Quick Pivot Helped Maintain Standard of Schizophrenia Care During COVID

Megan Brooks

May 26, 2022

During the COVID-19 pandemic, mental health clinics in the United States successfully upheld the standard of care for patients with schizophrenia using telepsychiatry and long-acting injectable antipsychotics (LAIs), a new survey data show.

"Mental health centers rose to the challenge and did what they needed to do for their patients," study investigator Dawn Velligan, PhD, University of Texas Health Science Center at San Antonio, told Medscape Medical News.

"Some decided to put patients on longer-acting injectable formulations. Some centers gave injections outside to make people feel safer," Velligan said.

She added that other patients who might not have had transportation, or were too afraid to come in, were switched to oral medications. However, "switching to orals isn't something that should be done lightly. I would only want patients to switch to orals as a last resort, but you do what you have to do," Velligan said.

The findings were presented at the American Psychiatric Association (APA) 2022 Annual Meeting.

No Going Back?

When COVID hit, many mental health clinics closed for in-person visits. "This was unprecedented and we wanted to understand how clinics adapted their services and clinical management of patients with schizophrenia" on LAIs, Velligan said.

She and her colleagues surveyed 35 mental health clinics, with one respondent at each clinic, between October and November 2020.

All 35 clinics reported using telepsychiatry; 15 had been using telepsychiatry before the pandemic, while 20 (57%) began using it after COVID hit.

Across outpatient visit types, telepsychiatry use for non-injection visits rose from 12%-15% before the pandemic to 45%-69% after the pandemic.

In addition, patients were more apt to keep their telehealth visit. The frequency of appointment "no shows" and/or cancellations for telepsychiatry visits decreased by roughly one third after the pandemic vs before the pandemic.

For patients with schizophrenia treated with LAIs, the frequency of telepsychiatry visits increased in 46% of the clinics during the pandemic.

For these patients, management options included switching patients from LAIs to oral antipsychotics in 34% of clinics and switching patients to LAIs with longer injection intervals in 31% of clinics.

Chief barriers to telepsychiatry visits were low reimbursement rate and lack of access to technology/reliable internet.

Nearly all respondents reported being satisfied with the use of telepsychiatry to support patients with schizophrenia, whether treated with LAIs (94%) or with oral antipsychotics (97%).

Sixty percent of respondents reported no change in medication adherence for patients treated with LAIs since the start of the pandemic, while less than half (43%) reported no change in adherence to oral antipsychotics.

Most respondents (69%) felt that telepsychiatry visits would very likely continue to be used in combination with in-person office visits after the pandemic.

"Telemedicine is here to stay," Velligan said.

Moving to a "Hybrid Universe"

Hector Colon-Rivera, MD, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and president of the APA's Hispanic Caucus, agrees.

Commenting on the findings for Medscape Medical News, he noted that, because of shifts in care brought on by COVID, psychiatrists had to adopt telemedicine practices. As a result, many "now feel more comfortable" with telehealth visits for medication management and psychotherapy, said Colon-Rivera, who was not involved with the research.

He added this study is important because it shows that even patients with severe mental illness can be successfully managed with telepsychiatry, and with good adherence.

"Especially for patients with schizophrenia who have access issues, telepsychiatry is really helpful," Colon-Rivera said.

"Telepsychiatry is becoming standard. Most clinics are moving to the hybrid universe now by having a telemedicine component and also seeing patients in-person. Even places like emergency rooms and psychiatrists who do consults on medical floors are using telepsychiatry as an option," he added.

Study funding was provided by Alkermes. Velligan has reported financial relationships with Alkermes, Otsuka, Janssen, and Lyndra. Colon-Rivera has reported no relevant financial relationships.

American Psychiatric Association (APA) 2022 Annual Meeting. Poster: 8-090. Presented May 24, 2022.

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