Department of Health Policy and Management, Texas A&M University, College Station, TX, USA.
Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA.
BMC Health Serv Res. 2024 Apr 22;24(1):494. doi: 10.1186/s12913-024-10898-0.
Utilization of telemedicine care for vulnerable and low income populations, especially individuals with mental health conditions, is not well understood. The goal is to describe the utilization and regional disparities of telehealth care by mental health status in Texas. Texas Medicaid claims data were analyzed from September 1, 2012, to August 31, 2018 for Medicaid patients enrolled due to a disability.
We analyzed the growth in telemedicine care based on urban, suburban, and rural, and mental health status. We used t-tests to test for differences in sociodemographic characteristics across patients and performed a three-way Analyses of Variance (ANOVA) to evaluate whether the growth rates from 2013 to 2018 were different based on geography and patient type. We then estimated patient level multivariable ordinary least square regression models to estimate the relationship between the use of telemedicine and patient characteristics in 2013 and separately in 2018. Outcome was a binary variable of telemedicine use or not. Independent variables of interest include geography, age, gender, race, ethnicity, plan type, Medicare eligibility, diagnosed mental health condition, and ECI score.
Overall, Medicaid patients with a telemedicine visit grew at 81%, with rural patients growing the fastest (181%). Patients with a telemedicine visit for a mental health condition grew by 77%. Telemedicine patients with mental health diagnoses tended to have 2 to 3 more visits per year compared to non-telemedicine patients with mental health diagnoses. In 2013, multivariable regressions display that urban and suburban patients, those that had a mental health diagnosis were more likely to use telemedicine, while patients that were younger, women, Hispanics, and those dual eligible were less likely to use telemedicine. By 2018, urban and suburban patients were less likely to use telemedicine.
Growth in telemedicine care was strong in urban and rural areas between 2013 and 2018 even before the COVID-19 pandemic. Those with a mental health condition who received telemedicine care had a higher number of total mental health visits compared to those without telemedicine care. These findings hold across all geographic groups and suggest that mental health telemedicine visits did not substitute for face-to-face mental health visits.
利用远程医疗为弱势群体和低收入人群提供医疗服务，特别是为有心理健康问题的人群提供服务，这方面的情况还不太清楚。本研究旨在描述德克萨斯州的远程医疗服务利用情况及其与心理健康状况之间的地区差异。本研究分析了 2012 年 9 月 1 日至 2018 年 8 月 31 日期间因残疾而加入医疗补助计划的患者的医疗补助索赔数据。
我们根据城市、郊区和农村地区以及心理健康状况分析了远程医疗服务的增长情况。我们使用 t 检验来检验患者之间社会人口特征的差异，并进行了三因素方差分析（ANOVA），以评估 2013 年至 2018 年期间的增长率是否因地理位置和患者类型而异。然后，我们使用患者水平的多元最小二乘回归模型来估计 2013 年和 2018 年患者使用远程医疗的情况与患者特征之间的关系。结果变量为是否使用远程医疗的二分类变量。感兴趣的独立变量包括地理位置、年龄、性别、种族、民族、计划类型、是否有资格参加医疗保险、诊断的心理健康状况和 ECI 评分。
总体而言，使用远程医疗的医疗补助患者增长了 81%，其中农村患者的增长率最快（181%）。有远程医疗心理健康诊断的患者增长了 77%。与没有心理健康诊断的远程医疗患者相比，有心理健康诊断的远程医疗患者每年的就诊次数平均多 2 到 3 次。2013 年，多元回归显示，城市和郊区患者、有心理健康诊断的患者更有可能使用远程医疗，而年龄较小、女性、西班牙裔以及双重资格的患者则不太可能使用远程医疗。到 2018 年，城市和郊区患者使用远程医疗的可能性降低。
2013 年至 2018 年间，即使在 COVID-19 大流行之前，远程医疗服务在城市和农村地区的增长势头就很强劲。与没有远程医疗服务的患者相比，接受远程医疗服务的心理健康患者的总心理健康就诊次数更多。这些发现适用于所有地理群体，表明心理健康远程医疗就诊并没有替代面对面的心理健康就诊。
