Association Between Telehealth Delivery and Same-day Access to Integrated Mental Health in a National VA Sample.

Abstract

Background: Same-day access to mental health services is associated with better patient outcomes (e.g., diagnosis, treatment). Telehealth appointments via video or phone can improve timely access to care but may complicate in-person care transfers ("warm handoffs") between primary care and mental health teams.

Objective: To examine associations between receiving telehealth services and same-day access to integrated mental health services within primary care (PCMHI).

Design, setting, and participants: This retrospective cohort study included 1,220,902 Veterans who newly initiated PCMHI services between 10/01/18 and 09/30/23.

Main measure(s): Our primary outcome of interest was whether "same-day access" occurred, defined as a PCMHI visit that took place on the same day as a primary care visit. Our exposure of interest was whether a patient's initial PCMHI visit took place through in-person versus telehealth, defined as either video or phone. Using multi-level regression models, we examined the association between same-day access and PCMHI visit modality (in-person/phone/video), adjusting for time, region, patient (e.g., demographics, physical and mental health diagnoses), and clinic (e.g., rurality, staffing). Models were stratified by pre-/early-pandemic (FY19-21) versus late-pandemic (FY22-23) periods.

Results: Patients with an initial PCMHI visit conducted through telehealth (video/phone) had 86% lower odds of receiving same-day access than those with an in-person PCMHI visit (95% CI = 0.1444-0.1448). Lower odds of same-day access with PCMHI providers were found for both video (OR = 0.0912; 95% CI = 0.0909-0.0915) and phone (OR = 0.1604, 95% CI = 0.1602-0.1606) visits. Odds of same-day access from primary care to telehealth-based PCMHI care improved with time (OR_FY19-21 = 0.10, 95% CI = 0.09-0.12; OR_FY22-23 = 0.18, 95% CI = 0.16-0.20).

Conclusions and relevance: Results suggest that primary care patients who receive integrated mental health services via telehealth may be less likely to access primary care services on the same day. Further research should consider how traditional primary care workflows (e.g., warm handoffs) may need to adapt to better integrate tele-mental health services.