Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic.

This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.

Merging Outpatient Addiction and Opioid-Maintenance Programs During A Disaster: Lessons From Hurricane Sandy.

OBJECTIVE: After Hurricane Sandy flooded Bellevue Hospital in New York City, its opiate maintenance patients were displaced and Bellevue's outpatient program was temporarily merged with the program at Metropolitan Hospital for continuation of care. The merger forced Metropolitan to accommodate a program twice as large as its own and required special staff coordination and adjustments in clinical care. METHODS: Physicians, clinicians, and administrators from both institutions participated in interviews regarding the merger. RESULTS: Issues that emerged in the interviews fell into 4 major themes: (1) organization and meshing of professional cultures, (2) regulation, (3) communication, and (4) accommodations. CONCLUSIONS: Despite these barriers, data collected after the merger showed high retention rates and low rates of positive urine toxicology results. (Disaster Med Public Health Preparedness. 2017;11:531-537).

Methadone-Induced Hyperhidrosis Treated With Oxybutynin.

OBJECTIVES: This case report aims to help healthcare providers and methadone clinic patients to recognize one of the less recognized adverse effects of methadone, hyperhidrosis, and to suggest oxybutynin as a possible solution. METHODS: A 35-year-old man on methadone maintenance therapy presented with excessive sweating, which began promptly after methadone was introduced. Urine toxicology was conducted every 2 weeks to rule out other illicit substances that may have contributed to the sweating. RESULTS: Oxybutynin (5 mg PO QID) resulted in cessation of the methadone-induced hyperhidrosis within 2 days of starting the medication. CONCLUSIONS: Methadone-induced excessive sweating is an adverse effect of the medication that reportedly affects up to 45% of those prescribed methadone, and oxybutynin is a potent treatment for methadone-induced excessive sweating.