Clinical considerations for the delivery of virtual dialectical behavior therapy to high-risk patients

This article discusses the clinical considerations for the delivery of virtual dialectical behavior therapy to high-risk patients. The COVID-19 pandemic has required rapid recalibration of behavioral health services, which has been challenging across all sectors of healthcare, but particularly so for high-risk patients for whom the use of telehealth has raised concerns. The telehealth model for DBT can be successfully implemented, but requires careful planning to mitigate potential risks and the use of particular strategies to facilitate relationship building and communication. Furthermore, virtual Dialectical behavior therapy (vDBT) requires a specific technological infrastructure, as well as unique policies to govern patient behavior in the presence of increased distractions found in the home environment. The dropout rates were on the lower end for comprehensive DBT programs, suggesting that the virtual modality may improve convenience for patients, thus improving retention. Although vDBT presents some unique challenges, the authors were able to overcome many of these challenges by using them as opportunities for patients to practice DBT skills, emphasizing the dialectical perspective that challenging experiences and opportunities can co-exist. vDBT provides a promising model for improving access to appropriate, high-quality care while simultaneously reducing healthcare costs. However, the understanding of vDBT is still in its infancy and work is needed to optimize clinical processes for the virtual delivery of DBT as well as evaluate clinical outcomes among patients receiving vDBT, and determine the impact of vDBT on medical expenditure associated with comorbid chronic conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Associations between psychiatric morbidity and COVID-19 vaccine hesitancy: An analysis of electronic health records and patient survey.

Psychiatric illness confers significant risk for severe COVID-19 morbidity and mortality; identifying psychiatric risk factors for vaccine hesitancy is critical to mitigating risk in this population. This study examined the prevalence of vaccine hesitancy among those with psychiatric illness and the associations between psychiatric morbidity and vaccine hesitancy. Data came from electronic health records and a patient survey obtained from 14,365 patients at a group medical practice between February and May 2021. Logistic regression was used to calculate odds for vaccine hesitancy adjusted for sociodemographic characteristics and physical comorbidity. Of 14,365 participants 1,761 (12.3%) participants reported vaccine hesitancy. Vaccine hesitancy was significantly more prevalent among participants with substance use (29.6%), attention deficit and hyperactivity (23.3%), posttraumatic stress (23.1%), bipolar (18.0%), generalized anxiety (16.5%), major depressive (16.1%), and other anxiety (15.5%) disorders, tobacco use (18.6%), and those previously infected with COVID-19 (19.8%) compared to participants without . After adjusting for sociodemographic characteristics and physical comorbidities, substance use disorders and tobacco use were significantly associated with increased odds for vaccine hesitancy and bipolar disorder was significantly inversely associated with vaccine hesitancy. Interventions to improve uptake in these populations may be warranted.

The Impact of the Covid-19-Related Transition to Telehealth on Visit Adherence in Mental Health Care: An Interrupted Time Series Study.

Covid-19 has led to an unprecedented shift to telemental health (TMH) in mental healthcare. This study examines the impact of this transition on visit adherence for mental health services in an integrated behavioral health department. Monthly visit data for 12,245 patients from January, 2019 to January, 2021 was extracted from the electronic medical record. Interrupted time series (ITS) analysis examined the impact of the Covid-19 transition to TMH on immediate level and trend changes in the percentage of cancelled visits and no shows in the 10 months following the transition. ITS also compared changes across the three largest services types: adult, pediatric, and substance use. Following the TMH-transition, completed visits increased by 10% amounting to an additional 3644 visits. In April, 2020, immediately following the TMH-transition, no shows increased by 1.4%, (95% CI 0.1, 2.7, p < 0.05) and cancellations fell by 13.5% (95% CI - 17.9, - 9.0, p < 0.001). Across the 10-month post-TMH period, 18.2% of visits were cancelled, compared to 28.3% across the 14-month pre-TMH period. The proportion of no-shows remained the same. The pattern was similar for pediatric and adult sub-clinics, but no significant changes in cancellations or no shows were observed in the substance use sub-clinic. TMH during the Covid-19 pandemic is associated with improved visit adherence over time and may be a promising model for improving the efficiency of mental health care delivery once it is safe to resume in person care.