Mongan Institute Health Policy Center, Massachusetts General Hospital.
Department of Medicine.
Med Care. 2021 Jul 1;59(7):572-578. doi: 10.1097/MLR.0000000000001537.
Use of telemental health has increased among rural Medicare beneficiaries, particularly among individuals with serious mental illness (SMI). Little is known about what leads to the initiation of telemental health.
To categorize the different patterns of mental health care use before initiation of telemental health services among individuals with SMI.
A cohort of rural beneficiaries with SMI (defined as schizophrenia/related psychotic disorders or bipolar disorder) with an index telemental health visit in 2010-2017 was built using claims for a 20% random sample of fee-for-service Medicare beneficiaries. The authors used latent class analysis to identify classes of mental health care use in the 6 months before the index telemental health visits. Across the classes, the authors also described characteristics of index and subsequent mental health visits.
The cohort included 4930 rural Medicare beneficiaries with SMI. Three classes of mental health care use before initiation of telemental health were identified. The largest class (n=3066) had minimal use of primary care provider mental health care and the second largest class (n=1537) had minimal specialty mental health care. The smallest class (n=327) was characterized by recent hospitalization or emergency department care. In the overall cohort, index visits were frequently established visits and were often with specialty prescribers.
Our findings highlight 3 distinct patterns of care before telemental health initiation, providing insight into the role that telemedicine may play in mental health care for rural Medicare beneficiaries with SMI. Overall, telemental health was most often used to maintain care with existing providers.
在农村医疗保险受益人中，远程心理健康服务的使用有所增加，尤其是在有严重精神疾病（SMI）的人群中。对于导致远程心理健康服务启动的原因知之甚少。
对有 SMI 的个体在开始远程心理健康服务之前的心理健康护理使用模式进行分类。
使用 2010 年至 2017 年期间的索引远程心理健康就诊记录，为有 SMI 的农村受益人（定义为精神分裂症/相关精神病性障碍或双相情感障碍）建立了一个队列，其中包括 20%的按服务收费医疗保险受益人的随机样本。作者使用潜在类别分析来确定索引远程心理健康就诊前 6 个月的心理健康护理使用类别。在这些类别中，作者还描述了索引和随后的心理健康就诊的特征。
该队列包括 4930 名农村医疗保险有 SMI 的受益人。确定了三种远程心理健康服务启动前的心理健康护理使用模式。最大的类别（n=3066）有很少的初级保健提供者心理健康护理使用，其次是最大的类别（n=1537）有很少的专业心理健康护理使用。最小的类别（n=327）的特点是最近住院或急诊护理。在整个队列中，索引就诊通常是定期就诊，通常是与专科开处方者就诊。
我们的发现突出了远程心理健康服务启动前的 3 种不同护理模式，为远程心理健康服务在农村医疗保险有 SMI 的受益人群中的作用提供了一些见解。总体而言，远程心理健康服务通常用于维持与现有提供者的护理。
