Quality of asynchronous webchats vs in-person consultations for postpartum depression in China: a cross-sectional, mixed methods study using standardized patients

Wenjie Gong; Lu Liu; Xiaoyu Li; Eric D Caine; Jingcheng Shi; Zhen Zeng; Kar Keung Cheng

doi:10.1016/j.lanwpc.2024.101053

Quality of asynchronous webchats vs in-person consultations for postpartum depression in China: a cross-sectional, mixed methods study using standardized patients

Lancet Reg Health West Pac. 2024 Mar 28:45:101053. doi: 10.1016/j.lanwpc.2024.101053. eCollection 2024 Apr.

Authors

Wenjie Gong^{1

2

3}, Lu Liu¹, Xiaoyu Li¹, Eric D Caine³, Jingcheng Shi⁴, Zhen Zeng¹, Kar Keung Cheng²

Affiliations

¹ HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha 410078, China.
² Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom.
³ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
⁴ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.

Abstract

Background: Prompt professional care for postpartum depression (PPD) is difficult to obtain in China. Though online consultations improve accessibility and reduce stigma, the quality of services compared to in-person consultations is unclear.

Methods: Five trained, undisclosed "standardized patients" (SPs) made "asynchronous webchats" visits and in-person visits with psychiatrists. Visits were made to 85 psychiatrists who were based in 69 hospitals in ten provincial capital cities. The care between online and in-person consultations with the same psychiatrist was compared, including diagnosis, guideline adherence, and patient-centeredness. False discovery rate (FDR) was used to adjust p values. Third visits using asynchronous webchats were made to psychiatrists who offered discrepant diagnoses. Thematic content analysis was used for the discrepancies.

Findings: The proportion of diagnostic accuracy was lower for online than in-person visits (76.5% [65/85] vs 91.8% [78/85]; p_FDR = 0.0066), as were the proportions of completing questions involving clinical history (16.6% vs 42.7%; p_FDR < 0.0001), and management decisions (16.2% vs 27.5%; p_FDR < 0.0001) consistent with recommended guidelines. Patient-centeredness was lower online than in-person (p_FDR < 0.0001). Fifteen of 16 psychiatrists completed third visits, most of them considered lack of nonverbal information online as a key barrier.

Interpretation: Online consultations using asynchronous webchats were inferior to in-person consultations, with respect to diagnostic accuracy, adherence to recommended clinical guidelines, and patient-centeredness. To fully realise the potential benefits of online consultations and to prevent safety issues, there is an urgent need for major improvement in the quality and oversight of these consultations.

Funding: China Medical Board, National Natural Science Foundation of China, and Swiss Agency for Development and Cooperation Global Cooperation Department.

Keywords: Comparative Study; Postpartum depression; Quality of Health Care; Standardized patients; Telemedicine.