(110) Psychotropic Medication Use After The COVID-19 Pandemic Transition to Telepsychiatry Services Among the Privately Insured in the United States

Publication Number: 1155

Background: The COVID-19 pandemic forced a rapid transition to telepsychiatry. Little is known how this affected psychotropic medication use.

Objectives: To determine how the transition to telepsychiatry in 2020 affected psychotropic use.

Methods: A retrospective cohort was derived from the 2019-2020 IQVIATM Pharmetrics Plus for Academics data. The cohort is US enrollees 2-64 years old with any mental health care in 2019 or 2020, continuously enrolled in both years, and no telepsychiatry use in 2019. We classified psychotropic medications into therapeutic classes using the American Hospital Formulary System. The dependent variables were binary indicators (1/0) for psychotropic use, overall and for each therapeutic class (i.e., stimulants, antidepressants, antipsychotics, mood stabilizers) in 2020. Telepsychiatry use in 2020, defined by the number of visits (i.e., 0, 1, 2-3, 4-9, ≥10), was the independent variable. Current Procedure Terminology and Healthcare Common Procedure Coding System codes identified telepsychiatry. We used multivariate logistic regression to estimate the odds ratio (OR) with a 95% confidence interval (CI) for psychotropic use among those who used telepsychiatry services relative to those who did not, adjusting for baseline mental health services, psychiatric diagnoses, age, gender, and type of health insurance coverage.

Results: The cohort included 47,233 enrollees, with 17% being 2-17 years old and 59% female. In 2020, 62% used any psychotropic medication, 46% of which used antidepressants. Among those with mental health care in 2020, 55% transitioned to telepsychiatry. In 2020, relative to in-person care, those with telepsychiatry care were more likely to use psychotropic medication (1 visit OR 2.0, CI 1.8, 2.1; 2-3 visits OR: 1.7, CI 1.8, 2.1, and 4-9 visits OR 1.1, CI 1.0, 1.2). Those with >10 telepsychiatry visits had a lower odds of psychotropic use than those who received in-person care (OR 0.9, CI 0.8, 0.9). These results were robust in the subgroup analysis by age (i.e., 2-17 years and 18 to 64 years).

Conclusions: Individuals with fewer telepsychiatry visits in 2020 were more likely to use psychotropic medication. The inverse relationship warrants further investigation to explore confounding by severity in the association between telepsychiatry services and psychotropic medication use.