Telehealth Implementation, Treatment Attendance, and Socioeconomic Disparities in Treatment Utilization in a Community Mental Health Setting During the COVID-19 Pandemic: A Retrospective Analysis of Electronic Health Record Data.

Telemedicine reports Pub Date : 2023-05-04 eCollection Date: 2023-01-01 DOI:10.1089/tmr.2022.0005
Jonathan Kris
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Abstract

Background: Previous studies have found that the widespread implementation of telehealth for outpatient mental health treatment during the COVID-19 pandemic has been associated with reduced no-show rates and increases in total number of appointments. However, it is unclear to what degree this is due to increased accessibility provided by telehealth, rather than to increased consumer demand for services fueled by the pandemic-related exacerbation of mental health needs. To shed light on this question, the present analysis examined changes in attendance rates for outpatient, home-, and school-based programs at a community mental health center in southeastern Michigan. Disparities in treatment utilization associated with socioeconomic status were also examined.

Methods: Two-proportion z-tests were conducted to examine changes in attendance rates, and Pearson correlations were calculated using the median income level and attendance rate by zip code to examine disparities in utilization associated with socioeconomic status.

Results: The proportion of appointments kept after telehealth implementation was statistically significantly higher for all outpatient programs, but not for any home-based programs. Specifically, absolute increases in the proportion of appointments kept ranged from 0.05 to 0.18 for outpatient programs, representing relative increases of 9.2% to 30.2%. Furthermore, before telehealth implementation, there was a strong positive correlation between income and attendance rate for all outpatient programs (ranging from r = 0.50 to 0.56). After telehealth implementation, there were no longer any significant correlations.

Discussion: Results highlight the utility of telehealth in increasing treatment attendance and mitigating disparities in treatment utilization associated with socioeconomic status. These findings are highly relevant to ongoing discussions surrounding the long-term fate of evolving insurance and regulatory guidelines pertaining to telehealth.

COVID-19 大流行期间社区精神卫生机构的远程医疗实施、治疗出席率和治疗利用率的社会经济差异:电子健康记录数据的回顾性分析》。
背景:先前的研究发现,在 COVID-19 大流行期间,远程医疗在门诊心理健康治疗中的广泛应用与未到诊率的降低和预约总数的增加有关。然而,目前还不清楚这在多大程度上是由于远程医疗提供了更多的可及性,而不是由于与大流行相关的心理健康需求加剧导致消费者对服务的需求增加。为了弄清这个问题,本分析研究了密歇根州东南部一家社区心理健康中心的门诊、家庭和学校项目就诊率的变化情况。此外,还研究了与社会经济地位相关的治疗利用率差异:方法:采用两比例 Z 检验法来检验就诊率的变化,并使用按邮政编码划分的收入水平中位数和就诊率来计算皮尔逊相关性,以检验与社会经济地位相关的治疗利用率差异:结果:实施远程医疗后,所有门诊项目的预约就诊率在统计学上都有显著提高,但所有居家项目的预约就诊率都没有显著提高。具体而言,门诊项目预约保留比例的绝对增幅在 0.05 到 0.18 之间,相对增幅在 9.2% 到 30.2% 之间。此外,在实施远程保健之前,所有门诊项目的收入与就诊率之间都存在很强的正相关性(r = 0.50 至 0.56)。实施远程保健后,两者之间不再存在任何显著的相关性:讨论:研究结果凸显了远程医疗在提高治疗就诊率和减少与社会经济地位相关的治疗利用率差异方面的作用。这些研究结果与目前围绕不断演变的远程医疗保险和监管准则的长期命运所展开的讨论高度相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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