Impact of Remote Appointments on the Outcomes of Community Mental Health Nurses in Primary Care Since the Covid Pandemic: A Retrospective Observational Cohort Study.
Mark Kenwright, Paula Fairclough, Charlotte Graham
PMID 40275605WHAT IT FOUND
Telephone-only mental health nursing appointments were linked to higher dropout and lower improvement.
Video or blended formats were linked to lower dropout, and blended delivery was linked to improvement, so reserve phone for brief support or monitoring.
Key findings
01Telephone-only appointments had the highest dropout rate (69 of 148; 47%) and were significantly less likely to show reliable improvement (OR 0.52; 95% CI 0.26 to 0.87).
02Blended face-to-face and remote appointments were positively associated with reliable improvement (OR 1.87; 95% CI 1.00 to 2.67), and web-camera-only appointments had the lowest dropout rate (53 of 299; 17%).
03Mean change scores on depression and anxiety measures were medium to large before and after the pandemic (0.5 to 0.9) and lower during restrictions (0.1 to 0.6).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective observational study, not a randomised trial, so appointment format was not assigned and may be confounded by patient severity, referral source, or digital access. The final analysis excluded 176 patients with incomplete outcome data, so the reported effect sizes need caution. Referral mix and severity changed over time, so comparisons across periods are difficult. The outcome measures were PHQ-9, GAD-7 and WASA, which do not capture emotional dysregulation or chaotic lifestyle indicators in complex problems. The study came from one primary care mental health service with 10 nurses, so it may not generalise to other settings.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not conclude that telephone appointments caused poorer outcomes. This was a retrospective observational study without random allocation, and telephone use may have clustered with patients who lacked web-camera devices, internet access, or IT skills. The analysis also excluded 176 patients with incomplete outcome data, so the reported effect sizes need caution.