Reshaping mental health care delivery during the COVID-19 pandemic: service response and telepsychiatry in a catchment area of 10 million people (preprint)

BackgroundDetailed information on the effects of the COVID-19 pandemic on large public health systems is lacking. Here we describe the overall functioning of a regional network comprising 58 community mental health centres (CMHCs), which covers a catchment area of approximately 10 million people.MethodsWe employed a registry–based approach to summarize descriptive information on demographic and clinical data retrieved from all CMHCs over a two–year period, grouped according to the provinces of Lombardy in Italy. We then described the progression of all subtypes of remote vs. in-person consultations across provinces after the onset of the pandemic, and calculated remote/face–to–face service delivery ratios according to gender, age and main diagnosis.ResultsCompared to the previous year, the largest drop of outpatient contacts was recorded in provinces that were most affected by the early impact of the viral outbreak, peaking in March and May 2020 (-21.89% and -16.86% respectively). A progressive increase of telepsychiatry interventions was observed diffusely, reaching a peak of almost one every four consultations. Remote/face–to–face ratios were significantly higher in females across all age and diagnostic subgroups, in patients from lower age groups and with diagnoses of Eating and Obsessive–Compulsive disorders.ConclusionsOur study is the first to describe the impact of the pandemic on a large public mental health system. Future research on service uptake and cost–effectiveness of blended remote delivery should be tailored to service users of different age groups and clinical diagnoses to optimize organization of services.

OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care activity across six clinical areas during the COVID-19 pandemic (preprint)

Background The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. Aims Using routinely collected data, our aim was to describe changes in the volume and variation of coded clinical activity in general practice in: (i) cardiovascular disease, (ii) diabetes, (iii) mental health, (iv) female and reproductive health, (v) screening, and (vi) processes related to medication. Design and setting With the approval of NHS England, we conducted a cohort study of 23.8 million patient records in general practice, in-situ using OpenSAFELY. Methods We selected common primary care activity using CTV3 codes and keyword searches from January 2019 - December 2020, presenting median and deciles of code usage across practices per month. Results We identified substantial and widespread changes in clinical activity in primary care since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health, e.g. "Depression interim review" (median across practices in December 2020 -41.6% compared to December 2019). Conclusions Granular NHS GP data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for key measures identified here as well as further studies, using primary care data to monitor and mitigate the indirect health impacts of Covid-19 on the NHS.