Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Am Med Dir Assoc. 2024 Jul;25(7):105027. doi: 10.1016/j.jamda.2024.105027. Epub 2024 May 18.
To examine disparities in mental health (MH) service utilization, via in-person and telemedicine (ie, tele-MH), by individuals' race, ethnicity, and community socioeconomic status, among community-dwelling older adults with Alzheimer disease and related dementias (ADRD) before and after the expansion of the Centers for Medicare and Medicaid Services' (CMS's) telemedicine policy.
Observational study.
A total of 3,003,571 community-dwelling Medicare beneficiaries with ADRD between 2019 and 2021 were included in the study.
Multiple national data were linked. The unit of analysis was individual-quarter. Three outcomes were defined: any MH visits (in-person or tele-MH), in-person MH visits, and tele-MH visits per quarter. Key independent variables included individual race and ethnicity, the socioeconomic status of the community, and an indicator for the implementation of the telemedicine policy. Regression analyses with individual random effects were used.
In general, Black and Hispanic older adults with ADRD and those in socioeconomically deprived communities were less likely to have MH visits than white adults and those from less-deprived communities. In-person and tele-MH visits varied throughout the pandemic and across subpopulations. For instance, at the beginning of the pandemic, white, Black, and Hispanic older adults experienced 5.05, 3.03, and 2.87 percentage point reductions in in-person MH visits, and 3.53, 1.26, and 0.32 percentage point increases in tele-MH visits (with P < .01 for racial/ethnic differences), respectively. During the pandemic, the increasing trend in in-person MH visits and the decreasing trend in tele-MH visits varied across different subgroups. Overall, racial and ethnic differences in any MH visits were reduced, but the gap in any MH visits between deprived and less-deprived communities doubled during the pandemic (P < .01).
Telemedicine may have provided an opportunity to improve access to MH services among underserved populations. However, although some disparities in MH care were reduced, others widened, underscoring the importance of equitable health care access strategies to address the unique needs of different populations.
通过个人的种族、民族和社区社会经济地位，在医疗保险和医疗补助服务中心（CMS）扩大远程医疗政策之前和之后，检查社区居住的阿尔茨海默病和相关痴呆症（ADRD）老年人的心理健康（MH）服务利用情况的差异，包括面对面和远程医疗（即远程 MH）。
观察性研究。
共有 3003571 名在 2019 年至 2021 年间患有 ADRD 的社区居住的医疗保险受益人纳入研究。
将多个国家的数据进行了链接。分析单位是个人季度。定义了三个结果：任何 MH 就诊（面对面或远程 MH）、面对面 MH 就诊和每季度远程 MH 就诊。主要的独立变量包括个人的种族和民族、社区的社会经济地位以及远程医疗政策实施的指标。使用个体随机效应的回归分析。
一般来说，患有 ADRD 的黑人和西班牙裔老年人以及来自社会经济贫困社区的老年人比白人成年人和来自贫困程度较低社区的老年人进行 MH 就诊的可能性较小。面对面和远程 MH 就诊在整个大流行期间和不同亚群中都有所不同。例如，在大流行开始时，白人、黑人和西班牙裔老年人的面对面 MH 就诊减少了 5.05%、3.03%和 2.87%，远程 MH 就诊增加了 3.53%、1.26%和 0.32%（种族/民族差异具有统计学意义）。在大流行期间，面对面 MH 就诊的增加趋势和远程 MH 就诊的减少趋势在不同亚组中有所不同。总体而言，任何 MH 就诊的种族和民族差异有所减少，但大流行期间贫困和贫困程度较低社区之间任何 MH 就诊的差距增加了一倍（P<.01）。
远程医疗可能为改善服务不足人群获得 MH 服务提供了机会。然而，尽管 MH 护理方面的一些差异有所缩小，但其他差异却扩大了，这突显了公平获得医疗保健的策略的重要性，以满足不同人群的独特需求。
