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Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets
Josephine C Jacobs1, Daniel M Blonigen1, Rachel Kimerling1
1U.S. Department of Veterans Affairs (VA) Health Economics Resource Center, Menlo Park, California (Jacobs); VA Center for Innovation to Implementation, Menlo Park (Blonigen, Kimerling, Slightam, Gregory, Gurmessa, Zulman); Department of Psychiatry and Behavioral Sciences (Blonigen) and Division of Primary Care and Population Health (Zulman), Stanford University School of Medicine, Stanford, California; VA National Center for Post-Traumatic Stress Disorder, Menlo Park (Kimerling).
Objective:
In 2016, the Veterans Health Administration (VHA) began distributing video-enabled tablets to veterans with access barriers. This study evaluated the implementation of this initiative for veterans with mental health conditions, including the impact of tablet receipt on access to and continuity of mental health care, missed opportunities for care, and use of urgent care.
Methods:
A retrospective matched cohort study was conducted, matching tablet recipients with diagnoses of mental disorders (N=728) to a comparison group (N=1,020) on the basis of sociodemographic characteristics, mental health utilization and diagnoses, and wireless coverage. A difference-in-differences approach was used to compare 6-month pre-post changes in number of psychotherapy and medication management visits, continuity of psychotherapy based on VHA's quality metric for mental health care continuity, missed opportunity rate (i.e., the proportion of mental health appointments that were missed or canceled), and probability of any and number of emergency department (ED) or urgent care visits.
Results:
Compared with the matched control group, tablet recipients experienced an increase of 1.94 (p<0.001) psychotherapy encounters, an increase of 1.05 (p<0.001) medication management visits, an 18.54 percentage point (p<0.001) increase in their likelihood of receiving recommended mental health care necessary for continuity of care, and a 20.24 percentage point (p<.001) decrease in their missed opportunity rate in the 6-month period following receipt of tablets (or the index date for the matched sample). No significant differences in ED or urgent care use were found.
Conclusions:
Distributing video-enabled tablets to veterans with mental health conditions appeared to improve access to and continuity of mental health services while also improving clinical efficiency by decreasing missed opportunities for care.
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