Who is More Likely to Attend Psychiatry Visits by Audio-Only versus Video or in-Person? A Comparison of Community Health Center Patients from 2020 to 2023

Objective: To examine which patients have relied most heavily on audio-only versus video or in-person visits to attend psychiatric care since the COVID-19 pandemic at Federally Qualified Health Centers (FQHCs). Methods: This observational study reviewed electronic health record data from all patients who attended psychiatric care at a large FQHC from January 2020 to December 2023. Patient sociodemographic characteristics (age, sex, race/ethnicity, preferred language) were extracted from the electronic health record, as was psychiatry visit information. Patients were categorized according to whether a majority of their psychiatry visits during the assessment period were attended by audio-only, video, or in-person. Results: Among the 9,569 patients who received psychiatric care during the assessment period, 48% (n = 4,563) attended most of their psychiatry visits by audio-only compared with 37% (n = 3,534) who attended most visits by video and 15% (n = 1,472) who attended most visits in-person. Relative risk (log-binomial) regression analyses identified patient age, sex, and language as consistent correlates of audio-only psychiatry visits. For example, patients who preferred to receive their care in Spanish were 12% (95% confidence interval: 0%, 25%) more likely to attend most psychiatry visits by audio-only versus video compared with those who preferred English. The effect of patient race/ethnicity on audio-only psychiatry visits was more variable and less precise. Conclusion: This study demonstrates that audio-only modalities are the most popular means for attending psychiatric care among FQHC patients and reaffirms the importance of audio-only modalities for attending psychiatric care among underserved populations.