Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA.
Cleveland Clinic Community Care, Cleveland, OH, USA.
J Gen Intern Med. 2022 Aug;37(11):2759-2767. doi: 10.1007/s11606-021-07326-y. Epub 2022 Jan 29.
The coronavirus disease 2019 pandemic has contributed to growing demand for mental health services, but patients face significant barriers to accessing care. Direct-to-consumer(DTC) telemedicine has been proposed as one way to increase access, yet little is known about its pre-pandemic use for mental healthcare.
To characterize patients, providers, and their use of a large nationwide DTC telemedicine platform for mental healthcare.
Retrospective cross-sectional study.
Mental health encounters conducted on the American Well DTC telemedicine platform from 2016 to 2018.
Patients and physicians.
Patient measures included demographics, insurance report, and number of visits. Provider characteristics included specialty, region, and number of encounters. Encounter measures included wait time, visit length and timing, out-of-pocket payment, coupon use, prescription outcome, referral receipt, where care otherwise would have been sought, and patient satisfaction. Factors associated with five-star physician ratings and prescription receipt were assessed using logistic regression.
We analyzed 19,270 mental health encounters between 6708 patients and 1045 providers. Visits were most frequently for anxiety (39.1%) or depression (32.5%), with high satisfaction (4.9/5) across conditions. Patients had a median 2.0 visits for psychiatry (IQR 1.0-3.0) and therapy (IQR 1.0-5.0), compared to 1.0 visit (IQR 1.0-1.0) for urgent care. High satisfaction was positively correlated with prescription receipt (OR 1.89, 95% CI 1.54-2.32) and after-hours timing (aOR 1.18, 95% CI 1.02-1.36). Prescription rates ranged from 79.6% for depression to 32.2% for substance use disorders. Prescription receipt was associated with increased visit frequency (aOR 1.95, 95% CI 1.57-2.42 for ≥ 3 visits).
As the burden of psychiatric disease grows, DTC telemedicine offers one solution for extending access to mental healthcare. While most encounters were one-off, evidence of some continuity in psychiatry and therapy visits-as well as overall high patient satisfaction-suggests potential for broader DTC telemental health use.
2019 年冠状病毒病大流行导致对心理健康服务的需求不断增长，但患者在获得护理方面面临着重大障碍。直接面向消费者（DTC）远程医疗被提议作为增加获得服务的一种方式，但对于其在精神保健方面的大流行前使用情况知之甚少。
描述大量全国性 DTC 远程医疗平台用于精神保健的患者、提供者及其使用情况。
回顾性横断面研究。
2016 年至 2018 年在美国 Well DTC 远程医疗平台上进行的心理健康就诊。
患者和医生。
患者指标包括人口统计学特征、保险报告和就诊次数。提供者特征包括专业、地区和就诊次数。就诊指标包括等待时间、就诊时长和时间安排、自付费用、优惠券使用、处方结果、转诊接收、本来会寻求的治疗地点以及患者满意度。使用逻辑回归评估与五星医生评分和处方接收相关的因素。
我们分析了 19270 例心理健康就诊，涉及 6708 名患者和 1045 名医生。就诊最常见的是焦虑症（39.1%）或抑郁症（32.5%），所有情况下的满意度均为 4.9/5。患者接受精神病学（IQR 1.0-3.0）和治疗（IQR 1.0-5.0）的就诊中位数为 2.0 次，而急诊就诊中位数为 1.0 次（IQR 1.0-1.0）。高满意度与处方接收（OR 1.89，95%CI 1.54-2.32）和下班后就诊时间（aOR 1.18，95%CI 1.02-1.36）呈正相关。处方率从抑郁症的 79.6%到物质使用障碍的 32.2%不等。处方接收与就诊频率增加相关（≥3 次就诊的 OR 1.95，95%CI 1.57-2.42）。
随着精神疾病负担的增加，DTC 远程医疗为扩大精神保健服务提供了一种解决方案。虽然大多数就诊都是一次性的，但精神病学和治疗就诊的连续性证据以及整体较高的患者满意度表明，DTC 远程心理健康服务可能有更广泛的应用。
