Equitable psychiatry, telehealth, and the COVID-19 pandemic: Analysis of national data.

Publisher: Frontiers Editorial Office Country of Publication: Switzerland NLM ID: 101616579 Publication Model: eCollection Cited Medium: Internet ISSN: 2296-2565 (Electronic) Linking ISSN: 22962565 NLM ISO Abbreviation: Front Public Health Subsets: MEDLINE

Original Publication: Lausanne : Frontiers Editorial Office

Psychiatry*/statistics & numerical data ; Telemedicine*/organization & administration ; Telemedicine*/statistics & numerical data ; COVID-19*/epidemiology ; COVID-19*/psychology ; Data Analysis* ; Pandemics*; Humans ; Australia/epidemiology ; Remote Consultation/statistics & numerical data ; Healthcare Disparities/statistics & numerical data ; Mental Health/standards ; Mental Health/statistics & numerical data ; Young Adult ; Adult ; Middle Aged ; Office Visits/statistics & numerical data ; Rural Health/statistics & numerical data ; Urban Health/statistics & numerical data ; Videoconferencing/statistics & numerical data

Background: At the beginning of the COVID-19 pandemic, it was foreseen that the number of face-to-face psychiatry consultations would suffer a reduction. In order to compensate, the Australian Government introduced new Medicare-subsidized telephone and video-linked consultations. This study investigates how these developments affected the pre-existing inequity of psychiatry service delivery in Australia.
Methods: The study analyses five and a half years of national Medicare data listing all subsidized psychiatry consultation consumption aggregated to areas defined as Statistical Area level 3 (SA3s; which have population sizes of 30 k-300 k). Face-to-face, video-linked and telephone consultations are considered separately. The analysis consists of presenting rates of consumption, concentration graphs, and concentration indices to quantify inequity, using Socio Economic Indexes for Areas (SEIFA) scores to rank the SA3 areas according to socio-economic disadvantage.
Results: There is a 22% drop in the rate of face-to-face psychiatry consultation consumption across Australia in the final study period compared with the last study period predating the COVID-19 pandemic. However, the loss is made up by the introduction of the new subsidized telephone and video-linked consultations. Referring to the same time periods, there is a reduction in the inequity of the distribution of face-to-face consultations, where the concentration index reduces from 0.166 to 0.129. The new subsidized video-linked consultations are distributed with severe inequity in the great majority of subpopulations studied. Australia-wide, video-linked consultations are also distributed with gross inequity, with a concentration index of 0.356 in the final study period. The effect of this upon overall inequity was to cancel out the reduction of inequity resulting from the reduction of face-to face appointments.
Conclusion: Australian subsidized video-linked psychiatry consultations have been distributed with gross inequity and have been a significant exacerbator of the overall inequity of psychiatric service provision. Future policy decisions wishing to reduce this inequity should take care to reduce the risk posed by expanding telepsychiatry.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2023 Yeatman, Enticott, Lakra and Meadows.)

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Keywords: COVID-19; concentration index; equity; psychiatry; telehealth; telepsychiatry; video consultations

Date Created: 20230320 Date Completed: 20230324 Latest Revision: 20230327

20240628

PMC10014820

10.3389/fpubh.2023.1014302

36935672