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Chen S, Aldrich A, Andrews-Higgins S, Back-Haddix S, Bartkus M, Brown JL, Davis J, Drainoni ML, Goddard-Eckrich D, Goetz M, Gumudavelly D, Huerta TR, McAlearney AS, Roberts S, Walker DM. The Digital Divide and Tele-MOUD: A Qualitative Study of Opioid Community Coalition Perspectives During COVID-19. Telemed J E Health 2025. [PMID: 40323675 DOI: 10.1089/tmj.2024.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2025] Open
Abstract
Background: The rapid expansion of telehealth-delivered medication for opioid use disorder (MOUD) during the COVID-19 pandemic highlighted critical digital divide issues in communities. How community context influences the digital divide remains unclear, creating uncertainty about ameliorating the gaps in access to tele-MOUD. Methods: We qualitatively examined the perspectives of 315 opioid community coalition members who were part of the HEALing Communities Study (HCS) to understand how the digital divide created access barriers in urban and rural communities. Primary coding for all interviews used a deductive approach with codes derived from the Reach, Effectiveness, Adoption, Implementation, Maintenance/Practical Robust Implementation and Sustainability Model overarching HCS framework. Secondary coding used the nine determinants of Lythreatis's 2022 digital divide framework, and inductive thematic analysis was used to identify themes with each of the nine determinants. Results: Shared issues across communities related to the digital divide, including trust, social support, technological infrastructure, digital literacy, policy changes, and pandemic-related disruptions, critically influenced telehealth expansion and effectiveness. Rural communities reported specific barriers around infrastructure and socioeconomics, whereas urban communities reported specific barriers around sociodemographic factors. Conclusions: To address these digital divide issues, policymakers should continue to invest in rural infrastructure and improve internet access for underserved populations. Clear guidelines are also needed for when tele-MOUD is appropriate versus in-person visits and when urine drug screening is necessary. Additionally, emphasizing patient choice and maintaining in-person care is important to support equitable access to these services.
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Affiliation(s)
- Sadie Chen
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alison Aldrich
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shaquita Andrews-Higgins
- Substance Use Priority Research Area, Center for Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Sandra Back-Haddix
- Substance Use Priority Research Area, Center for Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Mary Bartkus
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jennifer L Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Jill Davis
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Dawn Goddard-Eckrich
- Social Intervention Group, School of Social Work, Columbia University, New York, New York, USA
| | - Michael Goetz
- Substance Use Priority Research Area, Center for Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA
| | - Divya Gumudavelly
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center & Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Timothy R Huerta
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sara Roberts
- Department of Population and Quantitative Health Sciences CTR Clinical Investigation, Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel M Walker
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Steidtmann D, McBride S, Mishkind M, Shore J. From Couch to Click: Opportunities and Challenges of Hybrid Work Models in Mental Health Care. Curr Psychiatry Rep 2025:10.1007/s11920-025-01607-7. [PMID: 40186706 DOI: 10.1007/s11920-025-01607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE OF REVIEW Hybrid work is common in mental health care following the COVID-19 pandemic. Although widespread, little is known about how to optimize it. We review relevant literature for patients, employees and mental health systems, and offer guidance on navigating tradeoffs in the application of hybrid work. RECENT FINDINGS Patients often prefer telehealth visits due to convenience, but in-person visits are sometimes clinically indicated or preferred. The mental health workforce appreciates reduced commutes and flexibility, though may risk increased isolation and work fatigue. Mental health systems may realize cost savings, although these may create challenges for accommodating patient in-person needs or employee preferences. Hybrid work in mental health care presents a promising path forward but requires thoughtful tradeoff management. It is unlikely that all benefits of hybrid work can be realized at once. Settings may benefit from identifying top priorities and designing hybrid work arrangements accordingly.
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Affiliation(s)
- Dana Steidtmann
- Helen & Arthur E. Johnson Depression Center, University of Colorado-Anschutz Medical Campus, 1890 N. Revere Ct. Suite 5240, Aurora, CO, 80045, USA.
- Brain and Behavior Innovations Center, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - S McBride
- Helen & Arthur E. Johnson Depression Center, University of Colorado-Anschutz Medical Campus, 1890 N. Revere Ct. Suite 5240, Aurora, CO, 80045, USA
| | - M Mishkind
- Helen & Arthur E. Johnson Depression Center, University of Colorado-Anschutz Medical Campus, 1890 N. Revere Ct. Suite 5240, Aurora, CO, 80045, USA
- Brain and Behavior Innovations Center, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - J Shore
- Brain and Behavior Innovations Center, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, 80045, USA
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Karim SA, Tilford JM, Bogulski CA, Hayes CJ, Eswaran H. Exploring telehealth adoption and financial outcomes for rural hospitals during the COVID-19 public health emergency. J Rural Health 2025; 41:e70038. [PMID: 40432258 DOI: 10.1111/jrh.70038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 01/31/2025] [Accepted: 05/03/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE To examine factors associated with rural hospital telehealth adoption during the COVID-19 public health emergency (PHE), and evaluate its relationship with rural hospital financial performance before and during the PHE. METHODS This panel study used retrospective data (2017-2021) from the American Hospital Association Annual Survey, the Centers for Medicare & Medicaid Services Healthcare Cost Report Information Systems, and the Area Health Resource File. Rural hospitals were categorized as persistent adopters, persistent nonadopters, or switchers based on telehealth adoption status. Bivariate analyses assessed differences in subgroup means and frequencies, while a difference-in-difference model estimated the impact of telehealth adoption on rural hospital financial performance. FINDINGS Telehealth adoption varied among rural hospitals. Before the PHE, 75% (751) of rural hospitals had adopted telehealth, while 25% (247) were nonadopters. Despite efforts to promote remote care delivery during the PHE, 58% (144) of pre-PHE nonadopters did not adopt telehealth. Among the 42% (103) that did adopt telehealth during the PHE, no statistically significant effect was observed on operating or total margins. CONCLUSION Rural hospitals in economically disadvantaged and sparsely populated areas, which stand to benefit the most from telehealth adoption, often face substantial barriers that limit their ability to adopt this technology. Financial constraints and limited resources continue to hinder adoption, underscoring the need for targeted policies and investments to expand telehealth access and improve health care outcomes in rural communities.
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Affiliation(s)
- Saleema A Karim
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - J Mick Tilford
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Hari Eswaran
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Uscher-Pines L, Sousa JL, Mehrotra A, Busch AB, Horgan CM, Huskamp HA. The role and reach of alcohol reduction apps. HEALTH AFFAIRS SCHOLAR 2025; 3:qxaf034. [PMID: 39990728 PMCID: PMC11845864 DOI: 10.1093/haschl/qxaf034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/05/2025] [Accepted: 02/12/2025] [Indexed: 02/25/2025]
Abstract
Although apps are widely available and have several advantages as a tool to support alcohol reduction and recovery, little is known about how individuals are using them. In 2024, we conducted an exploratory sequential mixed-methods study that coupled in-depth interviews with 22 app users and a nationally representative survey of 2002 adults. We explored experiences with and perceptions of alcohol reduction apps. Approximately 6% of US adults in the sample reported using alcohol reduction apps, and for most, it was the only support to address problematic drinking. In interviews, some users viewed apps as an alternative to traditional services and a way to independently address alcohol use; however, apps were seen as disconnected from care even by those who also used other supports. App users accessed a variety of features, with the most common being motivational content, tracking alcohol consumption, and educational content. Findings suggest that there are opportunities to not only introduce apps to individuals receiving healthcare services or participating in mutual support groups, but to reference and embed them in those settings. New approaches to regulation and reimbursement may support adoption as well as integration into healthcare services.
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Affiliation(s)
| | | | - Ateev Mehrotra
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02912, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
- Health Services Research Division, McLean Hospital, Belmont, MA 02478, United States
| | - Constance M Horgan
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, United States
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States
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Links AR, Perrin EM, Polk S, Konduru D, Meraj S, Showell NN, Grieb SM, Hughes H. Pediatric Primary Care Telemedicine: Perspectives from English- and Spanish-Speaking Medicaid Enrollees. TELEMEDICINE REPORTS 2024; 5:380-392. [PMID: 39759899 PMCID: PMC11693964 DOI: 10.1089/tmr.2024.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 01/07/2025]
Abstract
Objective To qualitatively explore Medicaid-enrolled parents' and young adult patients' perspectives and experiences with telemedicine in pediatric primary care. Methods We conducted semi-structured interviews with participants to explore their experiences with telemedicine. Participants consisted of English- and Spanish-speaking parents and young adults (18-21) who engaged in a telemedicine visit between March 15, 2021 and December 31, 2022 at two pediatric primary care clinics whose patients are predominantly insured by Medicaid. A qualitative descriptive design was used to develop a taxonomy. Frequencies were obtained to identify the most prevalent themes. Results Twenty-six participants (22 parents, 4 young adults) were interviewed. Twelve (46%) participants were English-speaking and 14 (53%) were Spanish-speaking. Four domains were identified, each further classified into themes: pre-visit expectations (option for in-person visit, general anticipation, and specific worries), visit experience (general sentiment, technology, and quality of care), comfort (with overall process, privacy, and communication), and feelings about telemedicine (advantages, disadvantages, and loss of telemedicine). Although many participants had negative expectations of telemedicine prior to their appointment, a majority indicated positive experiences with visits and concerns about a possible future where telemedicine visits at home were no longer covered by their health insurance. Discussion Most participants indicated positive experiences with telemedicine and perceived negative impact if access was removed. Findings related to perceived quality of care, advantages, and disadvantages suggest that patient preferences and individual circumstances should be taken into account when choosing visit modality in similar settings.
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Affiliation(s)
- Anne R. Links
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eliana M. Perrin
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins School of Public Health, Baltimore Maryland, USA
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Centro SOL-Center for Salud/Health and Opportunity for Latinxs, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Shafkat Meraj
- Johns Hopkins School of Public Health, Baltimore Maryland, USA
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Nakiya N. Showell
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Suzanne M. Grieb
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Helen Hughes
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Office of Telemedicine, Johns Hopkins University, Baltimore, Maryland, USA
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Worthen A, Torous J, Khan S, Hammes N, Rabinowitz T. Telepsychiatry Current Practice and Implications for Future Trends: A 2023 American Psychiatric Association Member Survey. Telemed J E Health 2024; 30:2662-2668. [PMID: 39133114 DOI: 10.1089/tmj.2024.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Introduction: Although telehealth was a viable means of delivering psychiatric care even before the COVID-19 public health emergency, flexibilities at the federal and state levels during the pandemic prompted mass adoption in a short timeframe. Little is known about how psychiatrists plan to offer care going forward and to what degree services will be offered virtually, in-person, or in a hybrid format. Methods: We conducted a survey of American Psychiatric Association (APA) members regarding telepsychiatry practice and potential barriers. Results: The survey was completed by 1,660 APA members. Most survey respondents (94%) conduct at least some telepsychiatry. Most respondents indicate operating in a hybrid environment in which they maintain a physical practice location, while 16% indicate that they do not have a physical practice and only see patients remotely. Across all setting types, 82% of respondents deliver telehealth via all or mostly video; 11% report conducting telehealth visits via mostly audio-only modalities; and 7% report equal usage of both modalities. Barriers to telepsychiatry noted by respondents include limited reimbursement, state medical licensure, federal and state regulations regarding controlled substance prescribing via telehealth, and technical challenges. Conclusion: Results of this survey of APA members show that the majority conduct at least some telepsychiatry; operate in a hybrid environment; and deliver telehealth via all or mostly video. Reported barriers to telepsychiatry practice include legal, regulatory, reimbursement, and technical issues. The future of telepsychiatry may largely be determined by which legal, regulatory, and reimbursement flexibilities are ended, extended temporarily, or made permanent.
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Affiliation(s)
- Abigail Worthen
- American Psychiatric Association, Washington, District of Columbia, USA
| | - John Torous
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shabana Khan
- New York University Langone Health, New York City, New York, USA
| | - Noah Hammes
- American Psychiatric Association, Washington, District of Columbia, USA
| | - Terry Rabinowitz
- Larner College of Medicine at the University of Vermont and University of Vermont Medical Center, Burlington, Vermont, USA
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Boyd J, Carter M, Baus A. Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth. J Prim Care Community Health 2024; 15:21501319241233198. [PMID: 38420885 PMCID: PMC10906046 DOI: 10.1177/21501319241233198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV). METHODS We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021. RESULTS We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth. CONCLUSIONS This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.
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Affiliation(s)
- Jennifer Boyd
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Martha Carter
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
| | - Adam Baus
- West Virginia Alliance for Creative Health Solutions, Inc., Culloden, WV, USA
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Bareis N, Tepper MC, Wang R, Tang F, Olfson M, Dixon LB, Kimhy D, Wall MM, Medalia A, Finnerty MT, Anderson A, Smith TE. Engagement of individuals with serious mental illness in outpatient mental health services and telehealth use during the COVID-19 pandemic. Psychiatry Res 2023; 329:115497. [PMID: 37778232 PMCID: PMC10842636 DOI: 10.1016/j.psychres.2023.115497] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Questions remain regarding whether the transition and continued use of telehealth was associated with changes in treatment engagement among patients with serious mental illness (SMI). Using NYS Medicaid claims, we identified 116,497 individuals with SMI receiving outpatient mental health services from September 1, 2019-February 28, 2021 and a comparison cohort of 101,995 from September 1, 2017-February 28, 2019 to account for unmeasured and seasonal variation. We characterized engagement in three 6-month increments (T0-T1-T2) using clinically meaningful measures of high, partial, low, and none. Subgroup differences were compared, and telehealth users were compared to those with only in-person visits. Engagement, as characterized, was largely maintained during COVID. The 19.0 % with only in-person visits during COVID had different characteristics than telehealth users. Telehealth use was greater among younger people by T2 (33.1 %), women (57.7 %), non-Hispanic White people (38.9 %), and those with MDD (18.0 %), but lower among non-Hispanic Black people, in NYC, and those with schizophrenia or SUD. Most telehealth users were highly engaged (77.1 %); most using only in-person services had low engagement (47.5 %). The shift to telehealth preserved access to many outpatient services for this SMI population. Exploring reasons for not using telehealth may identify opportunities to increase care access.
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA.
| | - Miriam C Tepper
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | - Rui Wang
- New York State Office of Mental Health, New York, USA
| | - Fei Tang
- New York State Office of Mental Health, New York, USA
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Melanie M Wall
- Mailman School of Public Health, Columbia University, New York, USA
| | - Alice Medalia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | | | | | - Thomas E Smith
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA; New York State Office of Mental Health, New York, USA
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