Addiction and Mental Health Clinicians’ Attitudes Toward Telepsychology: Predicting Post-Pandemic Telepsychology Uptake (Preprint)

BACKGROUND The COVID-19 pandemic has resulted an unprecedented uptake of telepsychology services; however, clinicians are mixed in their attitudes toward virtual technologies. OBJECTIVE This study explored clinician attitudes towards video, telephone, and in-person services and tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinician intention to offer telepsychology post-pandemic. METHODS Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone while ease of communication, technology attitudes, and intention to use post-pandemic were compared across video and telephone services in 118 addiction and mental health clinicians during the COVID-19 pandemic. RESULTS Clinicians reported more positive attitudes toward in-person services than both virtual technologies, and more positive attitudes towards video- than telephone-based services across measures (P < .001). Based on the UTAUT, performance expectancy positively predicted concurrent intention to use video (β = 0.46, P < .001) and telephone (β = 0.35, P < .001) services in future practice. Social influence (β = 0.24, P = .004) and facilitating conditions (β = 0.19, P = .028) additionally predicted intention to use telephone. CONCLUSIONS Clinicians have more positive attitudes towards in-person than virtual technologies, with video perceived more positively than telephone; performance expectancy is a primary facilitator to uptake of both virtual modalities. Recommendations and limitations are discussed.

TP10.2.9The effect of COVID-19 on Breast clinic follow ups – a change in future practice?

Aims Prior to March 2020, at Princess Royal University Hospital (PRUH), Kings College NHS Foundation Trust, almost daily face to face benign/malignant breast clinic follow ups occurred. On March 23rd 2020 the UK went into official COVID-19 pandemic lockdown. The effect on elective follow up practice was swift with cancellation, triaging and replacement of face-to-face by telephonic/virtual consultations. We compared the change of follow up pattern, pre and post COVID-19. Could this effect the future of consultations at PRUH? Methods A comparison of all patients attending PRUH breast unit outpatients in January 2020 (preCOVID-19) for follow up, with those attending in April 2020 (postCOVID-19). Data collection from clinic lists and electronic patient records, with Excel version 16 analysis. Results 343 patient follow up consultations 01/2020. 53 patient follow up consultations 04/2020. Malignant cases: January 65%, April 60% Benign/B3 cases: January 35%, April 20% Summary follow up types. Conclusions Impact of COVID has been widespread in our practice. Our results show a significant reduction in face-to-face appointments, to allow social distancing. Further evaluation of this model will show its sustainability. Patient satisfaction will have to be assessed, with a view to a full move to video/telephone consultation where indicated.

745 Prospective Evaluation of Virtual Consultations in Paediatric Surgery and Urology: Lessons from the Pandemic Times

Aim Virtual consultation (VC) became the new norm for providing outpatient clinics during the COVID-19 pandemic. This is likely to be adopted in some form going forward. This study prospectively evaluated the effectiveness&safety of VC undertaken at a UK tertiary paediatric surgical centre during the pandemic. Method Data on paediatric surgery/urology outpatient video/telephone consultations between May-June 2020 was prospectively collected. VC episodes were given outcomes (1,2or3) depending how well surgeons were able to make definitive diagnoses/plans. 6months later, findings at later face-to-face visit were retrospectively compared with earlier VC to assess accuracy of decision-making using VC. Telephone survey of patient experience was done. Results 186VC were evaluated. 95 (51%) were paediatric general surgical patients and 91 (49%) urology. 118 (63%) were follow-ups and 68 (37%) new. In 70% of cases, clinicians were able to make definitive diagnosis/plan using VC (outcome1) while 26% could be delayed till face-to-face consultation is safe (outcome2). 7 patients (4%) needed to be brought in urgently (outcome3). Clinicians were significantly more able to make definitive diagnosis/plan in urology and follow-up patients. Of those brought back for scheduled follow-up/surgery, there was 93% correlation between findings at physical consultation compared to the definitive plans made at VC. Patient survey showed 92% overall satisfaction rate. 75% felt VC is comparable to face-to-face/would use VC again. Conclusions This study provides evidence that VC is an effective&safe way to structure paediatric surgical outpatient care and it highlights the patient categories in which VC is most suitable.

Service user experience of remote consultations during COVID-19 in an older adult community mental health setting

AimsThe COVID-19 pandemic has had a significant effect on our ability to communicate face-to-face with patients freely. Similar to other medical specialities and general practice (1), to continue providing a service for our service users, we employed other means of communication including telephone and video consultations (although face-to-face consultations were available for high clinical concern and/or identified risk). We set out to explore the acceptability of remote consultation for service users of an older adult (>65 years) Community Mental Health Team (CMHT).Reference: BMJ 2020;371:m3945MethodA total of 34 service users were selected randomly from the CMHT caseload (9% of total 372 caseload). 4 clinicians were involved in collecting data between July and October 2020. We used our trust's (East London Foundation Trust) standard questionnaire on patient satisfaction and contacted individuals by telephone to complete the survey.ResultFor both questions of ‘I felt listened to by the team’ and ‘I feel I have been given enough information regarding my care’ 17 (50%) responders ‘agreed’ with this statement and an additional 13 (38%) ‘strongly agreed’ (total of 88%). For the statement ‘I feel involved in decisions about my care’ 16 (47%) responders ‘agreed’ and a further 11 (32%) responders ‘strongly agreed’ with this statement. The statement ‘The professionals involved in my care talk to each other and we all work as a team’ had 15 (44%) responders ‘agree’ and 13 (38%) responders ‘strongly agree’. When asked ‘If you experienced telephone/video sessions, were these helpful?’ 31 responders said ‘yes’.ConclusionOverall most responders agreed or strongly agreed that they felt listened to, were given enough information about their care, felt involved in decisions about their care and that they worked as a team with the professionals involved in their care. 91% of responders felt that the video/telephone sessions had been helpful. These data have provided reassurance that telemedicine methods were a useful substitute for face-to-face consultations during the early stages of the pandemic. However this was a small scale study. This study cannot tell us about the experience after the initial 6 months of the pandemic, how often it would be optimal for people have face to face reviews, or whether satisfaction with telemedicine altered over a longer period. We were also not able to tell whether the experience varied for those who had less robust and longstanding relationships with their clinicians.

The future of tele-oncology: Trends and disparities in telehealth and secure message utilization in the COVID-19 era.

1506 Background: The COVID-19 pandemic created an imperative to re-examine the role of telehealth in oncology. Herein we report trends and demographic disparities in utilization of telehealth and secure messaging (SM; i.e., email via portal/app), before and during the pandemic, at a large integrated healthcare system. Methods: This population-based retrospective cohort study examines utilization of various patient-provider visit types (office, video, telephone) and SM from 1/1/2019-9/30/2020 at 22 Kaiser Permanente Northern California Hematology and Oncology practices. We explored changes associated with the pandemic (i.e., since 03/2020, when stay home orders were introduced) as well as demographic differences, using Chi-square for categorical and the Mann-Whitney U Test for non-parametric comparisons. Results: During the study period, there were 334,666 visits and 1,161,239 SM sent between patients and providers. Since the pandemic, total monthly average of visits declined only slightly by 4.1%, but monthly average office visits decreased by 80% from 11,001 to 2,170, monthly average video visits increased from 40 to 4,666, and monthly average telephone visits increased by 69% from 5,114 to 8,663. The monthly average SM increased by 26% from 50,788 to 64,315. The trend of increasing telehealth utilization was sustained and stabilized between 07-09/2020. New consultations initially decreased from a mean of 1,995 per month (12.4% of all visits) in 2019, to a minimum of 1,179 (8.6%) by 05/2020, returning to 1,619 (11.7%) by 09/2020. Pandemic era video visits were a significantly higher fraction of all visits (p < 0.01) in: (1) younger patients (Gen Z 48%, Gen Y/Millennials 46%; Gen X 40%; Baby Boomers 34.4%; Pre-Boomers 24.5%); (2) patients with commercial insurance (39%) compared to those with Medicaid (32.7%) or Medicare (28.1%); (3) Primary English speakers (33.7%) compared to those who require an interpreter (24.5%);(4) Asians (35%) and non-Hispanic Whites (33.7%) compared to Blacks (30.1%) and Hispanic Whites (27.5%); (5) married/ domestic partner patients (35%) compared to single/divorced/widowed patients (29.9%); (6) patients with a Charlson comorbidity index ≤3 (36.2%) compared to > 3 (31.3%); and (7) males (34.6%) compared to females (32.3%). Similar statistically significant SM utilization patterns were also seen. Conclusions: In the pandemic era, utilization of telehealth and SM rapidly increased in all demographic categories, shifting the landscape and resource allocation of hematology/oncology practices in a manner that is feasible and sustained. New consultations decreased early in pandemic with return to pre-pandemic levels by 09/2020. Utilization of video visits and SM significantly differ between various demographic populations with disparities seen by age, insurance plan, English proficiency, race/ethnicity, marital status, comorbidities, and gender.

Greatly increased Victorian outpatient private psychiatric care during the COVID-19 pandemic: new MBS-telehealth-item and face-to-face psychiatrist office-based services from April–September 2020

Objective: The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of telehealth, and face-to-face consultations for April–September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019. Method: MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April–September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia. Results: Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April–September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria’s increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April–September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April–September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations. Conclusions: During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.

P101 Remote risk stratification of dyspnoea in acute respiratory disorders and applications for COVID-19 and future pandemics: a systematic review of the literature

Background Due to the highly infectious nature of the disease, a large amount of community-based triage of COVID-19 is performed by video/telephone consultation, especially in primary care. This presented clinicians with a new challenge in risk stratification of patients with dyspnoea due to suspected COVID19. This review searched existing literature to identify existing modalities to remotely assess patients with acute respiratory distress, which can be adapted for the COVID-19 pandemic and in future similar situations. Methods We conducted a systematic search of Medline, Embase and Medrxiv for studies of the remote assessment of dyspnoea in acute respiratory disorders in adults/children. The study was registered on PROSPERO (ID: CRD42020202292): 3014 abstracts were screened independently by two reviewers and 32 studies were progressed to full text screening. Results Five studies were selected for review, including 1317 patients. Two studies assessed video consultation, two assessed telephone related triage tools, and one study assessed an online triage tool for dyspnoea. In one study, video consultation was found to have 83% sensitivity for diagnosing ‘severe’ respiratory distress in comparison to face-to-face assessment. The online triage tool was found to have 87.5% sensitivity for detecting dyspnoea requiring emergency level care. Conclusion A range of successful remote risk stratification tools and clinical features were identified for assessing dyspnoea severity which can be adapted to COVID-19 and future pandemics to assess respiratory distress via telemedicine. These findings will influence development of comprehensive evidence-based tools to assess dyspnoea which will reduce resource strain during current/future pandemics. References Loinaz C, Marcacuzco A, Fernández-Ruiz M, Caso O, Cambra F, San Juan R, et al. Varied clinical presentation and outcome of SARS-CoV-2 infection in liver transplant recipients: Initial experience at a single center in Madrid, Spain. Transpl Infect Dis Off J Transplant Soc. 2020 Jun 20;e13372.

Evaluation of a video, telephone follow-ups, and an online forum as components of a psychoeducational intervention for caregivers of persons with advanced cancer

Objective:Our aim was to evaluate caregivers' perceptions of a video, telephone follow-up, and online forum as components of a psychoeducational intervention.Method:Qualitative semistructured face-to-face interviews were conducted with 12 participants two weeks post-intervention. The study was conducted from September of 2012 to May of 2015. Family caregivers were recruited from four home hospice organizations (HCA Hospice Care, Metta Hospice, Singapore Cancer Centre, and Agape Methodist Hospice) and the National Cancer Centre outpatient clinic in Singapore. A purposive sample was employed, and participants were recruited until data saturation. Qualitative interviews were transcribed verbatim. Transcripts were coded and analyzed using content analysis. Two of the research team members were involved in the data analysis.Results:Two-thirds of participants were females (n= 8). Their ages ranged from 22 to 67 (mean = 50.50,SD= 11.53). About two-thirds were married (n= 7). Most participants were caring for a parent (n= 10), one for a spouse, and one for her mother-in-law. Caregivers favored the use of video for delivery of educational information. They liked the visual and audio aspects of the video. The ability to identify with the caregiver and scenarios in the video helped in the learning process. They appreciated telephone follow-ups from healthcare professionals for informational and emotional support. The online forum as a platform for sharing of information and provision of support was not received well by the caregivers in this study. The reasons for this included their being busy, not being computer savvy, rarely surfing the internet, and not feeling comfortable sharing with strangers on an online platform.Significance of Results:This study provided insight into caregivers' perceptions of various components of a psychoeducational intervention. It also gave us a better understanding of how future psychoeducational interventions and support for caregivers of persons with advanced cancer could be provided.