Virtual psychotherapy improved patient engagement, cut time between visits during pandemic

Key takeaways:

• Psychotherapy patients had better continuity of care after the widespread adoption of virtual care during the pandemic.
• The finding was consistent across all demographic subgroups.

A study of more than 110,000 patients receiving psychotherapy found improved continuity of care and significantly fewer days between appointments after the switch to virtual care during the COVID-19 pandemic.

Improvements in patient engagement were observed across all demographic subgroups and major mental health conditions. The finding supports further use of virtual psychotherapy and could pave the way for the wider adoption of virtual care, study author Brian K. Ahmedani, PhD, said during a press briefing.

“It really looks like virtual care is here to stay,” Ahmedani said. “It also appears to be an important part of mental health service delivery, particularly for psychotherapy, which is a great fit for it.”

The population-level study examined 110,089 individuals with at least one psychiatric diagnosis using health data from HealthPartners, Henry Ford Health and Kaiser Permanente. Ahmedani and colleagues looked at how often patients had a disruption in care — defined as a gap of 45 days or more between psychotherapy visits — in the 9 months prior to March 14, 2020, compared with the 9 months afterward.

Study participants were 68.9% female and 67.9% white, with a median age of 46 years. Patients made a total of 555,620 psychotherapy visits during the study period, with more occurring in the 9 months before onset of the pandemic (n = 284,826) than the 9 months after (n = 270,794).

Prior to the pandemic, 3.1% of all visits had been virtual, a portion that climbed to 51.8% after pandemic onset.

In the 9 months before the pandemic, 35.4% of all psychotherapy visits in the study were followed by a 45-day-or-more disruption. But in the 9 months after onset, that number dropped to 17.9%.

Brian K. Ahmedani

After adjustment for demographic, mental health and other factors, Ahmedani and colleagues found that patients were less likely to have disruptions in psychotherapy following onset of the pandemic (adjusted OR = 0.45; 95% CI, 0.44-0.46). The median time between visits also nearly halved from 27 days to 14 days following pandemic onset.

The decline in psychotherapy disruption was consistent across all sociodemographic subgroups and across all major mental health conditions.

“Every single demographic subgroup that we looked at had fewer disruptions in care after this transition to virtual services,” Ahmedani said, adding, “I was a little bit surprised, quite honestly.”

He said the consistent finding could encourage the further loosening of regulations that restricted virtual care before the pandemic, such as insurance coverage issues and rules about providing services across state lines.

The study’s limitations include the possibility that patients seeking care after pandemic onset may have had more flexible schedules and been more motivated, or perceived a greater need, to attend.

Ahmedani emphasized during the briefing that the study measured the “engagement” of patients already receiving psychotherapy, not access to an initial visit. Previous research has indicated access to the first visit may be the “the biggest barrier” to receiving psychotherapy, Ahmedani and colleagues noted in the study.

Reference:

• Ahmedani BK, et al. Psychiatr Serv. 2023;doi:10.1176/appi.ps.20230181.