Health Services/Policy
The association between the introduction of virtual care and follow-up mental health care among youth whose first mental health contact was through the emergency department or hospital Erica Wennberg* Erica Wennberg Aditi Patrikar Amreen Babujee Peter Austin Paul Kurdyak Kate Nelson Astrid Guttmann
Background: Timely follow-up care is crucial for youth whose first mental health contact is through an emergency department (ED) visit or hospital admission; virtual care could facilitate this. We examined the association between the introduction of virtual care in Ontario, Canada and rates of follow-up mental health care for these youth.
Methods: We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified youth (10-24 years old) with an ED or hospital first contact visit for self-harm, mood disorders, or psychosis between 1/Mar/2009 and 29/Feb/2024. Virtual care was introduced through temporary (Mar/2020-Nov/2022) and permanent billing codes (Dec/2022-present) (TBCs and PBCs). We used an ARIMA interrupted time series analysis to examine changes (vs pre-virtual care) in age- and sex-standardized monthly rates of 7-day mental health follow-up, with a March-June 2020 wash-out period.
Results: The study population included 40,598 youth with an ED (70.6%) and 16,886 with a hospital first contact visit. Pre-virtual care, the average standardized monthly rate of 7-day follow-up was 17.9 per 100 for youth with ED visits, and 18.1 per 100 for admitted youth. In the ED group, TBC introduction was associated with an immediate increase in 7-day follow-up (step change=5.3; 95% CI: 3.4 to 7.2), which then decayed (ramp change=-0.28; -0.38 to -0.17). In the admitted group, there was a similar immediate increase (step change = 6.6; 3.4 to 9.8) and subsequent decline (ramp change= -0.29; -0.49 to -0.10) in rates with TBC introduction. PBC introduction was not associated with significant changes in either group vs pre-virtual care.
Conclusion: For youth whose first mental health contact was through the ED or hospital, virtual care was not associated with changes in follow-up rates, excepting an initial increase in the first year of the COVID-19 pandemic. Further analyses will stratify by rurality and socioeconomic status.
