Matching Primary Care and Integrated Mental Health Visits by Care Modality and Linkage to Same-Day Services for...

The Veterans Health Administration (VHA) aims to provide same-day access from Primary Care to Integrated Mental Health (PCMHI) teams but faces challenges coordinating virtual services across traditional clinic workflows. This study examined whether modality concordance for primary care and PCMHI visits (i.e., both video, both phone, or both in-person) is associated with higher probability of receiving same-day PCMHI care.

This retrospective cohort study included 952,749 VHA primary care patients who newly initiated PCMHI services between FY2019 and FY2023 (October 1, 2018 and September 30, 2023). Same-day care was defined as receiving PCMHI services on the same day as a primary care visit. The exposure was the modality combination used for primary care visits and their resulting PCMHI visits. Multilevel regression models controlled for patient characteristics, clinic-level factors, year, VHA regional network, and clinic clustering.

The highest probability for same-day PCMHI care was when both visits were conducted in-person (59%, p < 0.001). This probability dropped to 35% and below for all cases where phone or video was utilized for either visit. Further analysis demonstrated that modality concordance contributed minimally to same-day care after calculating the variance contributed by any telehealth (phone/video) use.

The use of phone or video visits appeared to hinder the ability to provide same-day patient handoffs from primary care to PCMHI, even when the same modality was used for both visits. Interdisciplinary team workflows need to overcome barriers associated with telehealth (phone/video) use in general, which may not be easily rectified by matching on visit modality.