All authors are with Harvard Medical School, Department of Health Care Policy, Boston, MA. Alisa B. Busch is also with Harvard Medical School, Department of Psychiatry, and McLean Hospital, Belmont, MA. Ateev Mehrotra is also with Beth Israel Deaconess Medical Center, Boston.
Am J Public Health. 2020 Sep;110(9):1308-1314. doi: 10.2105/AJPH.2020.305657. Epub 2020 Jul 16.
To examine whether growing use of telemental health (TMH) has reduced the rural-urban gap in specialty mental health care use in the United States. Using 2010-2017 Medicare data, we analyzed trends in the rural-urban difference in rates of specialty visits (in-person and TMH). Among rural beneficiaries diagnosed with schizophrenia or bipolar disorder, TMH use grew by 425% over the 8 years and, in higher-use rural areas, accounted for one quarter of all specialty mental health visits in 2017. Among patients with schizophrenia or bipolar disorder, TMH visits differentially grew in rural areas by 0.14 visits from 2010 to 2017. This growth partially offset the 0.42-visit differential decline in in-person visits in rural areas. In net, the gap between rural and urban patients in specialty visits was larger by 2017. TMH has improved access to specialty care in rural areas, particularly for individuals diagnosed with schizophrenia or bipolar disorder. While growth in TMH use has been insufficient to eliminate the overall rural-urban difference in specialty care use, this difference may have been larger if not for TMH. Targeted policy to extend TMH to underserved areas may help offset declines in in-person specialty care.
为了检验美国远程心理健康（TMH）的使用日益增加是否缩小了农村和城市之间在专业心理健康护理使用方面的差距。我们使用了 2010 年至 2017 年的医疗保险数据，分析了农村和城市之间在专业就诊率（面对面和 TMH）方面的差异趋势。在被诊断患有精神分裂症或双相情感障碍的农村受益人中，TMH 的使用在 8 年内增长了 425%，在使用率较高的农村地区，TMH 在 2017 年占所有专业心理健康就诊的四分之一。在患有精神分裂症或双相情感障碍的患者中，TMH 就诊量从 2010 年到 2017 年在农村地区每年增长 0.14 次。这种增长部分抵消了农村地区面对面就诊量每年减少 0.42 次的差异。总的来说，到 2017 年，农村和城市患者在专业就诊方面的差距更大。TMH 改善了农村地区获得专业护理的机会，特别是对被诊断患有精神分裂症或双相情感障碍的患者。虽然 TMH 的使用增长不足以消除专业护理使用方面的整体城乡差异，但如果没有 TMH，这种差异可能会更大。有针对性的政策将 TMH 扩展到服务不足的地区，可能有助于抵消面对面专业护理的下降。
