Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic

BMC Psychiatry

Research

Jamie Robertson¹  Karen Foley²  Keyvan Karkouti³  Karim S Ladha⁴  Alon Vaisman⁵  David Koczerginski⁶  Zafiris J Daskalakis⁷  Sagar V Parikh⁸  Alastair J Flint⁹  Daniel M Blumberger^1,10  Arpana Balachandar^1,11  Vanessa K Tassone^1,11  Sarah Dunnett^1,11  Sophie Li^1,11  Ilya Demchenko^1,12  Venkat Bhat^1,13  Sidney H Kennedy^1,13  Melanie Anderson^1,14 

[1] Centre for Clinical Ethics, St. Michael’s Hospital, Toronto, ON, Canada;Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada;Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada;Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada;Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada;Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada;Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada;Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada;Department of Anesthesia, St. Michael’s Hospital, Toronto, ON, Canada;Department of Infection Prevention and Control, University Health Network, Toronto, ON, Canada;Department of Psychiatry, North York General Hospital, Toronto, ON, Canada;Department of Psychiatry, University of California San Diego, San Diego, CA, United States;Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States;Institute of Medical Science, University of Toronto, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;Centre for Mental Health, University Health Network, Toronto, ON, Canada;Institute of Medical Science, University of Toronto, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada;Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Toronto, ON, Canada;Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Toronto, ON, Canada;Institute of Medical Science, University of Toronto, Toronto, ON, Canada;Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael’s Hospital, Toronto, ON, Canada;Institute of Medical Science, University of Toronto, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;Library and Information Services, University Health Network, Toronto, ON, Canada;

关键词: Electroconvulsive therapy;    Mental health services;    Health services research;    Healthcare utilization;    Health disparities;    Ethics;    Disadvantaged populations;    Access to care;    COVID-19;    Pandemics;   

DOI  :  10.1186/s12888-023-04832-7

 received in 2022-10-24, accepted in 2023-04-30,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundElectroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020).MethodsA multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada).ResultsClinical operations of ECT programs were disrupted across all four regions – however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases.ConclusionsThe results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians’ activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.

【 授权许可】

CC BY   
© The Author(s) 2023

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