"I rather talk on the phone": Factors affecting compliance with outpatient visits during COVID-19 Pandemic

Introduction: The COVID-19 pandemic presented a global publichealth crisis that demanded healthcare to adapt at an unprecedented pace. While challenging, it also created opportunities for the advancement of novel electronic-treatment-modalities. Telepsychiatry has emerged as an effective method to ensure continuity of care and ensure social distancing.1 Studies indicate that mentalhealth patients have higher rates of noncompliance to follow-up,1 thus finding means to increase compliance is critical. Objective(s): The objectives of this study are to determine the impact of telepsychiatry on compliance to follow-up and to identify numbers of psychiatric/medical emergency-room visits, most common contributing factors for admission, and compliance in terms of diagnosis. Method(s): This IRB approved study is a retrospective chart-review, that aims to study children/adolescents (5-18 years) who presented to the Child&Adolescent-Psychiatry Outpatient-clinic from July- December 2020 and engaged in telepsychiatry, compared to a group of patients presented in July-December 2019-Pre-Covid19-Pandemic. A review of clinical characteristics including diagnosis, demographic information, medication, and treatment compliance will be compared as well as admissions to inpatient-psychiatry/ emergency-room visits. Result(s): Our total sample (N=252) included patients from 2019- Pre-COVID19 (N=111) and 2020 Telehealth during COVID19- Pandemic (N=141). Our data analysis using SPSF and T-test has shown that Telehealth has significantly increased follow-up compliance (Two-tailed P-value=0.04);2019-Pre-COVID outreach mean=0.06, 2020-Telehealth-during COVID outreach mean=0.02);significantly decreased ER/CPEP visits (Pvalue= 0.02), and decreased In-patient-unit admissions (Pvalue= 0.02). Conclusion(s): According to the presented study, the incorporation of telepsychiatry has increased the compliance to psychiatric-care in outpatient and decreased the emergency-room visits and inpatient admission. Sufficient resources and steps need to be taken to further strengthen telehealth services.

Psychological IMPACT of Remote Learning in Children and Adolescents With Mental Health Disorders in the Community New York City Area

Objectives: The global crisis of COVID-19 demanded that schools adapt to online education at an unprecedented pace. Remote learning has followed social distancing protocols and helped in continuation of education. However, in children with mental health disorders (C-MHD), the outcomes of online learning are not similar to normal individuals. The primary objective of this study is to determine the prevalence of psychological distress of transitioning to remote learning in C-MHD. The secondary objective is to provide directions to increase student satisfaction for online education. Methods: An IRB-approved cross-sectional analysis was done on children aged 5 to 17 years (N = 172), including 87 boys (50.6%) and 85 girls (49.4%), from January to May 2021, at South Bronx Community Hospital, NY. A total of 111 children were Hispanic (65%) and 53 were African American (31%). Structured questionnaires were used by residents/fellows to determine effects of remote learning on children. A χ2 test was used to analyze the data, and p values were calculated across the variables of remote learning and psychiatric diagnosis of MDD, ADHD, and generalized anxiety disorder (GAD). Results: Our analysis showed that 105 (61%) of C-MHD students struggled to learn remotely compared to in-person learning (more children with MDD [20.35%, p < 0.05] as compared to GAD and ADHD). Due to long screen hours, more felt distracted (37%) than tired (14.5%). More felt sad (17%) than happy (0.06%), and 21.5% felt anxious. More children with GAD (42% vs 27%) as compared to MDD (35% vs 24%), rated e-learning as good. More children with ADHD (35% vs 30.6%) did not like e-learning. More children with MDD (26%, p < 0.05) reported feeling safe from COVID-19 in e-learning than did children with GAD (23%) and ADHD (17%). Conclusions: During the pandemic, C-MHD patients presenting to the emergency department with anxiety, aggression, and irritability have increased dramatically, where one of the main precipitating stressors was the inability to transition to remote learning. Online education during the pandemic has caused severe psychological and behavioral impacts on children. Student satisfaction will increase if streamlined digital processes and personalized support systems are fully integrated. SC, SAC, COMP