Jaske Erin, Wheat Chelle L, Rubenstein Lisa V, Leung Lucinda, Curtis Idamay, Wahlberg Lawrence, Felker Bradford
VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington, USA.
Primary Care Analytics Team, Department of Veterans Affairs, Seattle, Washington, USA.
Telemed J E Health. 2024 Jun;30(7):1857-1865. doi: 10.1089/tmj.2023.0573. Epub 2024 Apr 2.
Beginning in 2019, the Department of Veterans Affairs (VA) prioritized improving access to care nationally to deliver virtual care and implemented 18 regionally based Clinical Resource Hubs (CRHs) to meet this priority. This observational study describes the quantity and types of care delivered by CRH Mental Health teams, and the professions of those hired to deliver it. A retrospective cohort study, based on national VA CRH mental health care utilization data and CRH staffing data for CRH's first 3 years, was conducted. CRH Mental Health teams primarily used Telemental Health (TMH) to provide care (98.1% of all CRH MH encounters). The most common disorders treated included depression, post-traumatic stress disorder, and anxiety disorders. The amount of care delivered overtime steadily increased as did the racial and ethnic diversity of Veterans served. Psychologists accounted for the largest share of CRH staffing, followed by psychiatrists. CRH TMH delivered from a regional hub appears to be a feasible and acceptable visit modality, based on the continuously increasing CRH TMH visit rates. Our results showed that CRH TMH was predominantly used to address common mental health diagnoses, rather than serious mental illnesses. Traditionally marginalized patient populations increased over the 3-year window, suggesting that CRH TMH resources were accessible to many of these patients. Future research should assess barriers and facilitators for accessing CRH TMH, especially for difficult-to-service patient populations, and should consider whether similar results to ours occur when regional TMH is delivered to non-VA patient populations.
从2019年开始，美国退伍军人事务部（VA）将改善全国医疗服务可及性以提供虚拟医疗作为优先事项，并设立了18个基于地区的临床资源中心（CRH）来实现这一优先目标。这项观察性研究描述了CRH心理健康团队提供的医疗服务数量和类型，以及受雇提供这些服务的人员职业。基于VA全国CRH心理健康医疗利用数据和CRH前三年的人员配置数据，开展了一项回顾性队列研究。CRH心理健康团队主要使用远程心理健康（TMH）提供医疗服务（占所有CRH心理健康诊疗的98.1%）。治疗的最常见疾病包括抑郁症、创伤后应激障碍和焦虑症。随着时间的推移，提供的医疗服务量稳步增加，接受服务的退伍军人的种族和族裔多样性也在增加。心理学家在CRH人员配置中占比最大，其次是精神科医生。基于CRH TMH就诊率持续上升，从地区中心提供的CRH TMH似乎是一种可行且可接受的就诊方式。我们的结果表明，CRH TMH主要用于处理常见的心理健康诊断，而非严重精神疾病。在这三年期间，传统上被边缘化的患者群体有所增加，这表明许多这类患者能够获得CRH TMH资源。未来的研究应评估获取CRH TMH的障碍和促进因素，尤其是针对难以服务的患者群体，并且应考虑当向非VA患者群体提供地区性TMH时是否会出现与我们类似的结果。
