Loss to follow-up of ambulatory patients in the transition to telemedicine in the COVID-19 pandemic at a reference center for mental health in Lima, Peru

Abstract

AbstractProblem StatementDuring the COVID-19 pandemic, health care services were limited by the restrictive measures implemented. As an adaptation mechanism, telemedicine was introduced for ambulatory care at the Honorio Delgado Hideyo Noguchi National Institute of Mental Health (NIMH). This study aimed to estimate the survival function (SF) for loss to follow-up (LTFU) over two years before and after the onset of the COVID-19 pandemic, and its association with clinical and sociodemographic variables.Study DesignA single-cohort study was conducted, following a random sample of adult ambulatory patients at NIHM from April 15, 2018, to April 15, 2022. Patients were followed until LTFU, referral to another institution, death, or the end of study. The main analysis involved estimating the SF for LTFU for the overall follow up period, as well as separately for the periods pre and post implementation of telemedicine. Also, risk factors hypotheses were tested using Cox’s regression.ResultsData from 4887 visits of 356 patients were collected. A total of 118 (33.1%) presented LTFU, with SF of 53.9% during the overall four years of follow-up. After two years of follow-, those starting treatment at NIMH before the implementation of telemedicine had a higher SF (77.3 vs 63%). A higher hazard ratio (HR) for LTFU was found in the group that started care at NIMH after the implementation of telemedicine, compared to those who started previously (HR=2.53; 95% CI: 1.55-4.51). Additionally, receiving care in the anxiety disorders (HR=1.86; 95% CI: 1.03-3.33) and personality disorders programs (HR=1.81; 95% CI: 1.02-3.22) was associated with a higher risk of LTFU compared to the psychosis program. No significant difference was found in the risk of LTFU between telemedicine vs. face-to face attention.ConclusionsA significant association was found between LTFU and starting treatment at NIMH after the onset of the COVID-19 pandemic and implementation of telemedicine. However, no evidence supports that this might be due to the practice of telemedicine. A different clinical profile of patients that started treatment at NIMH following the government implementation of changes to the public health system might explain these findings and should be studied.Significant Outcomes-A moderate association was found between starting treatment at NIMH and loss to follow up in the period after the implementation of telemedicine due to the onset of COVID-19.-This, however, does not seem to be related to the practice of telemedicine, but to changes in the characteristics of patients across pre and post COVID 19.Limitations-The reason for loss to follow up (death, return to a lower-level health service, improvement of symptoms, etc.), our main outcome variable, could not be determined using the clinical and administrative data available.