PDF(Pubmed)
Abstract：
UNASSIGNED: Telehealth services expanded rapidly during the COVID-19 public health emergency (PHE).
UNASSIGNED: To evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE.
UNASSIGNED: In this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration\'s Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024.
UNASSIGNED: Callers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared.
UNASSIGNED: During W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics.
UNASSIGNED: Based on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.
UNASSIGNED: To evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE.
UNASSIGNED: In this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration\'s Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024.
UNASSIGNED: Callers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared.
UNASSIGNED: During W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics.
UNASSIGNED: Based on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.
摘要：
■在COVID-19公共卫生紧急情况（PHE）期间，远程医疗服务迅速扩展。
评估COVID-19PHE期间和之后美国门诊精神卫生治疗机构(MHTF)远程医疗服务可用性的变化。
■在这项队列研究中，从2022年12月至2023年3月，冒充潜在客户的来电者联系了从物质滥用和心理健康服务管理局的行为健康治疗定位器中抽取的1404MHTF的随机样本（第1波[W1]；在PHE期间）。从2023年9月到11月（第2波[W2]；PHE之后），呼叫者重新联系W1参与者。2024年1月进行了分析。
■呼叫者询问MHTF是否提供远程医疗（是与否），and,如果是,他们是否提供（1）纯音频远程医疗（与音频和视频）；（2）远程医疗治疗，药物管理,和/或诊断服务；和（3）共病酒精使用障碍（AUD）的远程医疗。维持者(在两波中都提供了远程医疗)，后期采用者(在W1没有提供远程医疗，但在W2提供)，非采用者(未在W1或W2提供远程医疗)，和中断者(在W1提供远程医疗，而不是W2)都进行了比较。
■在W2期间，成功地重新联系了1001MHTF（86.1％）。共有713个（71.2％）位于大都市县，151（15.1%）是公开运营的，935（93.4％）接受了医疗补助作为付款。提供远程医疗的百分比从799(81.6%)下降到765(79.0%)(赔率比[OR]，0.84；95%CI，0.72-1.00；P<0.05）。在提供远程医疗的MHTF中，W2中提供纯音频远程医疗的比例较小(369[49.3%]对244[34.1%]；或者，0.53；95%CI，0.44-0.64；P<.001）和远程医疗共病AUD（559[76.3%]vs457[66.5%]；或，0.62；95%CI，0.50-0.76；P<.001）与W1相比。在W2中，MHTF更有可能报告远程医疗仅在某些治疗条件下可用（141设施[18.0％]vs276[36.4％]；或，2.62；95%CI，1.10-3.26；P<.001）和药物管理（216个设施[28.0%]对304个设施[41.3%]；或，1.81；95%CI，1.48-2.21；P<.001）。共有684个MHTF(72.0%)构成了维持者，94人(9.9%)是中断者，106(11.2%)是不采用者，66人(7.0%)为晚期采用者。与维持者相比，中止者不太可能是私人营利性的(调整后的OR[aOR]，0.28；95%CI，0.11-0.68)或私人非营利组织(AOR，0.26；95%CI，0.14-0.48）在调整设施和区域特征后。
■基于这项1001个MHTF的纵向队列研究，自PHE结束以来，远程医疗的可用性在服务范围和方式方面有所下降，建议有针对性的政策可能是必要的，以维持远程医疗访问。
评估COVID-19PHE期间和之后美国门诊精神卫生治疗机构(MHTF)远程医疗服务可用性的变化。
■在这项队列研究中，从2022年12月至2023年3月，冒充潜在客户的来电者联系了从物质滥用和心理健康服务管理局的行为健康治疗定位器中抽取的1404MHTF的随机样本（第1波[W1]；在PHE期间）。从2023年9月到11月（第2波[W2]；PHE之后），呼叫者重新联系W1参与者。2024年1月进行了分析。
■呼叫者询问MHTF是否提供远程医疗（是与否），and,如果是,他们是否提供（1）纯音频远程医疗（与音频和视频）；（2）远程医疗治疗，药物管理,和/或诊断服务；和（3）共病酒精使用障碍（AUD）的远程医疗。维持者(在两波中都提供了远程医疗)，后期采用者(在W1没有提供远程医疗，但在W2提供)，非采用者(未在W1或W2提供远程医疗)，和中断者(在W1提供远程医疗，而不是W2)都进行了比较。
■在W2期间，成功地重新联系了1001MHTF（86.1％）。共有713个（71.2％）位于大都市县，151（15.1%）是公开运营的，935（93.4％）接受了医疗补助作为付款。提供远程医疗的百分比从799(81.6%)下降到765(79.0%)(赔率比[OR]，0.84；95%CI，0.72-1.00；P<0.05）。在提供远程医疗的MHTF中，W2中提供纯音频远程医疗的比例较小(369[49.3%]对244[34.1%]；或者，0.53；95%CI，0.44-0.64；P<.001）和远程医疗共病AUD（559[76.3%]vs457[66.5%]；或，0.62；95%CI，0.50-0.76；P<.001）与W1相比。在W2中，MHTF更有可能报告远程医疗仅在某些治疗条件下可用（141设施[18.0％]vs276[36.4％]；或，2.62；95%CI，1.10-3.26；P<.001）和药物管理（216个设施[28.0%]对304个设施[41.3%]；或，1.81；95%CI，1.48-2.21；P<.001）。共有684个MHTF(72.0%)构成了维持者，94人(9.9%)是中断者，106(11.2%)是不采用者，66人(7.0%)为晚期采用者。与维持者相比，中止者不太可能是私人营利性的(调整后的OR[aOR]，0.28；95%CI，0.11-0.68)或私人非营利组织(AOR，0.26；95%CI，0.14-0.48）在调整设施和区域特征后。
■基于这项1001个MHTF的纵向队列研究，自PHE结束以来，远程医疗的可用性在服务范围和方式方面有所下降，建议有针对性的政策可能是必要的，以维持远程医疗访问。
