Zoran Martinovich

BACKGROUND Beginning in March 2020, state-of-emergency policy changes at the state and federal level greatly expanded accessibility to telehealth, allowing patients to receive ongoing care while limiting in-person interactions to mitigate transmission of COVID-19. OBJECTIVE The purpose of this study was to broadly understand patients’ satisfaction with and attitudes towards receiving telemental health care 10 months into the COVID-19 pandemic. METHODS A questionnaire was designed and administered to elicit comprehensive feedback about telehealth care, and to gauge participants’ desire to use it in the future. Survey questions were rated on 5-point Likert scale. Participants were asked about their desire to continue telemental health care post-pandemic. RESULTS Most of the 602 participants reported favorable experiences with telemental health care. 505 (84.4%) were satisfied or extremely satisfied, and 527 (88.6%) rated the use of telehealth extremely easy or easy, 531(89.1 %) rated overall comfort with telehealth as very comfortable or comfortable. A majority felt at ease using a private 491(82.5%) and quiet space 509(86.0%) to communicate using telehealth. Perceived benefits of telemental health care were varied and included improved ability to manage work and family obligations. Quality of care was comparable to in-person visits. A majority 523(86.88%) of participants would like to have telemental health offered as an option in the future, even after the pandemic resolves. CONCLUSIONS Nearly a year into the COVID-19 pandemic, patients rated telemental health care highly across measures of satisfaction, comfort, ease of use, and quality of care. Participants reported tangible benefits of telemental health care such as time and money savings, and also intangible benefits, like increased flexibility and decreased stress. Participants expressed their desire that telemental health care be a readily available option in the post-pandemic future. Maintaining accessibility to telehealth care for psychiatric patients in the future should be a priority. CLINICALTRIAL ClinicalTrials.gov NCT04693052; https://clinicaltrials.gov/ct2/show/NCT04693052

Every day families and mental health providers are called upon to make tough decisions in determining the best quality of care for adolescents and young adults with serious mental health conditions. This study profiles the behavioral and emotional needs and risk behaviors of adolescents and young adults seeking mental health services based on assessment of strengths and needs at program entry.

Objectives To determine whether there is a difference in time to initial analgesic for patients with acute pain from sickle cell disease (SCD) versus renal colic (RC) and to identify factors contributing to variance in time to analgesic. Methods A retrospective cohort study of the adult emergency department (ED) patients with acute pain from SCD and RC in an urban ED (final ED discharge ICD-9 diagnosis codes were included). A structured medical record review abstracted the demographics, arrival shift, triage level, initial pain score, triage time, and time of initial analgesic dose. Data were compared with Kaplan-Meier plots of time to initial analgesic for both RC and SCD with the log-rank test to test for differences by disease category. A multivariable Cox regression model estimated differences in time to initial analgesic by disease category while controlling for other possible confounders. Results Median time to initial analgesic was 80 minutes for patients with SCD (interquartile range, 48 to 145) versus 50 minutes for patients with RC (interquartile range: 30 to 96). Patients with SCD reported a higher pain score on arrival when compared with RC patients and were more frequently assigned a higher triage priority level (P=0.05). Covariates that contributed the most delays to the model were afternoon arrival [hazard ratio (HR): 0.35, PPPP=0.01). Discussion ED patients with SCD experienced longer delays in the administration of the initial analgesic compared with RC patients, despite higher arrival pain scores and triage acuity levels.

Running away from residential treatment is a relatively common and dangerous outcome for youth. Both clinical and program factors have been associated with the risk of running away. The present study directly compared the relative importance of youth-specific and program-specific predictors in a large sample across 52 treatment sites. Data from a state-wide outcomes management system for residential treatment were used to study youth who were discharged because of running away. A sample of 2,114 treatment episodes was analyzed. Consistent with prior research, youth-specific variables such as gender and substance use were associated with risk of discharge due to running away. However, program was an equally powerful predictor of who runs from treatment. While some youth are at greater risk of running from treatment than others, it also appears to be the case that some programs are better at preventing running, even among high risk youth.