Data shows that despite declining visitation rates at federally licensed health centers, patients with diagnoses of psychological disorders during COVID-19 fared well when telemedicine was available.
The availability of telehealth at federally licensed health centers was associated with better care engagement for Medicaid enrollees who had a mental health diagnosis during the COVID-19 pandemic, despite declining rates of overall visits to health centres, according to the results of a study published on Open JAMA Network.
Investigators included people ages 18 to 64 who were enrolled in Medicaid and had basic mental health diagnoses, including anxiety, bipolar disorder and depression. All individuals belonged to the Community Care Cooperative of Massachusetts, which is the largest Medicaid care organization based in a US federally licensed health center.
People also had 1 or more visits in the past 18 months from each month, including 1 or more before the telehealth expansion.
Primary data was collected between 2019 and 2021 Community Care Cooperative Electronic Data Warehouse, including 11 federally qualified health centers, with 5 excluded, due to invalid telehealth data.
Study results included visit rates among people with a mental health diagnosis of one of the 4 most common mental health conditions and having a follow-up visit within 30 days of a related emergency department visit to mental health. Investigators included federally licensed health centers with high telehealth availability during the COVID-19 pandemic, as well as a comparison group with low telehealth availability.
Models were adjusted for age, months of study applied, clinical risk score, federally licensed health center fixed effects, gender, and code-level numeric access. postal.
Investigators included 143,205 people per month, of whom 11,267 had a mental health diagnosis. They found that visitation rates declined at all federally licensed health centers during the pandemic.
However, they also found that high availability of telehealth was associated with a larger relative increase in visitation rates for people with mental health diagnoses, with an incidence rate of 2.07 compared to a lower availability of telehealth. Additionally, they found comparable results for people with specific diagnoses of anxiety, depression, mood disorders, and stress.
Additionally, the greater availability of telehealth was associated with a 7.67 percentage point relative increase in the likelihood of having a follow-up visit within 30 days of a mental health-related ED visit.
Limitations of the study included having only one year of post-telehealth expansion data, potential errors in data reporting, and unmeasured confounding, due to concurrent implementation of the telehealth and other pandemic-related programs.
The investigators also cautioned that the findings could potentially be limited to Massachusetts and not generalizable to the entire United States.
The study findings suggest that care delivery models supporting telehealth for mental health care may be associated with better engagement of Medicaid enrollees, according to the investigators.
The Boston University Institutional Review Board waived informed consent because only anonymized data was used and investigators followed STROBE reporting guidelines.
Cole MB, Lee EK, Davoust M, Carey K, Kim J. Comparison of visit rates before and after the expansion of telehealth among patients with mental health diagnoses treated at federally licensed health centers. JAMA Netw Open. 2022;5(11):e2242059. doi:10.1001/jamanetworkopen.2022.42059
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