Advanced Fellowship Program in Mental Illness Research and Treatment, Mid-Atlantic Mental Illness Research Education and Clinical Center, Central Virginia VA Health Care System.
VA San Diego Healthcare System.
Psychol Serv. 2023;20(Suppl 2):20-32. doi: 10.1037/ser0000704. Epub 2022 Sep 1.
Military veterans experiencing relationship or family difficulties are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Health Care System. Although family services have historically been provided face-to-face (F2F), the COVID-19 pandemic necessitated a sudden shift to the provision of care via telemental health, which includes videoconferencing (TMH-V) or audio-only phone appointments. This study demonstrated an unprecedented 16-fold increase in the number of TMH-V appointments for family services in VA during the first 9 months of the pandemic. The present study also examined demographic, mental health, and military variables associated with TMH-V utilization before and during the pandemic using a large national VA data set of 13,344 veterans who were referred to couple or family therapy from October 2017 through December 2020. Logistic regression was used to evaluate predictors of having any appointments via TMH-V before and during COVID-19, respectively, as well as predictors of having 50% or more of family service appointments via TMH-V versus phone versus face-to-face appointments during the COVID-19 era. Pre-COVID predictors of TMH-V utilization were limited to obsessive-compulsive disorder diagnosis and history of psychiatric hospitalization, suggesting that TMH-V usage was largely related to clinical indications. In the COVID-19 era, older and rural veterans were less likely to attend appointments via TMH-V than younger and suburban/urban veterans, while Hispanic veterans were more likely to do so than non-Hispanic veterans. The findings from the present study may aid efforts to ensure equity in access to care among veterans in the VA Health Care System. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
有家庭或人际关系问题的退伍军人可以通过退伍军人事务部（VA）医疗保健系统获得家庭服务（即夫妻和家庭治疗）。尽管家庭服务历来是面对面（F2F）提供的，但 COVID-19 大流行需要突然转向通过远程心理健康（包括视频会议（TMH-V）或仅音频电话预约）提供护理。这项研究表明，在大流行的前 9 个月，退伍军人事务部的家庭服务 TMH-V 预约数量增加了 16 倍。本研究还使用了退伍军人事务部 13344 名退伍军人的大型全国数据，这些退伍军人在 2017 年 10 月至 2020 年 12 月期间被转介到夫妻或家庭治疗，检查了与大流行前和大流行期间 TMH-V 使用相关的人口统计学、心理健康和军事变量。使用逻辑回归分别评估了在 COVID-19 之前和期间通过 TMH-V 预约的任何预约的预测因素，以及在 COVID-19 期间通过 TMH-V 预约与电话预约与面对面预约相比，有 50%或更多的家庭服务预约的预测因素。TMH-V 使用的大流行前预测因素仅限于强迫症诊断和精神病住院史，这表明 TMH-V 使用主要与临床指征有关。在 COVID-19 期间，与年轻和郊区/城市退伍军人相比，年龄较大和农村退伍军人通过 TMH-V 预约的可能性较小，而西班牙裔退伍军人比非西班牙裔退伍军人更有可能这样做。本研究的结果可能有助于努力确保退伍军人事务部医疗保健系统中退伍军人获得医疗保健的公平性。（PsycInfo 数据库记录（c）2023 APA，保留所有权利）。
