University of North Carolina at Chapel Hill, Department of Family Medicine, School of Medicine, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241303605. doi: 10.1177/21501319241303605.
COVID-19 accelerated federally qualified health centers' use of telemental health. However, factors associated with telemental health service delivery remain unclear. We examined telemental health delivery by clinician type and mental health workforce composition across the U.S. to understand how staffing and other organizational characteristics are related to telemental health delivery at health centers.
Using data from the 2021 Uniform Data System, we characterized the proportion of mental health care delivered via elemental (i.e., virtual visits) at health centers in the U.S. that received HRSA grant funding (n = 1,270) overall and by state and clinician type. Then, we conducted multivariate beta regression analyses to assess the proportion of mental health visits delivered via telemental health at health centers as a function of mental health workforce composition, while adjusting for health center size, patient mix, and state.
In 2021, health centers delivered 43% of their mental health visits via telemental health, with significant variation by state and clinician type. On average, the proportion of mental health visits delivered via telemental health was greater among psychiatrists (61%, < .001) than psychologists (49%) and clinical social workers (45%). Factors significantly associated with the increased proportion of telemental health delivered by health centers included a higher supply of psychiatrists per patient, more grant dollars per patient, and a greater proportion of Asian patients served.
Access to telemental health varies by state and across health centers based on mental health workforce composition. Future work is needed to examine funding and workforce strategies to increase telemental health service availability.
COVID-19 加速了合格的联邦健康中心使用远程医疗。然而，与远程医疗服务提供相关的因素仍不清楚。我们检查了美国各地临床医生类型和心理健康劳动力构成的远程医疗服务提供情况，以了解人员配备和其他组织特征与健康中心的远程医疗服务提供之间的关系。
使用 2021 年统一数据系统的数据，我们描述了美国获得 HRSA 赠款资助的健康中心（n=1270）通过元素（即虚拟访问）提供的精神卫生保健的比例，以及按州和临床医生类型进行的描述。然后，我们进行了多元 beta 回归分析，以评估健康中心通过远程医疗提供的精神卫生访问比例作为精神卫生劳动力构成的函数，同时调整健康中心规模、患者构成和州。
2021 年，健康中心通过远程医疗提供了 43%的精神卫生访问，各州和临床医生类型之间存在显著差异。平均而言，通过远程医疗提供的精神卫生访问比例在精神科医生（61%，<.001）中高于心理学家（49%）和临床社会工作者（45%）。与健康中心提供更多远程医疗服务的比例显著相关的因素包括每患者精神科医生的供应量较高、每患者的赠款美元增加，以及服务的亚裔患者比例增加。
远程医疗的可及性因州和健康中心的心理健康劳动力构成而异。需要进一步研究资金和劳动力战略，以增加远程医疗服务的可用性。
