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Connolly Gibbons MB, Duong L, Chiu RY, Crits-Christoph P, Gallop R, Mandell D, Barg O, Newman CF, Brown LA, Oquendo MA. A cohort study of engagement in telehealth psychotherapy versus in-person services. Psychother Res 2024:1-11. [PMID: 39034438 DOI: 10.1080/10503307.2024.2375231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Although telehealth psychotherapies have been studied for over 20 years, mental health services remained largely delivered in person until the COVID-19 pandemic forced clinics to reconsider the utility of telehealth psychotherapy. This study aims to compare patient engagement in in-person versus telehealth services in outpatient psychotherapy for mood and anxiety disorders. METHOD A cohort investigation was conducted, using a propensity score matched sample, extracted from an electronic health record (EHR) to compare engagement in psychotherapy for 762 patients who used in-person services before the pandemic to a cohort of 762 patients who used telehealth psychotherapy after the onset of COVID-19. The authors compared cohorts on initial engagement in psychotherapy services following an initial intake, number of psychotherapy sessions attended, and the rate of missed sessions. RESULTS There was a 26% increase in the total number of individual psychotherapy sessions attended when the clinics transitioned to telehealth services (p < .001). In addition, patients who received telehealth psychotherapy were five times more likely to not cancel or miss any scheduled sessions (p < .001). CONCLUSION These results indicate that telehealth services may result in improved treatment engagement for outpatient centers focused on brief evidence-based psychotherapies for mood and anxiety disorders.
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Affiliation(s)
| | - Lang Duong
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rachel Y Chiu
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Olga Barg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Cory F Newman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Cain SM, Bennetts S, Riddoch G, Pratt D, Stock A, Isidron V, Lopez M, Orchowsky M. Behavioral Health Integrated Support Network (BHISN). Mil Med 2024; 189:1696-1701. [PMID: 37738666 DOI: 10.1093/milmed/usad351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/10/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION This article reviews process and performance of an innovative effort leveraging virtual health to manage unmet demand for behavioral health and substance use disorder services across a large military region. This effort began in June 2022 and included nearly all of the Defense Health Agency Region-Europe's military behavioral health and substance abuse clinics participating. The two goals of improving access to behavioral health and substance use services for active duty service members and improving utilization of the military clinics were employed. Operational and remote locations with known care gaps could access services as well. Connecting services to the point of need is an established strength of virtual health delivery systems of care. MATERIALS AND METHODS A team consisting of clinical leaders and Virtual Medical Center-Europe staff developed a centralized screening process and simple business rules. When a clinic was unable to meet its access-to-care standard of 28 days, the patient requesting or referral from a remote location, was offered a virtual video option with a provider from another clinic with availability. Centralized screening was created and staffed by three technicians. The Behavioral Health Integrated Support Network (BHISN) screening clinic assessed appropriateness of virtual care using established exclusion criteria. Once screened, the patient was scheduled for an appointment with one of the 31 therapists in 14 participating clinics in a 3- to 5-day window. The military health system's video connect platform was used. RESULTS Between June 2022 and November 2023, 131 patients who were unable to find routine care in their home clinic were screened, scheduled, and completed a virtual visit with one of the 31 participating therapists from 14 behavioral health and substance use clinics. Seventy-eight (59%) participants were active duty empaneled to military treatment facilities in Europe and 53 (39%) were active duty enrolled in Tricare Prime Remote and deployed to remote locations with limited care. Forty-four percent of patients were recommended for continued virtual therapy or counseling kept their first follow-up demonstrating good follow-up care using a virtual option. The overall no-show rate was low at 7%. Care and consultation were successfully delivered using video visits to location in 18 countries in three geographic Europe, the Middle East and, Africa. CONCLUSION The Virtual Medical Center-Europe, Army Europe Behavioral Health, and Substance Use leadership work collaboratively to plan and optimize program performance. For BHISN to function as intended requires key dedicated support staff, such as mental health and social services assistants to screen and coordinate virtual care. Scheduling can be performed by a central cell requiring clinics to relinquish some local control in the interest of meeting patient demand in large and diverse area that covers three continents. BHISN shows promising initial success by providing a process of managing demand and connecting requests for behavioral health and substance use care leveraging capacity from all clinics using a virtual video service in a diverse operating environment.
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Affiliation(s)
- Steven M Cain
- Virtual Medical Center-Europe, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
| | - Sara Bennetts
- Substance Abuse Program, Medical Readiness Command-Europe, Sembach 67681, Germany
| | - Gage Riddoch
- Clinical Psychology, U.S. Army Behavioral Health Clinic Stuttgart, Stuttgart 70569, Germany
| | - Damon Pratt
- Substance Use Disorder Clinic, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
| | - Audra Stock
- Substance Use Disorder Clinic, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
| | - Veronica Isidron
- U.S. Army, School-Based Behavioral Health-Vilseck High School, Vilseck 92249, Germany
| | - Maria Lopez
- Substance Use Disorder Clinic, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
| | - Matthew Orchowsky
- Substance Use Disorder Clinic, Landstuhl Regional Medical Center, Landstuhl 66849, Germany
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Kelber MS, Smolenski DJ, Boyd C, Shank LM, Bellanti DM, Milligan T, Edwards-Stewart A, Libretto S, Parisi K, Morgan MA, Evatt DP. Evidence-based telehealth interventions for posttraumatic stress disorder, depression, and anxiety: A systematic review and meta-analysis. J Telemed Telecare 2024:1357633X231224491. [PMID: 38254285 DOI: 10.1177/1357633x231224491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The goal of this systematic review was to examine the efficacy of behavioral health care treatments for posttraumatic stress disorder (PTSD), depression, and anxiety delivered via telehealth. METHODS We searched a combination of keywords related to telehealth, relevant mental health disorders, and evidence-based psychotherapies in three databases (PubMed, PsycInfo, and Embase) from database inception to April 2022. We included randomized controlled trials published in English wherein at least one arm received an evidence-based psychotherapy via telehealth. To be included, studies also had to enroll an adult population with symptoms or diagnosis of PTSD, depressive disorder, or anxiety disorder. RESULTS Moderate quality of evidence was consistent with only small differences, if any, in efficacy between video teleconferencing (VTC) and in-person delivery for patients with PTSD (d = 0.06, 95% CI -0.17, 0.28). However, for those with depression, in-person delivery was associated with better outcomes compared to VTC (d = 0.28, 95% CI 0.03, 0.54; low quality of evidence). We also found that evidence-based treatments delivered over telephone were more efficacious for depression compared to treatment as usual (d = -0.47, 95% CI -0.66, -0.28; very low quality of evidence). Very low quality of evidence supported the use of telehealth versus waitlist for anxiety (d = -0.48, 95% CI -0.89, -0.09). CONCLUSIONS A synthesis across 29 studies indicates that the efficacy of telehealth for delivery of evidence-based behavioral health interventions varies by target diagnosis and telehealth modality. More research is needed on the efficacy of telehealth treatments for depression and anxiety.
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Affiliation(s)
- Marija S Kelber
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Courtney Boyd
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Lisa M Shank
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Dawn M Bellanti
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Tiffany Milligan
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | | | - Salvatore Libretto
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Kelly Parisi
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Maria A Morgan
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Daniel P Evatt
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
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Chi W, Nguyen B, Ma Q, Gray D, Bailly E, LoSasso A, Agrawal S. Impact of COVID-19 on Behavioral Health Services Use Among Medicaid Enrollees with Chronic Behavioral Needs by Race and Ethnicity. Popul Health Manag 2023; 26:325-331. [PMID: 37676993 DOI: 10.1089/pop.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
The COVID-19 pandemic may widen the disparities in access to behavioral health (BH) services among groups that have been historically marginalized. However, the rapid expansion of telehealth presents an opportunity to reduce these disparities. The objective was to assess the impact of COVID-19 on BH visits, including in-person and telehealth, and BH treatments by different race and ethnicity groups. This was a retrospective, observational study using administrative claim data. Two cohorts were created: a before-COVID-19 group and a during-COVID-19 group. A difference-in-differences analysis was conducted to assess the access to BH-related visits between the 2 groups by different race and ethnicity groups. The study sample included 90,268 patients aged 18 to 64 years with repeated BH diagnoses in baseline periods and continuous medical and pharmacy enrollment. During the pandemic, BH telehealth visits surged, whereas the overall utilization of BH services, mental health medication, and counseling declined among all racial groups as the BH telehealth increase did not fully compensate for the reduction of in-person visits. Latino patients had a higher likelihood of using BH telehealth visits than White patients. However, Black patients had a lower likelihood of using substance use disorder (SUD) treatment than their White counterparts. Our results also suggested that care continuation and pre-established care-seeking behaviors are associated with increasing BH visits and treatments. As policy makers and payers are expanding offerings of telehealth visits, it is imperative to do so through a health equity lens and center the needs of groups that have been economically and socially marginalized to advance equitable adoption of telehealth.
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Affiliation(s)
- Winnie Chi
- Department of Health Services Research, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Binh Nguyen
- Department of Health Services Research, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Qinli Ma
- Department of Health Services Research, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Darrell Gray
- Department of Health Outcomes Organizations, and Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Eric Bailly
- Department of Behavioral Health, Elevance Health, Inc., Indianapolis, Indiana, USA
| | - Anthony LoSasso
- Department of Economics, DePaul University, Chicago, Illinois, USA
| | - Shantanu Agrawal
- Department of Health Outcomes Organizations, and Elevance Health, Inc., Indianapolis, Indiana, USA
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Green EH, Aquino PR, Keitz SA. Telemedicine Postpandemic: Where Do We Go From Here? Med Care 2023; 61:491-494. [PMID: 37411002 DOI: 10.1097/mlr.0000000000001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Eric H Green
- Department of General Internal Medicine, Lahey Hospital & Medical Center
| | - Patrick R Aquino
- Tufts University School of Medicine, Lahey Hospital & Medical Center
| | - Sheri A Keitz
- Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA
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Rosen V, Blank E, Lampert E, Dominick K, Will M, Erickson C, Pedapati E, Lamy M, Shaffer R. Brief Report: Telehealth Satisfaction Among Caregivers of Pediatric and Adult Psychology and Psychiatry Patients with Intellectual and Developmental Disability in the Wake of Covid-19. J Autism Dev Disord 2022; 52:5253-5265. [PMID: 35987932 PMCID: PMC9392497 DOI: 10.1007/s10803-022-05712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/01/2022]
Abstract
Telehealth has been shown to be both acceptable and effective in many areas of healthcare, yet it was not widely adopted prior to the SARS-CoV-2 (COVID-19) pandemic. Additionally, previous evaluations of telehealth for autism spectrum condition (ASC) and intellectual and developmental disability (IDD) populations are limited in both number and scope. Here, we investigated satisfaction amongst Psychology and Psychiatry patient caregivers at Cincinnati Children’s Hospital Medical Center (CCHMC) after the onset of the COVID-19 pandemic. Results (640 responses) showed high rates of satisfaction across departments, appointment types, and diagnoses, with 92% indicating overall satisfaction with their appointment. There were, however, notable decreases in satisfaction among Group Therapy respondents, and those whose diagnosis was classified as Other.
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