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Insights from electronic health record data to improve mental health service delivery during the COVID-19 pandemic

Published online by Cambridge University Press:  13 August 2021

R. Patel ,
J. Irving ,
A. Brinn ,
M. Broadbent ,
H. Shetty ,
M. Pritchard ,
J. Downs ,
R. Stewart  and
R. Harland
R. Patel*
Affiliation:
Department Of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, KCL, London, United Kingdom
J. Irving
Affiliation:
Department Of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, KCL, London, United Kingdom
A. Brinn
Affiliation:
Department Of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, KCL, London, United Kingdom
M. Broadbent
Affiliation:
Nihr Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
H. Shetty
Affiliation:
Nihr Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
M. Pritchard
Affiliation:
Nihr Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
J. Downs
Affiliation:
Department Of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, KCL, London, United Kingdom
R. Stewart
Affiliation:
Department Of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, KCL, London, United Kingdom
R. Harland
Affiliation:
Nihr Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
*
*Corresponding Author.

Abstract

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Background

Remote consultation technology has been rapidly adopted due to the COVID-19 pandemic. However, some healthcare settings have faced barriers in implementation. We present a study to investigate changes in rates of remote consultation during the pandemic using a large electronic health record (EHR) dataset.

Methods

The Clinical Record Interactive Search tool (CRIS) was used to examine de-identified EHR data of people receiving mental healthcare in South London, UK. Data from around 37,500 patients were analysed for each week from 7th January 2019 and 20th September 2020 using linear regression and locally estimated scatterplot smoothing (LOESS) to investigate changes in the number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals and prescribing of antipsychotics and mood stabilisers. The data are presented in an interactive dashboard: http://rpatel.co.uk/TelepsychiatryDashboard.

Results

The frequency of in-person contacts was substantially reduced following the onset of the pandemic (β coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts increased significantly (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite the increase in remote contact, antipsychotic and mood stabiliser prescribing remained at similar levels.

Conclusions

The COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in prescribing. Further work is needed to support older patients in accessing remote mental healthcare.

Disclosure

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: RS has received funding from Janssen, GSK and Takeda outside the submitted work. RP has received funding from Janssen, Induction Healthcare and H

Keywords

telepsychiatrytelemedicineSARS-Cov2Electronic health records
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S38 - S39
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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