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Showing content from https://pubmed.ncbi.nlm.nih.gov/33091782/ below:

Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Observational Study

. 2020 Nov-Dec:67:100-106. doi: 10.1016/j.genhosppsych.2020.09.004. Epub 2020 Oct 12. Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Affiliations

¹ Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: jieynlp@gmail.com.
² Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
³ Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; McLean Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

PMID: 33091782
PMCID: PMC7550185
DOI: 10.1016/j.genhosppsych.2020.09.004

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Observational Study

Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts

Jie Yang et al. Gen Hosp Psychiatry. 2020 Nov-Dec.

. 2020 Nov-Dec:67:100-106. doi: 10.1016/j.genhosppsych.2020.09.004. Epub 2020 Oct 12. Affiliations

¹ Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: jieynlp@gmail.com.
² Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
³ Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
⁴ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; McLean Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

PMID: 33091782
PMCID: PMC7550185
DOI: 10.1016/j.genhosppsych.2020.09.004

Item in Clipboard

Abstract

Objective: To examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening.

Methods: Observational study of outpatient MH/SUD visits January 1st-June 30th, 2018-2020 by: 1) visit diagnosis group, 2) provider type, 3) patient race/ethnicity, 4) insurance, and 5) visit method (telemedicine vs. in-person).

Results: Each year, January-June 52,907-73,184 patients were seen for a MH/SUD visit. While non-MH/SUD visits declined during the surge relative to 2020 pre-pandemic (-38.2%), MH/SUD visits increased (9.1%)-concentrated in primary care (35.3%) and non-Hispanic Whites (10.5%). During the surge, MH visit volume increased 11.7% while SUD decreased 12.7%. During partial reopening, while MH visits returned to 2020 pre-pandemic levels, SUD visits declined 31.1%; MH/SUD visits decreased by Hispanics (-33.0%) and non-Hispanic Blacks (-24.6%), and among Medicaid (-19.4%) and Medicare enrollees (-20.9%). Telemedicine accounted for ~5% of MH/SUD visits pre-pandemic and 83.3%-83.5% since the surge.

Conclusions: MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine. Despite this, widening diagnostic and racial/ethnic disparities in MH/SUD visit volume during the surge and reopening suggest additional barriers for these vulnerable populations, and warrant continued monitoring and research.

Keywords: COVID-19; Disparities; Health care systems; Mental health; Substance use disorders.

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Conflict of interest statement

Drs. Yang, Zhou, and Busch have not conflict of interest disclosures; Dr. Landrum discloses husband's income from the on-going opioid litigation representing plaintiffs seeking damages.

Figures
Fig. 1

Weekly number of mental health…

Fig. 1

Weekly number of mental health and/or substance use disorder (MH/SUD) outpatient visits in…

Fig. 1

Weekly number of mental health and/or substance use disorder (MH/SUD) outpatient visits in the healthcare system, January–June 2018–2020 (unadjusted).^a ^a X-axes shows the timeline from January 1st to June 30th 2020 and January 1st to July 1st, 2018 and 2019, scaled and measured in every seven days. We used the 2020 calendar date to align the date information across the three years (after 2/28 of 2018 and 2019, there is one day difference between 2020 and previous two years, i.e. 2/29/2020). Y-axes vary in scale. The first vertical line corresponds to the time period (between 3/11 and 3/17) when Massachusetts declared a state of emergency and provider organization began to discontinue most in-person ambulatory care and transition to telemedicine (i.e., video, phone, or other forms of virtual care [asynchronous e-visits or e-consults]); the second vertical line corresponding to the partial reopening week (between 5/13–5/19). Figures (a) and (b) show that while the number of visits for non-MH/SUD conditions decreased after COVID-19 surge and remained low but increased during the partial reopening in 2020, visits for MH/SUD increased during the surge but then declined. Figures (c) and (d) show that visits for MH increased during the surge and then decreased during reopening, but visits for SUD declined during the surge and reopening. Figures (e) and (f) show that the MH/SUD visit increase primarily occurred in primary care versus MH/SUD specialty during the surge, and then returned to pre-COVID volumes in primary care during reopening.