Background: Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. Objective: We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. Methods: We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. Results: A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. Conclusions: The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness.

中文翻译：

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严重精神疾病中的治疗中断和远程医疗利用：回顾性纵向索赔分析

背景：避免门诊护理中断和辍学可以防止精神疾病症状恶化和昂贵的危机服务，例如急诊室就诊和住院精神病院。在 COVID-19 大流行期间，为了保持护理的连续性，远程医疗服务被越来越多地利用，尽管缺乏关于严重精神疾病患者疗效的数据。由于疾病恶化的波动，随着时间的推移，患有严重精神疾病的患者在随机对照试验中登记和维持具有挑战性。然而，在大流行期间捕获和检查社区精神卫生中心 (CMHC) 患有严重精神疾病的患者的利用率和疗效数据是为未来的临床和政策决策提供信息的独特机会。目的：我们旨在确定和描述在大流行期间经历过治疗中断和使用远程医疗的 CMHC 患有严重精神疾病的患者的特征。方法：我们对新罕布什尔州 CMHC 患者在 2019 年 12 月至 2020 年 6 月期间（与 2018 年 12 月至 2019 年 6 月期间相比）的治疗中断和远程医疗使用进行了回顾性观察研究。研究人群包括在针对 COVID-19 大流行宣布紧急状态前 3 个月接受治疗的所有患有严重精神疾病的 Medicaid 受益人。我们使用独立性卡方检验和逻辑回归来探索治疗中断与变量（性别、年龄、农村地区和诊断）之间的关联。远程医疗利用率分为低 (<25%)、中 (25%-75%) 或高 (>75%) 使用。结果：共确定了 16,030 名患者。与前一年相比，新罕布什尔州 CMHC 的治疗中断率仅增加了 4.9%。男性患者（优势比 [OR] 1.27，95% CI 1.17-1.38；P <.001），18 岁以下（0-12 岁：OR 1.37，95% CI 0.62-0.86，P < .001；13-17 岁：OR 1.49, 95% CI 0.57-0.79, P <.001)，或在较轻的诊断类别中，例如焦虑症 (OR 3.77, 95% CI 3.04-4.68; P <.001 ) 和创伤后应激障碍 (OR 3.69, 95% CI 2.96-4.61; P<.001)，最有可能经历治疗中断。女性（OR 0.89，CI 0.65-0.74）、18 至 34 岁（OR 0.74，CI 0.70-0.79）或处于轻度诊断类别中的患者，例如焦虑症（OR 0.69，CI 0.65-0.74）或创伤后压力障碍（OR 0.77，CI 0.72-0.83）和重度抑郁症（OR 0.73，CI 0.68-0.78）不太可能在远程医疗利用率低的组中。结论：远程医疗的整合支持大多数 CMHC 患者的护理连续性；然而，保留率因亚群而异，远程医疗的使用情况也是如此。制定政策和临床实践指南需要关于远程医疗在严重精神疾病患者中的有效性和局限性的经验证据。