ED, hospital visits for psychiatric care lack follow-up

Rates of follow-up after acute mental health service use in younger individuals were suboptimal, but improving involvement with outpatient mental health care providers may increase rates, per a new study published in Psychiatric Services.

“When we look at the numbers of young adults and adolescents that are struggling with behavioral health issues, the data trend is disturbing nationwide, and suicidality is increasing,” Brian Skehan, MD, PhD, co-author and assistant professor of psychiatry at the University of Massachusetts Chan Medical School, said in an American Psychiatric Association press conference announcing the study’s results.

Skehan and fellow researchers sought to explore the number of follow-ups after hospitalization and ED use for mental health among youths and young adults with private insurance.

The retrospective cohort study employed the IBM MarketScan commercial database, searching between the years 2013 and 2018. Individuals aged 12 to 27 years who logged an acute mental health event, including but not limited to major depressive disorder, bipolar disorder, schizophrenia, anxiety or PTSD, and who logged either a mental health hospitalization (n = 95,153) or ED visit (n = 108,576) were included. Patients found to be without continuous insurance coverage during the study period, those missing information on health plan coverage, or those who had a subsequent inpatient or ER visit before an outpatient follow-up visit were excluded.

Two primary binary outcome variables were created: outpatient mental health follow-up within 7 and within 30 days of discharge from the acute mental health visit, as defined in the Healthcare Effectiveness Data and Information Set. Outpatient mental health care was defined as a visit with a specialty mental health care provider for evaluation, management, psychotherapy or other psychiatric care, including psychiatric facility partial hospitalizations.

Secondary outcomes included any follow-up care (primary care, outpatient mental health care). Primary care use included visits with a primary care provider (eg, internal medicine, family practice or pediatric provider) for health promotion, disease prevention, health maintenance or patient education in an outpatient setting.

Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation.

Results showed that of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ED use, 28.6% received follow-up within 7 days (46.4% within 30 days). Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted OR=2.81, 95% CI =2.68–2.94; ED use, aOR=4.06, 95% CI=3.72–4.42), followed by those with mental health care only (hospitalization, aOR=2.57, 95% CI=2.45–2.70; ED use, aOR=3.48, 95% CI=3.17–3.82) and those with primary care only (hospitalization, aOR=1.20, 95% CI=1.15–1.26; ED use, aOR=1.22, 95% CI=1.16–1.28). Similar trends were observed within 30 days of discharge.

When asked during the press conference what professionals can do better to address these issues, Skehan said, “Reduce barriers to access and also increase communication. Things like telehealth are going to hopefully expand access.”

Reference:

American Psychiatric Association Psychiatric services briefing. https://americanpsych-my.sharepoint.com/personal/khodge_psych_org/_layouts/15/stream.aspx?id=%2Fpersonal%2Fkhodge%5Fpsych%5Forg%2FDocuments%2FPsychiatric%20Services%20Briefing%2Emp4&ga=1. Held Oct. 12, 2022. Accessed Oct. 12, 2022.