Use of Patient-Reported Outcome Measures to Assess the Effectiveness of Hybrid Psychiatric Visits.

OBJECTIVE: Little empirical evidence exists to support the effectiveness of hybrid psychiatric care, defined as care delivered through a combination of telephone, videoconferencing, and in-person visits. The authors aimed to investigate the effectiveness of hybrid psychiatric care compared with outpatient waitlist groups, assessed with patient-reported outcome measures (PROMs). METHOD: Participants were recruited from an adult psychiatry clinic waitlist on which the most common primary diagnoses were unipolar depression, generalized anxiety disorder, and bipolar disorder. Patients (N=148) were randomly assigned to one of two waitlist groups that completed PROMs once or monthly before treatment initiation. PROMs were used to assess symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and daily psychological functioning (Brief Adjustment Scale-6 [BASE-6]). Patient measures were summarized descriptively with means, medians, and SDs and then compared by using the Kruskal-Wallis test; associated effect sizes were calculated. PROM scores for patients who received hybrid psychiatric treatment during a different period (N=272) were compared with scores of the waitlist groups. RESULTS: PROM assessments of patients who engaged in hybrid care indicated significant improvements in symptom severity compared with the waitlist groups, regardless of the number of PROMs completed while patients were on the waitlist. Between the hybrid care and waitlist groups, the effect size for the PHQ-9 score was moderate (d=0.66); effect sizes were small for the GAD-7 (d=0.46) and BASE-6 (d=0.45) scores. CONCLUSIONS: The findings indicate the clinical effectiveness of hybrid care and that PROMs can be used to assess this effectiveness.

Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US.

OBJECTIVE: To identify potential barriers to care, this study examined the general psychiatry outpatient new appointment availability in the US, including in-person and telepsychiatry appointments, comparing results between insurance types (Medicaid vs. private insurance), states, and urbanization levels. METHOD: This mystery shopper study investigated 5 US states selected according to Mental Health America Adult Ranking and geography to represent the US mental health care system. Clinics across five selected states were stratified sampled by county urbanization levels. Calls were made during 05/2022-07/2022. Collected data included contact information accuracy, appointment availability, wait time (days), and related information. RESULTS: Altogether, 948 psychiatrists were sampled in New York, California, North Dakota, Virginia, and Wyoming. Overall contact information accuracy averaged 85.3%. Altogether, 18.5% of psychiatrists were available to see new patients with a significantly longer wait time for in-person than telepsychiatry appointments (median = 67.0 days vs median = 43.0 days, p < 0.01). The most frequent reason for unavailability was provider not taking new patients (53.9%). Mental health resources were unevenly distributed, favoring urban areas. CONCLUSION: Psychiatric care has been severely restricted in the US with low accessibility and long wait times. Transitioning to telepsychiatry represents a potential solution for rural disparities in access.

Multilevel analysis of BMI growth trajectories of US school children: Features and risk factors.

Childhood obesity continues to be a major focus of public health efforts in the United States, where nearly 17% of children are obese. In this study, we focused on two significant features that characterize U.S. society-school mobility and a single-parent family structure-and how they relate to childhood obesity/overweight. Using a nationally representative sample from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) class of 1998, we examined the body mass index (BMI) growth trajectories of children to determine how these two key features interacted with demographic characteristics of gender, race/ethnicity, and socio-economic status (SES), which are known to be associated with BMI. We analyzed five waves of data from kindergarten through fifth grade of 9041 students applying a two-level hierarchical linear model (HLM). Results indicated that children who changed schools more than two times from kindergarten to fifth grade had higher BMI growth trajectories compared to children who changed only once or did not change schools. To our knowledge, no prior studies have examined this association. Results also indicated children in single-parent families were more likely to have higher BMI growth trajectories compared to children in two-parent families. Although both school mobility and family structure had an impact on children's BMI, we found that family structure had a larger impact than school mobility. Being in a two-parent family was a protective factor for children; that is, even if children in two-parent families moved schools twice or more, they still maintained a healthy BMI on average. For children in single-parent families, however, moving schools tended to have a greater, negative impact on their BMI statuses.