Virtual Behavioral Health Program No Better Than Usual Care


A telehealth program is not significantly better than usual care for patients presenting to the emergency department with a behavioral health crisis.

Christine Zazzaro, MEd

Christine Zazzaro, MEd

A behavioral health-virtual patient navigation program did not significantly decrease hospitalizations among patients who presented to the emergency department with a behavioral health crisis or need.

Although the program was not significantly beneficial, there was an 8% reduction in hospital admission rate for those who used the telehealth program compared with traditional care.

Christine Zazzaro, MEd, assistant vice president at Atrium Health, and colleagues assessed whether a 45-day behavioral health-virtual patient navigation program would decrease hospitalizations. The reason there was not a statistically significant difference was because there were not enough participants enrolled, Zazzaro told HCPLive® in an interview. Regardless, any reduction was still beneficial, despite it not being statistically significant, she said.

The virtual patient navigation program included video contact with a patient while there were in the emergency department and outreach via telephone 24-72 hours after discharge, then at least weekly for < 45 days.

Zazzaro and her team’s primary outcome was the shift from an emergency department encounter to hospital admission. Additional outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use.

The investigators enrolled 637 patients who presented to 6 emergency departments spanning urban and suburban locations from June 2017-February 2018. Patients were > 18 years old with a behavioral health crisis and a completed telepsychiatric emergency department consultation. Each participant was followed up for < 45 days.

During the study period, the intervention was randomly allocated to specific days so that in a two-week block, there were 5 intervention days and 5 usual care days. Overall, 323 patients presented on days when the program was offered and 314 presented on the traditional care days.

A navigator—licensed behavioral health clinician&mdash;introduced themselves to a patient via video to those in the emergency department who were deemed eligible for discharge. The patient and navigator explored barriers to treatment and established best contact time, telephone numbers, inclusion and exclusion of supportive people, and types of behavioral health follow-up indicated by the patient and psychiatric recommendation.

The goal of the program was to ensure close and regular follow-up.

One or 2 navigators would follow-up with the patient, which included a suicide ideation safety screening; an appointment reminder; appointment barrier evaluation; medication obtainment follow-up; substance use disorder follow-up supportive listening; psychoeducation; community resource follow-up; and additional crisis planning. If a patient was deemed to be actively suicidal, the navigator recommended transfer to a mobile crisis unit.

Usual care was done by a licensed behavioral health clinician who completed an initial telephone assessment with all patients who were referred by the emergency department physician for telepsychiatric consultation. The patients were then seen by a psychiatric using a telehealth platform.

Overall, the admission rate was 55.1% (178 of 323) on days when the intervention was in place vs 63.1% (198 of 314) during traditional care days (OR, .74; 95% CI, .54-1.02; P = .06). Postdischarge inpatient and emergency department admission rates after 45 days were numerically higher, but not significantly significant, in the intervention group (inpatient admission, 5.3% [17 of 323] vs 4.1% [13 of 314]; P = .5; emergency department admission, 29.7% [96 of 323] vs 25.2% [79 of 314]; P = .20), and the observation admission rates were similar (5.9% [19 of 323] vs 6.1% [19 of 314]; P = .93).

Significantly fewer patients in the intervention group had follow-up encounters regarding a self-harm diagnosis within 45 days compared with the other patients (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03).

Future research is needed with a broader population of patients, so the result is more statistically significant, Zazzaro said.

The study, “Effect of a Virtual Patient Navigation Program on Behavioral Health Admissions in the Emergency Department,” was published online in JAMA Psychiatry.

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