U.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).
Psychiatr Serv. 2019 Nov 1;70(11):976-982. doi: 10.1176/appi.ps.201900104. Epub 2019 Aug 5.
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.
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.
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.
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.
2016 年，退伍军人事务部（VA）开始向有就诊障碍的退伍军人分发配备视频功能的平板电脑。本研究评估了该倡议在有心理健康问题的退伍军人中的实施情况，包括平板电脑的获得对获取和持续的心理健康护理、错失护理机会以及使用紧急护理的影响。
进行了一项回顾性匹配队列研究，根据社会人口统计学特征、心理健康利用和诊断以及无线覆盖情况，将患有精神障碍诊断的平板电脑使用者（n=728）与对照组（n=1,020）进行匹配。采用差异法比较了 6 个月前后心理治疗和药物管理就诊次数、基于 VA 心理健康护理连续性质量指标的心理治疗连续性、错失机会率（即错过或取消的心理健康预约比例）以及任何紧急护理或紧急护理就诊的概率和次数的变化。
与匹配的对照组相比，平板电脑使用者经历了 1.94 次（p<0.001）心理治疗就诊次数的增加，1.05 次（p<0.001）药物管理就诊次数的增加，接受建议的心理健康护理以维持连续性的可能性增加了 18.54 个百分点（p<0.001），错过机会的可能性降低了 20.24 个百分点（p<.001）（平板电脑使用者在获得平板电脑后的 6 个月内或匹配样本的索引日期）。在急诊或紧急护理使用方面未发现显著差异。
向有心理健康问题的退伍军人分发配备视频功能的平板电脑，似乎可以改善获取和持续心理健康服务的机会，同时通过减少错失护理机会来提高临床效率。
