Allyson Cruickshank, Pantelis Andreou, Debbie Johnson Emberly, Sandra Meier, Leslie Anne Campbell
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Insights gained from the comparison of treatment duration between modalities may improve our understanding of the effectiveness of virtual care and help to inform clinical decision-making and effective use of resources.</p><p><strong>Objective: </strong>We sought to improve our understanding of how treatment modality impacts treatment duration for children and adolescents accessing Community Mental Health and Addictions services at IWK Health following the rapid implementation of virtual care in March 2020. In this study, we aimed to compare the duration of treatment within episodes of care by treatment modality and determine whether client characteristics, system factors, or time period influenced any associations between treatment modality and treatment duration.</p><p><strong>Methods: </strong>Episodes of care were created using administrative data collected by the IWK Mental Health and Addictions program and used as the unit of analysis. A multilevel mixed-effects negative binomial model and time-to-event analysis were used to model the association between treatment modality and treatment duration, both in visits and days, adjusting for client and system characteristics.</p><p><strong>Results: </strong>Virtual episodes of care had more visits than in-person episodes between April 1, 2020, and March 31, 2021 (incidence rate ratio [IRR] 1.59, 95% CI 1.38-1.83), and April 1, 2021, and March 31, 2022 (IRR 1.22, 95% CI 1.10-1.35), whereas between April 1, 2022, and March 31, 2023, virtual episodes of care were associated with fewer visits (IRR 0.82, 95% CI 0.74-0.91). Comparable results were seen for treatment duration in days (2020-2021: hazard ratio [HR] 0.64, 95% CI 0.54-0.76; 2021-2022: HR 0.80, 95% CI 0.70-0.90; and 2022-2023: HR 1.10, 95% CI 0.97-1.25). These differences by time period relative to the onset of the COVID-19 pandemic and switch to virtual care were consistent after adjusting for client and system characteristics.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first study to examine the association between virtual or in-person treatment modality and treatment duration. While initially longer than in-person episodes of care, both in numbers of visits and length in days, over time the average length of episodes conducted mainly virtually had attenuated. These findings may be due to growing comfort with the technology or client factors not adequately captured in administrative data. This information can be valuable to clinicians, clients, and their families regarding expected treatment timelines and aid in informing service planning.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e70650"},"PeriodicalIF":5.8000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425424/pdf/","citationCount":"0","resultStr":"{\"title\":\"Child and Adolescent Virtual Mental Health Care and Duration of Treatment: Retrospective Cohort Study.\",\"authors\":\"Allyson Cruickshank, Pantelis Andreou, Debbie Johnson Emberly, Sandra Meier, Leslie Anne Campbell\",\"doi\":\"10.2196/70650\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Due to public health restrictions, the COVID-19 pandemic required significant changes in the delivery of child and adolescent mental health services. The use of virtual care for balancing access with treatment needs requires a shared decision between clients, caregivers, and clinicians. One aspect for consideration is the length of treatment necessary to achieve desired outcomes and whether it differs by treatment modality. Insights gained from the comparison of treatment duration between modalities may improve our understanding of the effectiveness of virtual care and help to inform clinical decision-making and effective use of resources.</p><p><strong>Objective: </strong>We sought to improve our understanding of how treatment modality impacts treatment duration for children and adolescents accessing Community Mental Health and Addictions services at IWK Health following the rapid implementation of virtual care in March 2020. 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引用次数: 0
摘要
背景:由于公共卫生限制,COVID-19大流行要求儿童和青少年精神卫生服务的提供发生重大变化。使用虚拟护理来平衡可及性和治疗需求需要客户、护理人员和临床医生之间的共同决策。需要考虑的一个方面是达到预期结果所需的治疗时间,以及治疗方式是否不同。从不同治疗方式的治疗持续时间的比较中获得的见解可能会提高我们对虚拟治疗有效性的理解,并有助于为临床决策和有效利用资源提供信息。目的:在2020年3月快速实施虚拟护理后,我们试图提高我们对治疗方式如何影响在IWK Health获得社区心理健康和成瘾服务的儿童和青少年的治疗时间的理解。在本研究中,我们旨在比较不同治疗方式的治疗持续时间,并确定患者特征、系统因素或时间段是否影响治疗方式和治疗持续时间之间的关联。方法:使用IWK心理健康和成瘾项目收集的管理数据创建护理情节,并将其作为分析单元。采用多水平混合效应负二项模型和事件时间分析来模拟治疗方式和治疗持续时间之间的关联,包括就诊次数和天数,并根据客户和系统特征进行调整。结果:在2020年4月1日至2021年3月31日期间(发病率比[IRR] 1.59, 95% CI 1.38-1.83),以及2021年4月1日至2022年3月31日期间(IRR 1.22, 95% CI 1.10-1.35),虚拟护理发作的就诊次数多于现场就诊次数(IRR 0.82, 95% CI 0.74-0.91)。治疗持续时间(以天为单位)也有类似的结果(2020-2021年:风险比[HR] 0.64, 95% CI 0.54-0.76; 2021-2022年:风险比[HR] 0.80, 95% CI 0.70-0.90; 2022-2023年:风险比1.10,95% CI 0.97-1.25)。在针对客户和系统特征进行调整后,这些与COVID-19大流行发病和转向虚拟医疗相关的时间段差异是一致的。结论:据我们所知,这是第一个研究虚拟或面对面治疗方式与治疗时间之间关系的研究。虽然最初比面对面的护理时间更长,无论是访问次数还是天数,随着时间的推移,主要进行的平均时间实际上已经减少。这些发现可能是由于对技术或管理数据中未充分捕获的客户因素越来越满意。这些信息对于临床医生、客户和他们的家庭对于预期的治疗时间表和帮助告知服务计划是有价值的。
Child and Adolescent Virtual Mental Health Care and Duration of Treatment: Retrospective Cohort Study.
Background: Due to public health restrictions, the COVID-19 pandemic required significant changes in the delivery of child and adolescent mental health services. The use of virtual care for balancing access with treatment needs requires a shared decision between clients, caregivers, and clinicians. One aspect for consideration is the length of treatment necessary to achieve desired outcomes and whether it differs by treatment modality. Insights gained from the comparison of treatment duration between modalities may improve our understanding of the effectiveness of virtual care and help to inform clinical decision-making and effective use of resources.
Objective: We sought to improve our understanding of how treatment modality impacts treatment duration for children and adolescents accessing Community Mental Health and Addictions services at IWK Health following the rapid implementation of virtual care in March 2020. In this study, we aimed to compare the duration of treatment within episodes of care by treatment modality and determine whether client characteristics, system factors, or time period influenced any associations between treatment modality and treatment duration.
Methods: Episodes of care were created using administrative data collected by the IWK Mental Health and Addictions program and used as the unit of analysis. A multilevel mixed-effects negative binomial model and time-to-event analysis were used to model the association between treatment modality and treatment duration, both in visits and days, adjusting for client and system characteristics.
Results: Virtual episodes of care had more visits than in-person episodes between April 1, 2020, and March 31, 2021 (incidence rate ratio [IRR] 1.59, 95% CI 1.38-1.83), and April 1, 2021, and March 31, 2022 (IRR 1.22, 95% CI 1.10-1.35), whereas between April 1, 2022, and March 31, 2023, virtual episodes of care were associated with fewer visits (IRR 0.82, 95% CI 0.74-0.91). Comparable results were seen for treatment duration in days (2020-2021: hazard ratio [HR] 0.64, 95% CI 0.54-0.76; 2021-2022: HR 0.80, 95% CI 0.70-0.90; and 2022-2023: HR 1.10, 95% CI 0.97-1.25). These differences by time period relative to the onset of the COVID-19 pandemic and switch to virtual care were consistent after adjusting for client and system characteristics.
Conclusions: To our knowledge, this is the first study to examine the association between virtual or in-person treatment modality and treatment duration. While initially longer than in-person episodes of care, both in numbers of visits and length in days, over time the average length of episodes conducted mainly virtually had attenuated. These findings may be due to growing comfort with the technology or client factors not adequately captured in administrative data. This information can be valuable to clinicians, clients, and their families regarding expected treatment timelines and aid in informing service planning.
期刊介绍:
JMIR Mental Health (JMH, ISSN 2368-7959) is a PubMed-indexed, peer-reviewed sister journal of JMIR, the leading eHealth journal (Impact Factor 2016: 5.175).
JMIR Mental Health focusses on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change. This includes formative evaluation and system descriptions, theoretical papers, review papers, viewpoint/vision papers, and rigorous evaluations.