Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Dr., Suite 300, Durham, NC, 27705, USA.
Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
J Racial Ethn Health Disparities. 2024 Oct;11(5):2663-2675. doi: 10.1007/s40615-023-01730-2. Epub 2023 Aug 16.
We examined factors associated with telehealth utilization during COVID-19 among adult Medicaid beneficiaries with behavioral health conditions.
NC Medicaid 2019-2021 beneficiary and claims data.
This retrospective cohort study examined and compared behavioral health service use pre-COVID-19 (03/01/2019 to 02/28/2020) and during COVID-19 (04/01/2020 to 03/31/2021). Telehealth users included those with at least one behavioral health visit via telehealth during COVID-19. Descriptive statistics were calculated for overall sample and by telehealth status. Multilevel modified Poisson generalized estimating equation examined associations between telehealth use and patient- and area-level characteristics.
DATA COLLECTION/EXTRACTION METHODS: We identified individuals ages ≥ 21-64, diagnosed with a behavioral health condition, and had at least one behavioral-health specific visit before COVID-19.
Almost two-thirds of the cohort received behavioral health services during COVID-19, with half of these beneficiaries using telehealth. Non-telehealth users had steeper declines in service use from pre- to during COVID-19 compared to telehealth users. Beneficiaries identifying as Black, multiracial or other were significantly less likely to use telehealth (ARR = 0.86; 95% CI: (0.83, 0.89)); (ARR = 0.92; 95% CI: (0.87, 0.96)) compared to White beneficiaries. Those eligible for Medicaid through the blind/disabled programs and who qualified for a state-specific specialized behavioral health plan were more likely to use telehealth (17% and 20%, respectively).
During the pandemic, telehealth facilitated continuity of care for beneficiaries with behavioral health conditions. Future research should aim to investigate how to reduce the digital divide and ensure equitable access to telehealth.
我们研究了在 COVID-19 期间，患有行为健康状况的成年医疗补助受益人使用远程医疗的相关因素。
北卡罗来纳州医疗补助计划 2019-2021 年受益人和索赔数据。
这项回顾性队列研究检查并比较了 COVID-19 之前（2019 年 3 月 1 日至 2 月 28 日）和 COVID-19 期间（2020 年 4 月 1 日至 2021 年 3 月 31 日）的行为健康服务使用情况。远程医疗用户包括在 COVID-19 期间至少通过远程医疗进行过一次行为健康就诊的患者。对总体样本和远程医疗状况进行了描述性统计。多水平修正泊松广义估计方程研究了远程医疗使用与患者和地区特征之间的关联。
数据收集/提取方法：我们确定了年龄在 21-64 岁之间、被诊断患有行为健康状况且在 COVID-19 之前至少有一次行为健康特定就诊的个体。
该队列中近三分之二的人在 COVID-19 期间接受了行为健康服务，其中一半的受益人使用了远程医疗。与远程医疗使用者相比，非远程医疗使用者在 COVID-19 期间的服务使用量下降幅度更大。与白人受益人相比，被认定为黑人、多种族或其他族裔的受益人使用远程医疗的可能性显著较低（ARR=0.86；95%CI：（0.83，0.89））；（ARR=0.92；95%CI：（0.87，0.96））。通过盲/残障项目有资格获得医疗补助的人和有资格获得特定于州的专门行为健康计划的人更有可能使用远程医疗（分别为 17%和 20%）。
在大流行期间，远程医疗为患有行为健康状况的受益人提供了连续的护理。未来的研究应旨在调查如何缩小数字鸿沟并确保公平获得远程医疗。
