Pediatric behavioral health care utilization in integrated primary care and hospital-based clinics during the pandemic – Implications for virtual care

Abstract

Introduction: The COVID-19 pandemic forced health care organizations and providers to adapt innovative approaches to ensure patient care needs are met. In particular, improving patient access to behavioral health services is essential to improving population health. 
 Methods and Aims: Clinical visit volume and utilization data were analyzed via the Tableau platform for behavioral health visits by providers within the division of Pediatric Psychology at the University of Michigan Health (UM) during the pandemic through the present. UM is a publicly funded academic medical center that manages a total of approximately 2.5 million patient visits per year. Psychologists provide care within hospital-based specialty clinics or primary care clinics, both of which utilize integrated models of care. Unprecedented changes were made with regards to care delivery format and workforce allocation, and the present paper examines the corresponding impact on patient behavior health care. 
 Results: During Fiscal Year 22 (July 2021 to June 2022), 24 pediatric psychology providers completed a total of 8,252 visits within 12,802 available patient slots, a utilization rate of 64.5%. Utilization was significantly higher in primary care clinics (80.9%) than in hospital-based clinics (51.6%), Z = 34.47, p < .00001. Services were delivered virtually in 100% of the 4549 visits completed in primary care and 72.6% of the 3703 completed hospital visits. These data are currently being analyzed for the present Fiscal Year 23. Patient satisfaction data revealed barriers impacting access to care, including scheduling issues, setting up virtual care and managing, technology problems. 
 Conclusions: Utilization data provides strong support for delivery of behavioral health services in primary care via virtual care means. However, patients area likely to encounter significant barriers to initiating and participating in care when systems are designed to exclusively or primarily support remote users.