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Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic

Ricklan, Sarah J; Sohler, Nancy; Ezie, C E Chiemeka; Avalone, Lynsey; Dinsell, Victoria; Lewis, Crystal; Fattal, Omar; Balan, Sabish; McQuistion, Hunter; Pastore, Frank; Sarcevic, Nermica; Swift, Ronnie; Espejo, Gemma; Lorenz, Carina
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
PMID: 38105337
ISSN: 1573-2789
CID: 5612592

Increased Attendance During Rapid Implementation of Telehealth for Substance Use Disorders During COVID-19 at the Largest Public Hospital System in the United States

Avalone, Lynsey; King, Carla; Popeo, Dennis; Perkel, Charles; Abara, Chidinma J; Linn-Walton, Rebecca; Gasca, Vladimir; Vitagliano, Laurie; Barron, Charles; Fattal, Omar
OBJECTIVE/UNASSIGNED:The objective of this study is to examine differences between; telehealth and in-person visits during COVID-19 and in a pre-COVID-19 reference period; COVID-19 televisit completion for patients with varying engagement in treatment during the reference period. METHODS/UNASSIGNED:-tests to compare patient demographics. Generalized estimating equations for estimating the odds of outcomes were used, controlling for demographics. RESULTS/UNASSIGNED: = 15,497) to COVID-19. For patients on buprenorphine, patients with no prior in-person visits during the pre-televisit period were 2.26 more likely to complete televisits compared with patients with two or more prior in-person visits. For all patients, those with two or more prior in-person visits in the reference period were 1.27 times more likely to complete a televisit compared with a patient with no in-person visits during the pre-televisit period. There was no significant difference when comparing with patients who had only one prior in-person visit to those patients with no prior visits. CONCLUSIONS/UNASSIGNED:In this study, outpatient substance use disorder (SUD) telehealth appointments were associated with higher odds of visit completion compared with in-person visits during and prior to COVID-19. Patients receiving buprenorphine, without prior in person visits, were more likely to attend if they did not have in-person visits prior to COVID-19. Regulators should consider permanently adopting telehealth flexibilities for SUD treatment once the federal emergency status has ended.
PMID: 35611875
ISSN: 1532-2491
CID: 5283352

Rapid Telepsychiatry Implementation During COVID-19: Increased Attendance at the Largest Health System in the United States

Avalone, Lynsey; Barron, Charles; King, Carla; Linn-Walton, Rebecca; Lau, Jen; McQuistion, Hunter L; Popiel, Maryann; Balasubramaniam, Meera; Freeman, Richard; Fattal, Omar
OBJECTIVE/UNASSIGNED:This study aimed to examine differences in completion rates between telepsychiatry and in-person visits during the COVID-19 pandemic and a prior reference period. METHODS/UNASSIGNED:The authors used electronic medical record data along with chi-squared or t tests to compare patients' demographic characteristics. Generalized estimating equations for estimating the odds of primary and secondary outcomes were used, controlling for demographic characteristics. RESULTS/UNASSIGNED:During COVID-19, the odds of completing a telepsychiatry visit (N=26,715) were 6.68 times the odds of completing an in-person visit (N=11,094). The odds of completing a telepsychiatry visit during COVID-19 were 3.00 times the odds of completing an in-person visit during the pre-COVID-19 reference period (N=40,318). CONCLUSIONS/UNASSIGNED:In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.
PMID: 33730881
ISSN: 1557-9700
CID: 4817872

Combat Stress Management and Resilience: Adapting Department of Defense Combat Lessons Learned to Civilian Healthcare during the COVID-19 Pandemic

Wei, Eric K; Segall, Jeremy; Linn-Walton, Rebecca; Eros-Sarnyai, Monika; Fattal, Omar; Toukolehto, Olli; Barron, Charles; Burke, Alison; Benedek, David M; West, James C; Fisher, Michael; Shmerler, David; Cho, Hyung J
PMID: 32706595
ISSN: 2326-5108
CID: 4534272

Overcoming barriers to larger-scale adoption of telepsychiatry

Mahmoud, H; Vogt, EL; Sers, M; Fattal, O; Ballout, S
Despite the staggering physical, economic, and societal costs of mental health conditions in the United States, there continues to be a significant gap in mental health service, as access lags behind the demand for them. The uneven distribution of mental health service providers contributes to this gap, making it necessary to incorporate novel approaches to the delivery of mental health services. Telepsychiatry has proven to be one of the more innovative approaches for improving access to mental health services. This article focuses on six challenges that have historically impeded larger-scale adoption of telepsychiatry: limited training, limitations of existing research, security and technology issues, clinical practice challenges, licensure, and reimbursement restrictions. The article discusses recent developments, ongoing advances, and future directions to overcoming these barriers
SCOPUS:85062421075
ISSN: 0048-5713
CID: 3785632

A Brief Overview of Advances in LGBT Mental Health Advocacy in Lebanon

Fattal, Omar; Mahmoud, Hossam; Bazzi, Lama
PMID: 29975341
ISSN: 1465-7309
CID: 3185852

A qualitative analysis of multi-level barriers to HIV testing among women in Lebanon

Clark, Kirsty A; Keene, Danya E; Pachankis, John E; Fattal, Omar; Rizk, Nesrine; Khoshnood, Kaveh
While the number of HIV cases in the Middle East and North Africa region is low compared to other regions, recent studies show that incidence is increasing especially among high-risk populations; in particular, little is known about women and HIV in the region. Through semi-structured interviews with sexual healthcare providers and staff at non-governmental organisations, we sought to understand barriers to HIV testing among women in Lebanon. Using snowball sampling, key informants were recruited from greater Beirut (12 physicians, 9 non-governmental organisation staff). Data were analysed using a grounded theory framework. Findings identified barriers to HIV testing among women at each level of an adapted social-ecological model (i.e. social-cultural barriers, policy barriers, interpersonal healthcare provider barriers and intrapersonal barriers). Primary findings include the culture of sex as taboo; lack of sexual health education among women; fear of disclosing HIV testing and diagnosis; financial barriers linked to stigmatising insurance policies; and provider attitudes towards women. Findings can be used to inform HIV-related sexual health interventions at multiple levels for women in Lebanon and the greater region.
PMID: 28276925
ISSN: 1464-5351
CID: 2681102

Factors Associated With Outpatient Visit Attendance After Discharge From Inpatient Psychiatric Units in a New York City Hospital

Humensky, Jennifer L; Fattal, Omar; Feit, Rachel; Mills, Sarah D; Lewis-Fernandez, Roberto
OBJECTIVE: A class action lawsuit in New York (Koskinas v. Cuomo) established the right of psychiatric inpatients to receive discharge planning, including arranging outpatient treatment. The attendance rate of the initial outpatient appointment after discharge from inpatient treatment in one city hospital was examined to determine whether rates varied by inpatient unit type. METHODS: The authors performed retrospective chart review of 1,884 discharges to outpatient care. Multivariate regression models were used to examine the odds of attending the initial appointment. RESULTS: Eighty-four percent of patients attended the initial appointment. Higher odds of attendance were associated with case management, living in a shelter or being homeless, general medical comorbidity, and inpatient treatment in a co-occurring disorders unit. Lower odds were associated with being non-Latino black. Inpatient treatment in a Latino unit had no significant effect. CONCLUSIONS: Hospital characteristics, patient population, and availability of local outpatient services may influence continuity of care.
PMCID:5481167
PMID: 28196463
ISSN: 1557-9700
CID: 2449152

Persecution Experiences and Mental Health of LGBT Asylum Seekers

Hopkinson, Rebecca A; Keatley, Eva; Glaeser, Elizabeth; Erickson-Schroth, Laura; Fattal, Omar; Nicholson Sullivan, Melba
INTRODUCTION: Asylum seekers are a unique population, particularly those who have endured persecution for their sexual orientation or gender identity. Little data exist about the specific experiences and needs of asylum seekers persecuted due to lesbian, gay, bisexual or transgender (LGBT) identity. METHODS: Quantitative data were gathered regarding demographics, persecution histories, and mental health of 61 clients from a torture survivors program in New York City who reported persecution due to LGBT identity. Thirty-five clients persecuted due to their LGBT identity were matched by country of origin and sex with clients persecuted for other reasons in order to explore how persecution and symptoms may differ for LGBT clients. RESULTS: LGBT asylum seekers have a higher incidence of sexual violence, persecution occurring during childhood, persecution by family members, and suicidal ideation. CONCLUSIONS: Understanding the type of persecution experiences and how these influence mental health outcomes is an essential step towards designing and delivering effective treatments.
PMID: 27831853
ISSN: 1540-3602
CID: 2304482

Lebanese Medical Association for Sexual Health: Advancing Lesbian, Gay, Bisexual, and Transgender Health in Lebanon

Abdessamad, Hasan M; Fattal, Omar
Lebanon is considered relatively liberal, but Lebanese lesbian, gay, bisexual, and transgender (LGBT) individuals continue to face social and legal challenges. Homophobia is common among health-care providers. Only 50% of physicians in a study were willing to "tend the medical needs" of homosexuals. Homosexuality is still perceived as a disease and the practice of reparative therapy is common. Programs focusing on sexual health are scarce, with only a few being LGBT-friendly. For Lebanese LGBT individuals, there remains a significant gap in access to health care. The Lebanese Medical Association for Sexual Health (LebMASH) was established to address this gap.
PMID: 26789616
ISSN: 2325-8306
CID: 1921532