Scientific Abstract

Background: Little is known about psychiatric MBC uptake after the onset of the COVID-19 pandemic, or clinic- or patient-level factors that may drive uptake. 

Methods: MBC was implemented at three pilot sites in an adult outpatient psychiatry department in 2021 using an MBC symptom tool (Computerized Adaptive Test for Mental Health; CAT-MH) that patients filled out online via phone, computer, or tablet. In the first 6 months of roll-out, electronic health record (HER) data was used to compare site-level CAT MH completion rates for. MBC implementation experience for providers were captured via repeated surveys (Site 1 only). Clinic differences in treatment focus and patient demographics were analyzed as possible drivers of uptake of MBC. 

Results: Patients completing at least one CAT-MH differed significantly by Site: Site 1, 35% (n=267 of 756 patients who had orders placed); Site 2, 25% (n=70 of 284); and Site 3, 16% (n=44 of 277). While clinic Site 1 was a general outpatient psychiatry clinic, Site 2 was primarily treating patients with substance use disorders, and Site 3 primarily served patients transitioning from hospital to outpatient care. Increased age and non-English language of care were significantly associated with lower completion rates (p<0.001). At Site 1, provider ratings of CAT-MH feasibility and utility remained steady or declined (first three months) and the two most frequently endorsed barriers by providers to engaging patients around CAT-MH were finding (1) time within the visit, as well as (2) bandwidth to accommodate something new in their workflow. 

Conclusions: Patient uptake of a self-report electronic, broad-focused MBC tool may be easier to facilitate in general psychiatry clinics than in specialty clinics (i.e., those focused on addictions or transition-related care). In general, psychiatric settings, system-level implementation strategies may be necessary to address time available to engage with patients regarding MBC, as well as more flexible workflows. Further investments may be needed to encourage uptake for some patient subgroups, such as those who are older or who generally access care in a language other than English.