Academic Medical Center during the COVID-19 pandemic

Kulp, William; Mitchell, Thomas; Pittman, Brian; Li, Luming

doi:10.1016/j.psychres.2021.114376

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Similar to this study, studies in several other regions, including the UK, Italy, Spain, Denmark, Switzerland, Australia, Canada, and the US, observed an overall decrease of inpatient admissions but an increase in involuntary admissions and more acute cases ( 4 , 26 – 35 ). Most regions reported reduced utilization for affective and anxiety disorders, but often no change for psychotic and sometimes addiction disorders ( 36 , 37 ). Similarly, despite often much higher COVID-19 incidences, service restrictions were much less pronounced in the second high incidence phase in winter 2020–2021 than in the first such phase in spring 2020.…”

Section: Discussionmentioning

confidence: 99%

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany – Results From the COVID Ψ Psychiatry Survey

et al. 2022

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Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. The Germany-wide COVID Ψ Psychiatry Survey surveyed department heads of German psychiatric inpatient institutions. It assessed changes in utilization during the first two high incidence phases of the pandemic (spring 2020 and winter 2020/21) and also consequences for care, telemedicine experiences, hygiene measures, treatment of patients with mental illness and co-occuring SARS-CoV-2, and coercive measures in such patients. A total of n = 71 psychiatric departments (of 346 contacted) participated in the survey. The results showed a median decrease of inpatient treatment to 80% of 2019 levels and of day hospital treatment to 50% (first phase) and 70% (second phase). Reductions were mainly due to decreases in elective admissions, and emergency admissions remained unchanged or increased in 87% of departments. Utilization was reduced for affective, anxiety, personality, and addiction disorders but appeared roughly unaffected for psychotic disorders. A lack of integration of patients into their living environment, disease exacerbations, loss of contact, and suicide attempts were reported as problems resulting from reduced capacities and insufficient outpatient treatment alternatives. Almost all departments (96%) treated patients with severe mental illness and co-occurring SARS-CoV-2 infection. The majority established special wards and separate areas for (potentially) infectious patients. Telephone and video consultations were found to provide benefits in affective and anxiety disorders. Involuntary admissions of persons without mental illness because of infection protection law violations were reported by 6% of the hospitals. The survey showed high adaptability of psychiatric departments, which managed large capacity shifts and introduced new services for infectious patients, which include telemedicine services. However, the pandemic exacerbated some of the shortcomings of the German mental health system: Avoidable complications resulted from the lack of cooperation and integrated care sequences between in- and outpatient sectors and limited options for psychiatric hospitals to provide outpatient services. Preventive approaches to handle comparable pandemic situations in the future should focus on addressing these shortcomings.

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Section: Discussionmentioning

confidence: 99%

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany – Results From the COVID Ψ Psychiatry Survey

et al. 2022

View full text Add to dashboard Cite

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“…Similar to this study, studies in several other regions, including the UK, Italy, Spain, Denmark, Switzerland, Australia, Canada, and the US, observed an overall decrease of inpatient admissions but an increase in involuntary admissions and more acute cases (4,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Most regions reported reduced utilization for affective and anxiety disorders, but often no change for psychotic and sometimes addiction disorders (36,37). Similarly, despite often much higher COVID-19 incidences, service restrictions were much less pronounced in the second high incidence phase in winter 2020-2021 than in the first such phase in spring 2020.…”

Section: International Comparisonsupporting

confidence: 84%

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“…In the initial months immediately following COVID-19-related restrictive measures, there was a reduction in total mental health-related emergency department visits and hospitalizations as compared to before the pandemic ( 47 – 50 ). There were fewer hospitalizations related to psychosis ( 51 ), schizophrenia ( 52 , 53 ), and suicidality ( 54 ), but an increase in hospitalizations for anxiety and depressive disorders ( 47 , 48 ) and substance use disorders ( 55 ). No differences were noted regarding the proportion of patients hospitalized following emergency department visit based on presenting condition ( 49 , 56 ).…”

Section: Introductionmentioning

confidence: 99%

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic

Lin,

Costakis,

John

et al. 2023

Front. Psychiatry

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ObjectiveThis study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic.MethodsMental health-related hospitalization rates among patients enrolled in a large academic hospital’s outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar’s test.ResultsIn the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777).ConclusionPsychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

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Shifts in inpatient psychiatry utilization patterns at a U.S. Academic Medical Center during the COVID-19 pandemic

Cited by 4 publications

References 26 publications

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany – Results From the COVID Ψ Psychiatry Survey

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany – Results From the COVID Ψ Psychiatry Survey

Table_2.DOCX

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic

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