The COVID-19 pandemic provoked a swift adoption of telemedicine in primary care settings. Amid this transition, the extent to which depression screening occurred during telehealth encounters remained poorly understood. To address this gap, researchers at the University of California, San Francisco (UCSF), conducted a meticulous study, the findings of which were published in JAMA Network Open. This study aimed to investigate depression screening probabilities across various visit types and patient demographics during the initial stages of the pandemic. Drawing from electronic health record (EHR) data, the researchers focused on adult depression screening in six UCSF primary care practices spanning from June 2020 to September 2021.
The study used an in-depth approach to define and assess depression screening. Depression screening was operationally defined as the completion of the Patient Health Questionnaire 2 (PHQ-2) during eligible visits, a validated tool commonly used in primary care settings. To ensure accuracy and consistency, visits were categorized into three modalities: in-person, video, or telephone encounters, based on billing information extracted from the electronic health records (EHR). This categorization allowed for a nuanced examination of depression screening rates across different modes of healthcare delivery. Leveraging the vast repository of EHR data, the study had an extensive sample size, comprising 57,301 eligible visits and 37,250 unique patients. This large dataset provided a strong foundation for a detailed analysis of depression screening rates across diverse visit types and patient demographics.
Upon scrutinizing the study’s findings, disparities in depression screening rates between various visit types emerged. Notably, patients undergoing video and telephone visits exhibited markedly lower odds of depression screening compared to those in in-person encounters. Adjusted odds ratios of 0.28 and 0.24 were observed for video and telephone visits, respectively, outlining the challenges inherent in integrating depression screening into telehealth amidst the demand imposed by the pandemic’s onset. The abrupt transition to telemedicine, coupled with the urgent need to adapt to remote care delivery, may have contributed to disparities in depression screening rates across different visit modalities.
The study unveiled disparities in depression screening rates based on patient demographics, shedding light on potential barriers to equitable access to mental healthcare. Patients preferring Chinese, Spanish, or other non-English languages, as well as older adults above 75 years and Medicaid beneficiaries, experienced diminished odds of screening. This outlines the importance of considering linguistic and socioeconomic factors when designing and implementing depression screening protocols within telehealth settings. Addressing these disparities is necessary to ensure equitable access to mental healthcare for all patient populations, particularly with the evolving nature of telemedicine.
Looking closer into the study’s implications, the authors emphasized the need for a recalibration of telemedicine practices to ensure equitable access to depression screening. They advocated for the seamless incorporation of screening into telehealth visits, outlining the importance of innovative solutions that alleviate burdens on support staff, such as pre-visit distribution of PHQ-9s through patient portals. Proactive measures are necessary to mitigate the resurgence of disparities along racial, ethnic, linguistic, and age lines, which persisted even in the telemedicine landscape. The study’s findings show the urgent need for healthcare professionals to increase efforts in integrating depression screening into telehealth visits, particularly as telemedicine continues to grow post-pandemic.
