Temporal Trends in Mental Health Service Utilization across Outpatient and Acute Care Sectors: A Population-Based Study from 2006 to 2014

Chiu, Maria; Gatov, Evgenia; Vigod, Simone N.; Amartey, Abigail; Saunders, Natasha; Yao, Zhan; Pequeno, Priscila; Kurdyak, Paul

doi:10.1177/0706743717748926

Cited by 25 publications

(24 citation statements)

References 29 publications

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“…We do not know to what extent the changes we observed included longer term trends in health services. However, the large effect sizes we observed are not consistent with past longitudinal research [ 58 , 59 ], where a change in health service use of more than 30% occurred across 5 years rather than only 1 year. Although we were able to describe how the reasons for consulting a family physician changed after the onset of the COVID-19 pandemic, we do not know to what degree these changes are the result of changes in disease prevalence in the population (e.g., reduced rates of respiratory illness), reluctance among patients to seek healthcare services during the pandemic, and/or changes in provider availability or accessibility (e.g., providers unable to do in-person visits due to lack of personal protective equipment).…”

Section: Discussioncontrasting

confidence: 99%

Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

et al. 2021

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Purpose We aimed to determine the degree to which reasons for primary care visits changed during the COVID-19 pandemic. Methods We used data from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits before and after the onset of the COVID-19 pandemic, focusing on the number of visits and the number of patients seen for each of the 25 most common diagnostic codes. The proportion of visits involving virtual care was assessed as a secondary outcome. Results UTOPIAN family physicians (N = 379) conducted 702,093 visits, involving 264,942 patients between March 14 and December 31, 2019 (pre-pandemic period), and 667,612 visits, involving 218,335 patients between March 14 and December 31, 2020 (pandemic period). Anxiety was the most common reason for visit, accounting for 9.2% of the total visit volume during the pandemic compared to 6.5% the year before. Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care for diabetes and hypertension, respectively. Preventive care visits were substantially reduced, with 89.0% fewer periodic health exams and 16.2% fewer well-baby visits. During the pandemic, virtual care became the dominant care format (77.5% virtual visits). Visits for anxiety and depression were the most common reasons for a virtual visit (90.6% virtual visits). Conclusion The decrease in primary care visit volumes during the COVID-19 pandemic varied based on the reason for the visit, with increases in visits for anxiety and decreases for preventive care and visits for chronic diseases. Implications of increased demands for mental health services and gaps in preventive care and chronic disease management may require focused efforts in primary care.

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Section: Discussioncontrasting

confidence: 99%

Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

et al. 2021

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“…The number of patients receiving psychiatric treatment worldwide was increasing before the COVID-19 outbreak. Psychiatric outpatient clinics usually have waiting lists for patients with mental illness to receive treatment by psychiatrists [ 75 - 79 ]. Psychiatric institutions should adopt a variety of services to provide continuous care during the crisis.…”

Section: Transformation Of Care and Managementmentioning

confidence: 99%

Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19

Puangsri¹,

Jinanarong²,

Wattanapisit³

2021

CPEMH

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The outbreak of coronavirus disease (COVID-19) in December 2019 has led to massive lifestyle, economic, and health changes. The COVID-19 pandemic has had broad impacts on psychiatric patients, exacerbating symptoms such as psychosis, depression, and suicidal ideation. Therefore, we aimed to review the psychological impacts of COVID-19 on psychiatric patients and mental healthcare staff and provide practical guidance for medical staff and authorities. The main findings of this review included the impacts of COVID-19 on psychiatric patients and mental health professionals as well as the transformation of mental health care. Greater consideration should be given to the care of patients with psychosis and depression because of their lack of self-care ability, neurocognitive impairment, and impaired immune function. Depressive symptoms can be exacerbated due to several factors, such as economic crises, social isolation, and limited physical activity. Unemployment and financial problems can lead to an increased suicide rate. Consequently, mental healthcare workers’ workload can increase, which could lead to burnout and psychological symptoms such as insomnia, depression, and anxiety. A transformation of psychiatric care is needed during the time of the pandemic. While emergency care should be maintained, outpatient care should be limited to decrease viral spread. Shifting care to telemedicine and community-based psychiatry can be helpful. Inpatient services should be adapted by tightening admission criteria, shortening the length of hospital stays, suspending some group activities, limiting visitors, and preparing for quarantine if necessary. Mental healthcare workers can be supported with telecommunication, appropriate work shifts, alternative accommodations, and good communication between the team leader and staff.

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“…Moreover, timely follow-up care after hospitalisation is considered an important measure of the quality of mental health services (Stein et al ., 2007 ). In Ontario, family doctors are much more numerous than psychiatrists and, therefore, are more likely to provide post-discharge follow-up care, particularly in rural areas (Chiu et al ., 2018 ).…”

Section: Methodsmentioning

confidence: 99%

Homelessness at discharge and its impact on psychiatric readmission and physician follow-up: a population-based cohort study

Laliberté

Stergiopoulos

Jacob

et al. 2019

Epidemiol Psychiatr Sci

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Aims A significant proportion of adults who are admitted to psychiatric hospitals are homeless, yet little is known about their outcomes after a psychiatric hospitalisation discharge. The aim of this study was to assess the impact of being homeless at the time of psychiatric hospitalisation discharge on psychiatric hospital readmission, mental health-related emergency department (ED) visits and physician-based outpatient care. Methods This was a population-based cohort study using health administrative databases. All patients discharged from a psychiatric hospitalisation in Ontario, Canada, between 1 April 2011 and 31 March 2014 (N = 91 028) were included and categorised as homeless or non-homeless at the time of discharge. Psychiatric hospitalisation readmission rates, mental health-related ED visits and physician-based outpatient care were measured within 30 days following hospital discharge. Results There were 2052 (2.3%) adults identified as homeless at discharge. Homeless individuals at discharge were significantly more likely to have a readmission within 30 days following discharge (17.1 v. 9.8%; aHR = 1.43 (95% CI 1.26–1.63)) and to have an ED visit (27.2 v. 11.6%; aHR = 1.87 (95% CI 1.68–2.0)). Homeless individuals were also over 50% less likely to have a psychiatrist visit (aHR = 0.46 (95% CI 0.40–0.53)). Conclusion Homeless adults are at higher risk of readmission and ED visits following discharge. They are also much less likely to receive post-discharge physician care. Efforts to improve access to services for this vulnerable population are required to reduce acute care service use and improve care continuity.

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Temporal Trends in Mental Health Service Utilization across Outpatient and Acute Care Sectors: A Population-Based Study from 2006 to 2014

Abstract: The increasing acute care service use coupled with the reduction in outpatient visits suggest, overall, an increase in demand for mental health care that is not being met in ambulatory care settings.

Cited by 25 publications

References 29 publications

Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada

Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19

Homelessness at discharge and its impact on psychiatric readmission and physician follow-up: a population-based cohort study

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