Outcomes of Virtual Versus Physical Psychiatric Admissions: A Retrospective Cohort Study.

Objective: Telepsychiatry is an effective alternative to in-person care in many settings. However, evidence is lacking on clinical outcomes when telepsychiatry is used to deliver virtual inpatient psychiatric care. This study compared clinical outcomes of patients virtually admitted with outcomes of those physically admitted to a psychiatric hospital in Ireland during the COVID-19 pandemic. Factors associated with transfer from virtual to physical admission were also investigated.

Methods: Data for this retrospective cohort study (N=1,579 patients) were extracted from electronic health records. Admissions were coded as physical or virtual. Outcome measures were treatment response, length of stay, and time to readmission or death within 6 months of discharge. Inverse probability of treatment weighting was used to control for confounding. Outcomes were analyzed by using logistic and Cox regressions.

Results: In 2021, a total of 214 patients were virtually admitted and 1,365 were physically admitted. The virtual admission group had significantly lower odds of treatment response (OR=0.58, 95% CI=0.41-0.81), longer lengths of stay (hazard ratio [HR]=0.83, 95% CI=0.71-0.97), and faster times to readmission or death (HR=2.11, 95% CI=1.52-2.93). Lower socioeconomic status, personality disorder or personality difficulties, history of suicide attempt or deliberate self-harm, and lack of insight into need for treatment were associated with a greater likelihood of transfer from virtual to physical admission.

Conclusions: Patients virtually admitted during the COVID-19 pandemic had worse outcomes than patients who were physically admitted. Postpandemic research should further evaluate the effectiveness of virtual psychiatric wards and identify patient characteristics associated with outcomes of such novel services.