Telehealth Treatment of Patients in an Intensive Acute Care Psychiatric Setting During the COVID-19 Pandemic: Comparative Safety and Effectiveness to In-Person Treatment

Abstract

Background: Most research evaluating telehealth psychiatric treatment has been conducted in outpatient settings. There is a great lack of research assessing the efficacy of telehealth treatment in more acute, intensive treatment settings such as a partial hospital. In the face of the COVID-19 pandemic, much of behavioral health treatment has transitioned to a virtual format. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the effectiveness of our partial hospital program (PHP).

Method: The sample included 207 patients who were treated virtually from May 2020 to September 2020 and a comparison group of 207 patients who were treated in the in-person partial program a year earlier. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being.

Results: For both the in-person and telehealth methods of delivering partial hospital level of care, patients were highly satisfied with treatment and reported a significant reduction in symptoms and suicidality from admission to discharge. On the modified Remission from Depression Questionnaire, the primary outcome measure, both groups reported a significant (P < .01) improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment (Cohen d > 0.8) was found in both treatment groups. The only significant difference in outcome between the patients treated in the different formats was a greater length of stay (mean ± SD of 13.5 ± 8.1 vs 8.5 ± 5.0 days, t = 7.61, P < .001) and greater likelihood of staying in treatment until completion (72.9% vs 62.3%, χ² = 5.34, P < .05) in the virtually treated patients.

Conclusions: Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, suicidal ideation reduction, and improved functioning and well-being. The treatment completion rate was higher in the telehealth cohort, and several patients who were treated virtually commented that they never would have presented for in-person treatment even if there was no pandemic. Telehealth PHPs should be considered a viable treatment option even after the pandemic has resolved.