How did ‘virtual visits’ to the doctor help depression care in the US?

‘Virtual visits’ which transpired following the shift to telemedicine during COVID-19 restrictions, improved depression care in quality and in quantity

In March 2020, at the beginning of the pandemic, healthcare systems across the United States rapidly pivoted from in-person appointments to virtual visits via telemedicine.

The unprecedented shift to virtual visits during the pandemic could have seriously disrupted care practices and outcomes, especially in vulnerable patient groups. However, these telemedicine visits did not adversely affect the quality of care – as research found that depression care actually improved.

For those with depression, it found, being able to contact help without in-person care could be better than the original healthcare system designs.

Nancy S. Weinfield, PhD, leader of the study, said: “A rapid shift to virtual behavioural health care was possible without compromising healthcare-related practices.”

A reduction in prescriptions for antidepressant medications

Looking at the implementation of telemedicine within three regions of the KP system, researchers examined trends in telemedicine utilisation and compared the impact of telemedicine and in-person visits on conditions including urinary tract infections, neck and back pain, and depression care.

Analysing electronic health record data of nearly 29,000 first telemedicine follow-up behavioural health visits by patients diagnosed with major depression, researchers found that two of three KP regions showed small but significant reductions in prescriptions for antidepressant medications during the peak pandemic shift to virtual care (April to June 2020), after adjustment for patient characteristics.

However, medication orders returned to pre-pandemic levels during the recovery period, beginning in the summer of 2020.

rates of patient completion of depression symptom screening tools increased

While prescription fulfilment rates were unchanged between the three periods, optimistically, rates of patient completion of depression symptom screening tools increased significantly in all three regions during the pandemic’s peak and continued to increase during the recovery period.

Overall, behavioural health for major depression continued to be delivered predominantly through telemedicine during the pandemic recovery period, indicating more people were receiving better depression care during this time.

“Virtual visits have proven to be a successful model for providers and patients”

The researchers noted: “The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signalling a potential new capacity for virtual health care delivery.”

Dr. Weinfield and coauthors conclude: “Within these three regions of KP, the fact that care has not rebounded to include substantial in-person visits suggests that virtual visits have proven to be a successful model for providers and patients.”

Other studies focus on vulnerable populations, including Medicare and Medicaid beneficiaries and patients receiving care in community health centres – highlighting telemedicine’s role in maintaining the continuity of primary care and the quality of diabetes care.