Patient Satisfaction with and Use of Telemental Health Services in the Perinatal Period: a Survey Study

Are virtual services equivalent for mood, anxiety, and bonding? examining a perinatal intensive outpatient program

PURPOSE

Perinatal Intensive Outpatient Programs (IOPs) address severe perinatal mood and anxiety disorders (PMADs) and mother-infant relationship concerns. Given the impact of PMADs on mothers and infants, rapid transitions to virtual services (telehealth) amid COVID-19, and service expansions to populations in need, it is critical to evaluate how effectively virtual and in-person perinatal IOP services treat PMADs and mother-infant bonding.

METHODS

This quality-improvement record review examined patient records (n = 361) for a perinatal IOP from May 2016 to July 2023, amid multiple transitions between in-person and virtual services related to COVID-19, influenza, and respiratory syncytial virus. Patients in the completed measures sample (n = 115) completed depression (EPDS), anxiety (GAD-7, PASS), and mother-infant bonding (PBQ) measures over the first 3 weeks of treatment. Patients also anonymously provided program satisfaction ratings and qualitative feedback.

RESULTS

While anxiety and depression symptoms improved similarly across service settings, mother-baby bonding only significantly improved with in-person treatment. Patient symptom outcomes also differed by public/private insurance, race, and number of children. Patients reported high service ratings and overall satisfaction, and available feedback indicates some preference for in-person services.

CONCLUSION

As perinatal mental health services and IOPs continue to expand, virtual services can similarly address anxiety and depression symptoms and help to reach in-need populations. However, for perinatal IOPs, the core treatment target of mother-infant bonding may be uniquely addressed via in-person services.

Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis

Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.

Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians

Despite the prevalence of perinatal mental health issues in the United States, gaps in care persist. To address this, perinatal health care settings are asked to focus on patients' mental health by administering standardized screening and, increasingly, by integrating mental health teams in their clinics. Using in-depth interviews and ethnographic observations, I investigated these emerging practices, exploring the experiences of certified nurse-midwives, obstetricians, and mental health clinicians. I found that certified nurse-midwives and obstetricians lack time, resources, and expertise, restricting their ability to address patients' mental health. Integrated mental health clinicians are constrained by the stratified organization of health care and structural deprioritization of mental health. Redesigning perinatal health care and de-siloing mental health training are necessary to increase clinicians' effectiveness and to improve perinatal health outcomes.

Perceptions of Patients, Caregivers, and Healthcare Professionals toward Telemedicine Use for Cognitive and Movement Disorders in the Aegean Islands, Greece: A Pilot Study of the SI4CARE European Project

BACKGROUND

Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands.

METHODS

Data were derived from the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network", March 2021-March 2023. The survey included 10 questions (5-point Likert scale).

RESULTS

We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information.

CONCLUSIONS

The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas.

Medication adherence in patients with mental disorders: A systematic review and meta-analysis of telemedicine interventions

BACKGROUND AND OBJECTIVE

Telemedicine interventions have emerged as a promising solution to improve medication adherence by providing remote support and monitoring of patients with mental disorders. This study aims to investigate the effectiveness of telemedicine interventions in enhancing medication adherence among patients with mental disorders.

METHODS

PubMed, Scopus, and Web of Science were searched systematically. After deleting the double-included studies, two researchers independently selected articles and extracted data using a standardized data collection form. The risk of bias in the included studies was assessed using the Mixed Methods Appraisal Tool. The intervention effects were combined using a random effects model. Standardized mean differences (Hedges's g) between the treatment and control groups were calculated. Heterogeneity variance was estimated using the Q test and I2 statistic. The analysis was performed in Stata version 17.0.

RESULTS

Out of the 1088 articles retrieved, nine studies were included in the analysis. Overall, telemedicine interventions demonstrated a statistically significant improvement in medication adherence among patients with mental disorders (Hedges' g = 0.25, 95% confidence interval: 0.12-0.38, p-value: < 0.01). The type of mental disorder was a significant moderator of the heterogeneity between studies (p = 0.022).

CONCLUSION

Telemedicine interventions have a positive impact on medication adherence in patients with mental disorders by offering remote support and monitoring. Integrating telemedicine into mental healthcare can enhance overall adherence rates, leading to improved management of mental disorders.

Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study

OBJECTIVES

Perinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in mental health symptoms and transmission risks associated with in-person appointments, many clinics transitioned to providing telepsychiatry care during the COVID-19 pandemic. This study sought to identify the facilitators and barriers to receiving perinatal telepsychiatry care from the perspective of patients, clinic staff and psychiatrists.

DESIGN

Qualitative study based on analysis of in depth semistructured interviews.

SETTING

The study was conducted in a virtual specialty mental health clinic in an academic setting.

PARTICIPANTS

Eight patients who had been scheduled for an appointment with the perinatal telepsychiatry clinic between 14 May 2021 and 1 August 2021, seven of whom had attended their scheduled appointment with the clinic and one of whom had not, and five staff members including psychiatrists, navigators and clinic managers, participated in in-depth interviews.

RESULTS

Telepsychiatry was perceived by most as preferable to in-person care and easy to attend and navigate. Alternatively, technological difficulties, personal preference for in-person care and scheduling conflicts related to the perinatal period were identified as barriers by some. Participants identified communication between care staff and patients, online patient portals, and appointment reminders as important for facilitating appointment preparedness and attendance.

CONCLUSIONS

The findings from this study suggest that telepsychiatry services are perceived positively by patients and care staff and have the potential to improve access to mental healthcare for perinatal patients.

Understanding Perinatal Depression Care Gaps by Examining Care Access and Barriers in Perinatal Individuals With and Without Psychiatric History

Background: Depression affects one in seven perinatal individuals and remains underdiagnosed and undertreated. Individuals with a psychiatric history are at an even greater risk of perinatal depression, but it is unclear how their experiences with the depression care pathway may differ from individuals without a psychiatric history. Methods: We conducted a secondary analysis evaluating care access and barriers to care in perinatal individuals who screened positive for depression using the Edinburgh Postnatal Depression Scale (N = 280). Data were analyzed from the PRogram in Support of Moms (PRISM) study, a cluster randomized controlled trial of two interventions for perinatal depression. Results: Individuals with no prepregnancy psychiatric history (N = 113), compared with those with a history (N = 167), were less likely to be screened for perinatal depression, and less likely to be offered a therapy referral, although equally likely to attend if referred. When examining how these differences affected outcomes, those without a psychiatric history had 46% lower odds of attending therapy (95% confidence interval [CI]: 0.19-1.55), 79% lower odds of taking medication (95% CI: 0.08-0.54), and 80% lower odds of receiving any depression care (95% CI: 0.08-0.47). Barriers were similar across groups, except for concerns regarding available treatments and beliefs about self-resolution of symptoms, which were more prevalent in individuals without a psychiatric history. Conclusions: Perinatal individuals without a prepregnancy psychiatric history were less likely to be screened, referred, and treated for depression. Differences in screening and referrals resulted in missed opportunities for care, reinforcing the urgent need for universal mental health screening and psychoeducation during the perinatal period. Clinical Trial Registration No.: NCT02935504.

Patient satisfaction with telemedicine in the Philippines during the COVID-19 pandemic: a mixed methods study

BACKGROUND

The capacity to deliver essential health services has been negatively impacted by the COVID-19 pandemic, particularly due to lockdown restrictions. Telemedicine provides a safe, efficient, and effective alternative that addresses the needs of patients and the health system. However, there remain implementation challenges and barriers to patient adoption in resource-limited settings as in the Philippines. This mixed methods study aimed to describe patient perspectives and experiences with telemedicine services, and explore the factors that influence telemedicine use and satisfaction.

METHODS

An online survey consisting of items adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group Adult Visit Survey 4.0 (beta) and the Telehealth Usability Questionnaire (TUQ) was completed by 200 participants aged 18 to 65 years residing in the Philippines. A subsample of 16 participants was interviewed to provide further insights on their experiences. We used descriptive statistics to analyze survey data and thematically analyzed data from interviews guided by the principles of grounded theory.

RESULTS

Participants were generally satisfied with telemedicine, and found it to be an efficient and convenient means of receiving healthcare. About 3 in 5 perceived telemedicine as affordable, with some finding telemedicine costs to be high and comparable to in-person consultations. Our results suggest that participants preferred telemedicine services, especially in cases where they feel that their condition is not urgent and does not need extensive physical examination. Safety against COVID-19, privacy, accessibility, and availability of multiple communication platforms contributed to patient satisfaction with telemedicine. Negative perceptions of patients on quality of care and service related to their telemedicine provider, inherent limitations of telemedicine in the diagnosis and management of patients, perceived high costs especially for mental health conditions, and poor connectivity and other technological issues were barriers to telemedicine use and satisfaction.

CONCLUSION

Telemedicine is viewed as a safe, efficient, and affordable alternative to receiving care. Expectations of patients on costs and outcomes need to be managed by providers to increase satisfaction. Continued adoption of telemedicine will require improvements in technology infrastructure and technical support for patients, training and performance evaluation of providers to ensure quality of care and service, better patient communication to meet patient needs, and integration of telemedicine services in remote areas that have limited access to medical services. Telemedicine, to realize its full potential, should be centered in health equity - addressing patient barriers and needs, reducing health disparities across population groups and settings, and providing quality services to all.

Telehealth Listening Visits for emotionally distressed mothers of hospitalized newborns: Proof-of-concept

Problem

Newborn admission to the neonatal intensive care unit (NICU) is stressful. Yet in clinical practice, at best, NICU mothers are screened for depression and if indicated, referred to a mental-health specialist. At worst, no action is taken. Listening Visits, an empirically supported nurse-delivered intervention addressing emotional distress, can be conveniently provided by a NICU nurse. Prompted by the need to minimize face-to-face contacts during the pandemic, the primary purpose of this small pilot trial was to assess the feasibility of having nurses provide Listening Visits to NICU mothers over Zoom. Secondarily, we assessed pre-to post-Listening Visits depression symptom scores as a preliminary evaluation of the effectiveness of this type of support.

Materials and methods

Nine NICU mothers with mildly to moderately severe depression symptoms received up to six Listening Visits sessions from a NICU nurse via Zoom. Participants completed the Inventory Depression and Anxiety Symptoms-General Depression scale (IDAS-GD) at study entry and 4- and 8-weeks post enrollment. They completed the Client Satisfaction Questionnaire (CSQ) at the 8-week assessment.

Results

Using an intent-to-treat approach, the effect of time from the mixed model analysis of IDAS-GD was statistically significant (F(2,26) = 10.50, p < 0.001), indicating improvement in IDAS-GD scores from baseline to follow-up. The average CSQ score was high (M = 29.0, SD = 3.3), with 75% of participants rating the quality of help they received as "excellent".

Discussion

In this pilot trial, we learned it is feasible to provide Listening Visits over Zoom, that this mode of delivery is associated with a significant decrease in depression symptom scores, and that women value this approach.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [#201805961].

Postpartum Psychosis: The Role of Women's Health Care Providers and the Health Care System

Importance

The postpartum period is a time of high risk for serious psychiatric symptoms and hospitalization. Postpartum psychosis (PPP) is the most severe disorder that emerges during this time, with significant and wide-ranging consequences that can include suicide and infanticide.

Evidence Acquisition

A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about PPP, including subtopics (eg, infanticide, maternal suicide). Citations in these articles were also reviewed for relevant references.

Results

Although it is clear that the triggering event for PPP is childbirth, the processes by which this occurs are not fully understood, which is a critical need for being able to predict, prevent, and manage PPP. There are risk factors that contribute to PPP, and specific groups of women may be at increased risk (eg, women with bipolar disorder). Many questions and challenges remain related to the phenomenology, nosology, prevention, and treatment of PPP. However, there are changes that women's health care providers and systems can take to improve the care of women at risk of and experiencing PPP.

Results

Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects. Synthetic slings available for review were either tension-free vaginal tape (TVT) or minisling. The vast majority of studies demonstrated similar short- and long-term success rates of AFS and SS procedures utilizing a range of outcome measures. Both AFS and TVT sling had low recurrence rates in short- and long-term follow-up. However, AFS had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling. Health-related quality-of-life scores, including sexual function, were similar between groups.

Conclusions and Relevance

Postpartum psychosis is a rare but serious condition. However, recovery is possible. Women's health care providers and systems can improve the care by better understanding the needs of women and families, offering patient-centered discussions and options for care, particularly those that promote recovery, minimize risk, and limit the interruption of the maternal-infant bond. Improving the prevention and treatment of PPP can have a broad impact for women, children, and families.

Virtual Care for Behavioral Health Conditions

The COVID-19 pandemic has highlighted the urgent need for behavioral health care services. A substantial portion of mental health care transitioned to virtual care during the COVID-19 pandemic, remains virtual today, and will continue that way in the future. Mental health needs continue to grow, and there has been growing evidence showing the efficacy of virtual health for behavioral health conditions at the system, provider, and patient level. There is also a growing understanding of the barriers and challenges to virtual behavioral health care.

Scaling up Mental Healthcare for Perinatal Populations: Is Telemedicine the Answer?

PURPOSE OF REVIEW

Telemedicine has transformed our ability to access and offer mental healthcare. There remain key questions to facilitate scalable, patient-centered solutions for perinatal mental health. We critically evaluate the recent literature and propose potential future directions.

RECENT FINDINGS

The current literature highlights the promise of telemedicine in the prevention and treatment of perinatal depression, including the preference for and the potential efficacy of telemedicine-delivered mental healthcare when compared to in-person treatments. There remains a need for large, adequately powered randomized controlled trials; integration of trauma into depression and anxiety trials, transdiagnostic treatment of perinatal women, and scaling up these effective treatments into existing health and payer systems. Pragmatic, evidence-based solutions exist to effectively scale-up treatments for perinatal mental health. While research is underway to address the growing treatment gap, questions remain regarding who will deliver and pay for these treatments and how we can leverage telemedicine to treat perinatal mental health transdiagnostically.

Perinatal mental health and COVID-19: Navigating a way forward

The COVID-19 pandemic and its aftermath have increased pre-existing inequalities and risk factors for mental disorders in general, but perinatal mental disorders are of particular concern. They are already underdiagnosed and undertreated, and this has been magnified by the pandemic. Access to services (both psychiatric and obstetric) has been reduced, and in-person contact has been restricted because of the increased risks. Rates of perinatal anxiety and depressive symptoms have increased. In the face of these challenges, clear guidance in perinatal mental health is needed for patients and clinicians. However, a systematic search of the available resources showed only a small amount of guidance from a few countries, with a focus on the acute phase of the pandemic rather than the challenges of new variants and variable rates of infection. Telepsychiatry offers advantages during times of restricted social contact and also as an additional route for accessing a wide range of digital technologies. While there is a strong evidence base for general telepsychiatry, the particular issues in perinatal mental health need further examination. Clinicians will need expertise and training to navigate a hybrid model, flexibly combining in person and remote assessments according to risk, clinical need and individual patient preferences. There are also wider issues of care planning in the context of varying infection rates, restrictions and vaccination access in different countries. Clinicians will need to focus on prevention, treatment, risk assessment and symptom monitoring, but there will also need to be an urgent and coordinated focus on guidance and planning across all organisations involved in perinatal mental health care.

Acceptability of Telehealth for Multidiagnostic Suicidal Patients in a Real-World Dialectical Behavior Therapy Clinic During the COVID-19 Pandemic

Objective: This study aimed to evaluate the acceptability of Dialectical Behavior Therapy (DBT) delivered through telehealth to complex, suicidal patients during the COVID-19 pandemic. Methods: We surveyed 163 adult participants enrolled in outpatient services at a private, free-standing DBT clinic certified by the DBT-Linehan Board of Certification for its fidelity to the treatment. Treatment satisfaction was assessed, as well as ease of telehealth over time, differences in satisfaction between patients who had previously experienced face-to-face treatment and those who had only experienced telehealth, patients' beliefs regarding the impact of telehealth on their progress, and preference for face-to-face versus telehealth services. Additionally, participants' reasons for liking and disliking telehealth were reported. Results: The average overall satisfaction rating was 82.26 (±18.71) on a 100-point scale. Factors identified as being relevant to satisfaction included increased access to care, saving time and money, and increased comfort participating in therapy from home. Factors identified as relevant to dissatisfaction included feeling less connected to therapists and other patients. The majority of participants reported that telehealth positively impacted or did not impact treatment progress. Satisfaction was significantly related to participants' perception of telehealth's impact on progress in treatment. Demographic variables were also included in the analyses, but were unrelated to satisfaction. Conclusions: Findings indicate that, from the point of view of consumer satisfaction, telehealth appears satisfactory for delivery of DBT and may play an increased role in behavioral health care postpandemic.

Experiences with use of technology and telehealth among women with perinatal depression

Background

Perinatal depression (PD) affects 10–20% of childbearing women. Telehealth is increasingly utilized for mental health services to increase access to care and overcome COVID-19 pandemic barriers. Women’s perspectives on telehealth services for PD is unknown, however. This study’s primary objective was to obtain the perspectives of women who participated in an 8-week group videoconference intervention for PD symptoms, including how technology impacted their experience.

Methods

We utilized theoretical sampling and included perinatal women who had completed the 8-week mindfulness-based cognitive-behavioral intervention group. Semi-structured focus groups with four to six women were conducted on a videoconference platform. Primary analysis used grounded theory and a secondary analysis used qualitative description and was conducted by two coding teams. The teams collaborated on the final themes across the analyses.

Results

Three groups, with a total of 17 participants were conducted. Composition consisted of seven postpartum and ten pregnant women from the 47 total participants. Identified core themes regarding their experiences of the videoconference intervention were: positive experiences, negative experiences, suggestions and ideas, and screening and communication.

Conclusion

This study provides growing evidence informed by perinatal women of positive experiences with engagement in a videoconference intervention for PD. Telehealth may be a reasonable and acceptable platform to increase access and retention for mental health services in childbearing women. Further, this pilot work showcases videoconferencing delivery for a wide range of effective and affordable mental health services in low-resource communities.

Telemedicine in perinatal mental health: perspectives

Background: The prevalence of perinatal mood and anxiety disorders has significantly increased with the COVID-19 pandemic. In parallel, the pandemic has caused a major shift in delivery of care to telemedicine.Purpose: This article aimed to discuss the different advantages and disadvantages of telemedicine for perinatal mental health. Telemedicine has significant benefits for perinatal mental health patients, including increased accessibility to specialized care, direct observation of child-parent interactions in their home environment, and facilitation of collaborative work between obstetrical providers and psychiatrists. Alternatively, telemedicine may impede recovery and contribute to an increase in social isolation. The use of telemedicine by obstetrical care providers may also contribute to a reduction in screening and identification of these disorders.Conclusion: A hybrid model of in-person and telemedicine delivery of care may serve as a durable compromise solution for these women and their families.

Racial inequities in the course of treating perinatal mental health challenges: Results from listening to mothers in California

BACKGROUND

Concern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling.

METHODS

This study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4-item Patient Health Questionnaire (PHQ-4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression.

RESULTS

We found non-Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non-Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6-21.7) to report counseling.

DISCUSSION

These findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.

Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study

BACKGROUND

Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic.

OBJECTIVE

The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic.

METHODS

A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively.

RESULTS

A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement.

CONCLUSIONS

Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients' feedback on future improvements should be considered to help ensure long-term success.

Telehealth adaptation of perinatal mental health mother-infant group programming for the COVID-19 pandemic

The COVID‐19 pandemic and ensuing isolation stressed pregnant and postpartum women and their families pervasively. This necessitated addressing young families’ mental health needs while protecting both patients and providers from COVID‐19 exposure. Our experience of rapidly adapting Pregnancy, Maternal Postpartum Peer Support, and Mother–Infant Postpartum Group interventions to high‐quality telehealth modalities elucidates benefits and challenges of mother–infant dyadic treatment amidst the pandemic. This study compares 2019 in‐person and 2020 telehealth services during the period from mid‐March through mid‐December in each year. Initial program Warmline contacts were similar across years despite pandemic‐related restrictions, with 2020 program contacts surpassing the 147 unique patient outreaches during the commensurate 2019 period. Pregnancy Group enrollment remained consistent. Maternal Postpartum Peer Support Group participation increased with transition to telehealth with 27 individuals with over 100 group‐based visits in 2020. Twenty‐five mother–infant Postpartum pairs initially enrolled in the 12‐week multicomponent Mother–Infant Therapy Group (M‐ITG) during 2019 in‐person services, and 16 completed the program (36% non‐completion rate). During 2020 telehealth, 15 of 18 mother–infant pairs completed the program (17% non‐completion rate); a greater than 50% reduction in non‐completion. We further compare pre‐/post‐pandemic onset M‐ITG participant demographics, enrollment, and Edinburgh Postnatal Depression Scale (EPDS) scores.

Survey of Provider Experiences of Telepsychiatry and Tele-Consultation-Liaison Psychiatry

Background

The COVID-19 pandemic created pressure to implement telepsychiatry across practice models.

Objective

We sought to evaluate the overall success of this change and to identify what types of practice settings, provider groups, and patient groups were best served by telepsychiatry and telepsychotherapy utilization. We were particularly interested in how providers of consultation-liaison psychiatry adapted to remote care.

Methods

An anonymous provider survey querying demographics, education, training, technological experience, practice setting, treatment modalities, patient groups, transition process, and outcomes was made openly available via social media and professional listservs. We used multivariable regression modeling to evaluate for predictors of the positive outcomes of overall satisfaction, subjective ability to diagnose and treat patients adequately using exclusively telepsychiatric platforms, and patient satisfaction by proxy.

Results

Three hundred thirty-three respondents, mostly young (59.4% younger than 50 years), female (69.7%), and physicians (67.9%), completed the survey. One hundred ninety-seven (59.1%) worked in consultation-liaison psychiatry. Of the total, 85.9% gave affirmative answers to overall satisfaction. Multivariable linear regression models found that satisfaction was predicted by general comfort with technology (P < 0.001), but negatively correlated with having technical issues (P < 0.001), a priori skepticism (P < 0.001), clinician being male (P = 0.004), and treating LGBTQ+ patients (P = 0.022). Completeness was associated with having training in telehealth (P = 0.039) and general comfort with technology (P < 0.001) but negatively associated with treating LGBTQ+ patients (P = 0.024) or inpatients (P = 0.002). Patient satisfaction by proxy was positively associated with general comfort with technology (P < 0.001) and the respondent being a nonphysician (P = 0.004) and negatively associated with encountering a technical issue (P = 0.013) or treating inpatients (P = 0.045). Consultation-liaison psychiatrists had similar results overall and were more likely to have other staff assist in making televisits effective (mean [standard deviation]: −1.25 [3.57] versus −2.76 [3.27], P < 0.001) especially if consultative (mean [standard deviation]: −0.87 [3.67] versus −2.39 [3.01], P = 0.010).

Conclusions

This study suggests high rates of overall satisfaction in telepsychiatry adoption, even in consultation-liaison psychiatry. There is distinct benefit in bolstering training, providing technical support, and addressing skepticism. Future research should include patient surveys and control groups and should focus on vulnerable populations such as sexual and gender minorities.