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. 2021 Nov;24(4):161-166.
doi: 10.1136/ebmental-2021-300287. Epub 2021 Sep 28.

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

James Sw Hong  1 , Rebecca Sheriff  1   2 , Katharine Smith  1   2 , Anneka Tomlinson  1   2 , Fathi Saad  2 , Tanya Smith  2 , Tomas Engelthaler  3 , Peter Phiri  4 , Catherine Henshall  2   5 , Roger Ede  2 , Mike Denis  3 , Pamina Mitter  1   2 , Armando D'Agostino  6 , Giancarlo Cerveri  7 , Simona Tomassi  8 , Shanaya Rathod  4 , Nick Broughton  2 , Karl Marlowe  2 , John Geddes  1   2 , Andrea Cipriani  9   2
Affiliations

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts

James Sw Hong et al. Evid Based Ment Health. 2021 Nov.

Abstract

Background: The effects of COVID-19 on the shift to remote consultations remain to be properly investigated.

Objective: To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak.

Methods: We used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python.

Findings: Mental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18-21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients.

Conclusions and clinical implications: The rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

Keywords: adult psychiatry; delirium & cognitive disorders; depression & mood disorders; eating disorders.

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Conflict of interest statement

Competing interests: AC has received research and consultancy fees from INCiPiT (Italian Network for Paediatric Trials), CARIPLO Foundation and Angelini Pharma, outside the submitted work. AT has received research and consultancy fees from INCiPiT (Italian Network for Paediatric Trials) and Angelini Pharma, outside the submitted work. PP reports grants from NovoNordisk, other from Queen Mary University of London, other from John Wiley & Sons, outside the submitted work. SR reports educational support from Janssen, Otsuka and Lundbeck, outside the submitted work.

Figures

Figure 1
Figure 1
Attended face-to-face (F2F) and non-face-to-face (Non-F2F) appointments.
Figure 2
Figure 2
Attended appointments by telephone and video.
Figure 3
Figure 3
Attendance rate of face-to-face (F2F) and non-face-to-face (Non-F2F) appointments in 2020.
See this image and copyright information in PMC

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