Are virtual follow-ups effective after psychiatric emergencies?
When someone visits the emergency department for a psychiatric emergency, follow-up appointments are an important next step to ensure they receive the care they need to recover. Virtual follow-up appointments, usually in the form of a video call, offer several advantages. For those who find travel difficult or have limited time, a virtual appointment can be much easier. But are virtual appointments as effective as an in-person visit when assessing the wellbeing of someone who has had a mental health emergency? Do patients who attend an in-person follow-up experience better outcomes?
Dr. Simone Vigod and her collaborators, including first author Matthew Crocker, MPH, of the Institute for Clinical Evaluative Sciences, and University of Toronto Department of Psychiatry members Drs. Paul Kurdyak, Lucy Barker, Tanya Hauck, and Martin Rotenberg, undertook a study to determine if virtual follow-up appointments are as effective as in-person appointments after a psychiatric emergency department visit.
We spoke to Dr. Vigod about what they learned.
What motivated this research?
SV: The use of virtual care exploded during the COVID-19 pandemic and it has been lauded as an important method to increase access to care for people who may face barriers to attending in-person appointments. There have been a number of studies showing that virtual care for psychological treatments are as good as in-person care. However, less research has focused on its use for psychiatric care in acutely ill populations. We know that getting timely outpatient follow-up care after a psychiatric emergency department (ED) visit is important, and that not enough people receive it. However, whether virtual care is an effective way to provide this type of follow-up is not known.
What was the most important finding of this study, in your opinion?
SV: Only about 30% of people discharged from the ED had a follow-up visit within 14 days of discharge, which is a problem in-and-of-itself. However, for those who received follow-up care, the risk of an adverse outcome after the original emergency department visit (such as repeat ED visit, hospitalization, self-harm, or suicide) did not differ between those who received virtual (~2/3rds of the group) and in-person care.
How does this change treatment in the future?
SV: This was not a randomized study, so we don’t know whether virtual care and in-person care are truly equivalent, or whether perhaps patients and providers selected the type of care that was more effective for them. However, the findings do give us confidence that virtual follow-up care is a reasonable option after a psychiatric ED visit, so could be used to try to increase the overall follow-up rates if possible.
Any next steps?
SV: We would suggest studying the effectiveness of different tools and strategies to improve rates of follow-up care after psychiatric ED visits. We would also recommend that these studies explore ways technology can be used to help improve the frequency of follow-up appointments.
What is the major take home message for the public?
SV: Rates of timely follow-up care after a psychiatric ED visit need to be improved, and our study indicates virtual care can be an appropriate way to deliver this care.
Crocker M, Huang A, Fung K, Stukel TA, Toulany A, Saunders N, Kurdyak P, Barker LC, Hauck TS, Rotenberg M, Hamovitch E, Vigod SN. Virtual Versus In-Person Follow-up After a Psychiatric Emergency Visit: A Population-Based Cohort Study: Suivi virtuel opposé à en personne après une visite à l'urgence psychiatrique : une étude de cohorte dans la population. Can J Psychiatry. 2024 Nov;69(11):809-819. doi: 10.1177/07067437241281068. Epub 2024 Sep 23. PMID: 39308421; PMCID: PMC11562897.